Statutes, codes, and regulations
New Jersey Administrative Code
Title 11 - INSURANCEChapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Subchapter 4 - POLICY FORMS
Section 11:21-4.1 - Policy forms

N.J. Admin. Code § 11:21-4.1

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Current through Register Vol. 56, No. 24, December 18, 2024
Section 11:21-4.1 - Policy forms
(a) Members shall use the standard policy forms for Plans B, C, D, and E which are set forth in the Appendix to this chapter as Exhibits F, and W subject to the "Explanation of Brackets" set forth in Exhibit K of the Appendix, incorporated herein by reference. Members shall not make any changes to the text of the standard policy forms, except as permitted consistent with the explanation of brackets set forth as Exhibit K.
(b) Members shall use the standard policy form for HMO Plan which is set forth in the Appendix to this chapter as Exhibit G and Y, subject to the "Explanation of Brackets" set forth in Exhibit K of the Appendix, incorporated herein by reference.
(c) Members shall use the standard policy form for HMO-POS Plan, which is set forth in the Appendix to this chapter as Exhibit HH and II, subject to the "Explanation of Brackets" set forth in Exhibit K of the Appendix, incorporated herein by reference.
(d) All health benefits plans and optional benefits riders issued to small employers on and after January 1, 1994, shall be issued in accordance with this subchapter.
(e) Members shall use the standard small group health benefits certificate for Plans B, C, D and E which is set forth in the Appendix to this chapter as Exhibit W, subject to the "Explanation of Brackets" set forth in Exhibit K of the Appendix, incorporated herein by reference.
(f) Members shall use the standard employee evidence of coverage for HMO Plan which is set forth in the Appendix to this chapter as Exhibit Y, subject to "Explanation of Brackets" set forth in Exhibit K of the Appendix, incorporated herein by reference.
(g) All small group health benefits certificates and employee evidences of coverage issued to employees covered under small employer health benefits plans on and after January 1, 1994, shall be issued in accordance with this subchapter.

N.J. Admin. Code § 11:21-4.1

Amended by 48 N.J.R. 2360(a), effective 11/7/2016