N.J. Admin. Code § 11:4-13.2

Current through Register Vol. 56, No. 19, October 7, 2024
Section 11:4-13.2 - Definitions

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise.

"Carrier" means any entity subject to the insurance laws and rules of this State, or subject to the jurisdiction of the Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital or health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services. For purposes of this subchapter, carriers that are affiliated carriers shall be treated as one carrier.

"Essential health benefits" means the categories of health care services required to be covered as specified at 45 CFR 156.110.

"Group student health insurance" is any general coverage accident and/or sickness insurance provided on a group basis to the students of a school.

"Preexisting condition" means a health condition that manifested itself on or before the effective date of coverage.

N.J. Admin. Code § 11:4-13.2

Amended by 51 N.J.R. 618(a), effective 5/6/2019