N.J. Stat. § 17:48G-4

Current through L. 2024, c. 87.
Section 17:48G-4 - Inapplicability of act relative to certain decisions of insurers, third party administrators

This act shall not be construed:

a. To regulate insurers' or third party administrators' making any decision, including, but not limited to, a decision concerning benefit or insurance coverage, that does not involve the making of a dental decision;
b. To regulate insurers' or third party administrators' use of a protocol for denying or limiting benefit payments for dental services where the protocol:
(1) has been approved for use by a dentist who is duly licensed in this State or who has been issued a limited registration certificate pursuant to section 4 of this act; and
(2) does not involve evaluation of an individual patient's dental care or condition; or
c. To regulate the application of contract limitations and exclusions, the credentialing of dentists or the conduct of retrospective fraud reviews.

N.J.S. § 17:48G-4

Added by L. 2007, c. 259,s. 7, eff. 4/10/2008.