New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 22 - HEALTH BENEFIT PLANS
Subchapter 6 - EXCLUSIONS AND PREAUTHORIZATION REQUIREMENTS
Section 11:22-6.3 - War exclusions
Universal Citation: NJ Admin Code 11:22-6.3
Current through Register Vol. 56, No. 24, December 18, 2024
(a) The Department shall permit war risk exclusions in health benefit plans only if they consist of military exclusions, noncombatant exclusions and/or civilian exclusions. Military, noncombatant and civilian exclusions shall be no more restrictive than the following:
1. Military
exclusions may exclude treatment of illness or injury suffered:
i. As a result of war or an act of war, if
the illness or injury occurs while the covered person is serving in the
military, naval or air forces of any country, combination of countries or
international organization; and
ii.
As a result of the special hazards incident to service in the military, naval
or air forces of any country, combination of countries or international
organization, if the illness or injury occurs while the covered person is
serving in such forces and is outside the home area.
2. Non-combatant civilian exclusions may
exclude treatment of injury or illness suffered:
i. As a result of war or an act of war while
the covered person is serving in any civilian non-combatant unit supporting or
accompanying any military, naval or air forces of any country, combination of
countries or international organization; and
ii. As a result of the special hazards
incident to service in any civilian non-combatant unit supporting or
accompanying such forces, provided the illness or injury occurs while the
covered person is serving in such unit and is outside the home area.
3. Civilian exclusions may exclude
treatment of illness or injury suffered as a result of war or an act of war
while the covered person is not in the military, naval or air forces of any
country, combination of countries or international organization or in any
civilian non-combatant unit supporting or accompanying such forces, if the
illness or injury occurs outside the home area.
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