New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 24 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter 5 - HEALTH CARE SERVICES
Section 11:24-5.1 - Provision of health care services
Universal Citation: NJ Admin Code 11:24-5.1
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The HMO shall, at a minimum, provide or arrange for the provision to its members all basic comprehensive health care services and all other services enumerated in this subchapter and in 26:2J-1 et seq., as it may be amended from time to time.
1. If the HMO
refers a member out of network, the service or supply shall be covered as an
in-network service or supply, such that the HMO is fully responsible for
payment to the provider and the member is only responsible for any applicable
in-network level copay, coinsurance or deductible for the service or
supply.
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