New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 24A - HEALTH CARE QUALITY ACT APPLICATION TO INSURANCE COMPANIES, HEALTH SERVICE CORPORATIONS, HOSPITAL SERVICE CORPORATIONS, AND MEDICAL SERVICE CORPORATIONS
Subchapter 4 - PROVISIONS APPLICABLE TO CARRIERS OFFERING ONE OR MORE HEALTH BENEFITS PLANS THAT ARE MANAGED CARE PLANS
- Section 11:24A-4.1 - Scope and applicability
- Section 11:24A-4.2 - Disclosures to covered persons
- Section 11:24A-4.3 - Disclosures to consumers
- Section 11:24A-4.4 - Submission of disclosures
- Section 11:24A-4.5 - Designation of a medical director
- Section 11:24A-4.6 - Complaint system
- Section 11:24A-4.7 - Provider application for participation
- Section 11:24A-4.8 - Termination of providers from a network
- Section 11:24A-4.9 - Hearings for provider terminations
- Section 11:24A-4.10 - Network adequacy
- Section 11:24A-4.11 - Utilization management program
- Section 11:24A-4.12 - Internal utilization management appeal process
- Section 11:24A-4.13 - Continuous quality improvement
- Section 11:24A-4.14 - Provider input on protocols
- Section 11:24A-4.15 - Minimum standards for provider contracts
- Section 11:24A-4.16 - Reporting of compensation arrangements
- Section 11:24A-4.17 - Requirement to offer a managed care plan without a gatekeeper system
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