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-4.3 - Disclosures to consumers
Universal Citation: NJ Admin Code 11:24A-4.3
Current through Register Vol. 56, No. 6, March 18, 2024
(a) Carriers shall, upon request, provide a written document to consumers setting forth the information required to be disclosed pursuant to 11:24A-4.2(a) through (c).
1. The
carrier shall not be required to provide the consumer with the same level of
detail that is provided to subscribers in the provider directory pursuant to
11:24A-4.2(a),
but the carrier shall provide at least the following information:
i. The number of medical providers
categorized by specialty by county in the carrier's network;
ii. The number of hospitals categorized by
county in the carrier's network;
iii. The approximate percentage of the
medical providers in the carrier's network that are board certified, and the
date on which the calculation of the percentage was last performed;
iv. The waiting time criteria that the
carrier utilizes in its selection of providers for participation in the
carrier's network, if any, including a statement that no such criteria apply in
those instances in which the carrier does not consider patient waiting times
for appointments for routine and urgent care in selecting participating
providers;
v. A statement that
consumers can check with providers directly to find out if the provider is a
participating provider; and
vi. A
statement that the consumer may obtain more detailed information, including a
provider directory (if not already included), and the process by which
consumers may obtain the information free of charge.
(1) Carriers that elect to make their lists
of participating providers available through an electronic database accessible
to the public shall not substitute electronic access to the information as the
only means by which consumers may obtain the information free of
charge.
2.
The information provided to consumers may be in a single document or multiple
documents.
(b) The carrier shall, upon request, provide to consumers the same information required to be made available to covered persons pursuant to 11:24A-4.2(d).
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