New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 28 - GROUP COORDINATION OF BENEFITS
Section 11:4-28.1 - Purpose and scope
Universal Citation: NJ Admin Code 11:4-28.1
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The purpose of this subchapter is to:
1. Discourage
overinsurance and avoid duplication of benefits by permitting a reduction of
benefits when a person is covered by more than one plan providing benefits or
services for medical, dental, or other care or treatment;
2. Avoid claims payment delays and
misunderstandings that result from the use of inconsistent or incompatible
nonduplication provisions; and
3.
Establish uniformity in the order in which plans pay their claims, and provide
the authority for the orderly transfer of information needed to pay claims
promptly.
(b) This subchapter applies to group contracts providing health care benefits which are issued, amended, delivered or renewed in New Jersey by insurers transacting the business of health insurance, health service corporations, hospital service corporations, medical service corporations, dental service corporations, dental plan organizations, health maintenance organizations and all similar organizations.
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