New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 37 - SELECTIVE CONTRACTING ARRANGEMENTS OF INSURERS
Section 11:4-37.1 - Purpose and scope

(a) The purpose of this subchapter is to set forth standards and procedures whereby a carrier shall obtain approval from the Commissioner of its offering of health benefits plans utilizing selective contracting arrangements that promote health care cost containment while adequately preserving quality of care.

(b) This subchapter applies to all carriers operating pursuant to Title 17B of the New Jersey statutes, and issuing health benefits plans utilizing selective contracting arrangements in this State. This subchapter shall not apply to the following: hospital service corporations operating pursuant to 17:48-1 et seq.; medical service corporations operating pursuant to 17:48A-1 et seq.; hospital and medical service corporations operating pursuant to 17:48B-1 et seq.; dental service corporations operating pursuant to 17:48C-1 et seq.; dental plan organizations operating pursuant to 17:48D-1 et seq.; or health service corporations operating pursuant to 17:48E-1 et seq.

(c) The provisions of these rules shall apply except where in conflict with any policy or contract issued pursuant to the New Jersey Individual Health Coverage Act at 17B:27A-1 et seq. or the New Jersey Small Employer Health Coverage Act at 17B:27A-17 et seq. If such a conflict exists, all remaining provisions of these rules determined not to be in conflict shall remain in effect.