New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 42 - GROUP LIFE, GROUP HEALTH AND BLANKET INSURANCE: GENERAL STANDARDS FOR CONTRACT PROVISIONS
Section 11:4-42.11 - Provisions concerning exclusions and limitations for the use of alcohol and drugs or relating to illegal occupations
Current through Register Vol. 56, No. 6, March 18, 2024
(a) A blanket insurance policy or certificate or other group policy or certificate providing health insurance, other than a group health benefits plan, may include an exclusion for losses resulting from the covered person's use of alcohol or drugs, but such exclusion shall be worded no more restrictively than as follows:
"The insurer shall not be liable for any loss sustained or contracted as a consequence of the covered person's intoxication or being under the influence of any narcotic unless administered or consumed on the advice of a physician."
(b) A group policy or certificate providing health insurance may include an exclusion for losses resulting from the covered person's involvement in an illegal activity, but such exclusion shall not be worded more restrictively than as follows:
"The insurer shall not be liable for any loss to which a contributing cause was the covered person's commission of or attempt to commit a felony or to which a contributing cause was the covered person's engagement in an illegal occupation."
