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 11:4-42.12 - Provisions for payment of benefits payable for automobile related injuries
Universal Citation: NJ Admin Code 11:4-42.12
Current through Register Vol. 56, No. 6, March 18, 2024
(a) A group policy or certificate providing health insurance benefits shall not include any provision that restricts, limits, or excludes coverage of services or expenses, directly or indirectly, that otherwise are eligible under the policy or certificate on the grounds that such expenses or services would be covered under an automobile no-fault medical benefits plan for which the covered person would be eligible, nor shall the policy or certificate include an automobile no-fault medical plan for which the covered person would be eligible in the definition of "plan" in any coordination of benefits provision.
1. A group policy or certificate providing
health insurance benefits shall contain the wording which appears in the
Appendix to this subchapter, incorporated herein by reference, or any alternate
wording that is at least as favorable to the covered person as the language
contained in the Appendix, if the insurer intends to adjust its benefits by
medical benefits payable under a group, group-type or individual automobile
no-fault or traditional fault type contract.
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