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 11:4-42.5 - Prohibited provisions
Current through Register Vol. 56, No. 6, March 18, 2024
(a) Group policies and certificates providing health, life, or blanket insurance shall not limit or exclude benefits because a covered person suffers a loss due to domestic violence.
(b) Blanket policies and certificates and group policies and certificates providing health insurance shall not limit or exclude health insurance benefits because a covered person suffers a loss attributable to the actions of a third party while the third party was intoxicated or under the influence of narcotics.
(c) Group and blanket policies or certificates that provide health insurance benefits shall not limit applicable benefits through designation of hospital facilities which perform specific categories of surgery.
(d) Group policies and certificates providing life insurance shall not limit or exclude life insurance benefits because a loss results from consumption of intoxicants or drugs by the covered person or the arrest, incarceration or illegal activity of the covered person.
(e) Policies providing group life insurance shall not provide life insurance coverage to the domestic partner of a covered person.
(f) Group health insurance, other than disability income, may be provided to the domestic partner of a covered person.
(g) Group policies and certificates providing disability income benefits shall not limit or exclude benefits for disabilities resulting from elective surgery or other medical treatment.
(h) Group policies and certificates providing accidental loss coverage shall not require a proposed covered person to submit satisfactory evidence of insurability as a prerequisite to coverage.
(i) Group policies and certificates providing hospital confinement indemnity benefits shall not condition receipt of benefits upon the covered person's incurrence of a charge for the confinement.
(j) Group policies and certificates providing life insurance may only include war exclusions that comply with 11:4-41.4(a)3 i through iii. Any amount payable as a result of a death from an excluded act shall be no less than the total premiums paid by or on behalf of the covered person.
