New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS
Section 11:4-50.5 - Health coverage plans
Current through Register Vol. 56, No. 6, March 18, 2024
(a) In accordance with 30:7E-3, State and County Treasurers shall file a claim for reimbursement of the value of the usual, customary and reasonable charges incurred for an inmate's medical care upon any health coverage plan providing benefits to an inmate as an enrollee or as a covered person.
(b) Subject to the terms of coverage of the policy or plan, health coverage plans shall be required to reimburse the State or county for costs expended in providing medical care to any inmate covered under the plan.
(c) Notwithstanding the provisions of N.J.A.C. 11:24-1.2 and 11:24A-1.2(definition of "emergency"), it shall be presumed that inmates are in need of emergency medical care and are not located in a place where it can be rendered by any network health care provider. The institutional medical health care provider is deemed to be the inmate's only available source of medical care.
(d) Where practicable, the institutional health care provider shall confer with the health coverage plan to preserve the right of said plans to negotiate fees for testing, specialists and hospitalization.
