New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 57 - MANDATED BENEFITS FOR BIOLOGICALLY-BASED MENTAL ILLNESS
Section 11:4-57.3 - Exclusions and benefit limits
Current through Register Vol. 56, No. 24, December 18, 2024
(a) Notwithstanding the applicability of such exclusions to persons with physical illness, carriers shall not apply any exclusion in a health insurance policy or health maintenance organization contract to deny benefits for services or supplies that are medically necessary for the treatment of covered persons with biologically-based mental illness, so long as such services or supplies are not experimental or investigational. This proscription shall include but not be limited to:
(b) Subject to (a) above, carriers may apply preauthorization requirements, to treatment of biologically-based mental illness only if those requirements are applicable to treatments of physical illnesses and consistent with the requirements of the Federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) part of Public Law 110-343, and further: