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RECENT LEGISLATION
2004
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Chapter 177, P.L. 2004 Concerns the retirement allowance of Teachers' Pension and Annuity Fund (TPAF) and Public Employees' Retirement System (PERS) veteran members who retire after having attained age 55, and who have at least 35 years of service credit.
Chapter 86, P.L. 2004 Requires health insurers, including health, hospital and medical service corporations, commercial individual, small employer and group health insurers, health maintenance organizations and the State Health Benefits Program (SHBP), to provide health benefits coverage for expenses incurred in conducting a mammogram for women under 40 years of age who have a family history of breast cancer or other breast cancer risk factors, at such age and intervals as deemed medically necessary by the woman's health care provider.
Chapter 207, P.L. 2003 Contains a number of provisions intended to promote greater public understanding and comparison of long‑term care coverage, protect applicants from unfair or deceptive sales practices, promote greater availability of long‑term care coverage and encourage the development of innovative long‑term care products.

Links to the New Jersey Legislature and other legislature information.


Chapter 177, P.L. 2004

Date Approved: December 22, 2004.

Effective Date:  December 22, 2004.

Description:

This law concerns the retirement allowance of Teachers' Pension and Annuity Fund (TPAF) and Public Employees' Retirement System (PERS) veteran members who retire after having attained age 55, and who have at least 35 years of service credit.  It provides that the retirement allowance shall be based on the 12-month period of membership providing the largest possible benefit to the member or the member's beneficiary instead of the last year of employment upon which contributions to the annuity savings fund or contingent reserve fund are made.

To view the new law, click here:  Chapter 177, P.L. 2004 Adobe PDF (20K)

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Chapter 86, P.L. 2004

Date Approved: July 7, 2004.

Effective Date:  October 5, 2004.

Description:

This law requires health insurers, including health, hospital and medical service corporations, commercial individual, small employer and group health insurers, health maintenance organizations and the State Health Benefits Program (SHBP), to provide health benefits coverage for expenses incurred in conducting a mammogram for women under 40 years of age who have a family history of breast cancer or other breast cancer risk factors, at such age and intervals as deemed medically necessary by the woman's health care provider.

The law also codifies in statute that the SHBP shall provide coverage for one baseline mammogram examination for women who are at least 35 but less than 40 years of age and a mammogram every year for women age 40 and over.

This act shall take effect on the 90th day after enactment and shall apply to all contracts and policies that are delivered, issued, executed or renewed or approved for issuance or renewal in this State on or after the effective date.

To view the new law, click here:  Chapter 86, P.L. 2004 Adobe PDF (125K)

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Chapter 207, P.L. 2003

Date Approved: January 8, 2004,

Effective Date: July 6, 2004,

Description:

This law is based on a Model Act adopted by the National Association of Insurance Commissioners (NAIC) to regulate long-term care insurance.

The law contains a number of provisions intended to promote greater public understanding and comparison of long‑term care coverage, protect applicants from unfair or deceptive sales practices, promote greater availability of long‑term care coverage and encourage the development of innovative long‑term care products.

Among the more important consumer protection measures included in the law are provisions that:

  1. Authorize the offering of products which combine long term care products and life insurance.

  2. Require a standard outline of coverage be delivered to a prospective insured at the time of initial solicitation.  The standard outline highlights a policy's benefits and points out its important features and facilitates comparison shopping by consumers.

  3. Prohibit termination of coverage on grounds of age or deterioration of health (mental or physical).

  4. Prohibit the establishment of a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company or affiliated company.

  5. Require disclosure of conditions imposed on eligibility for benefits, such as prior hospitalization or institutionalization.  No long-term care insurance policy shall be delivered or issued for delivery in this State if that policy conditions eligibility for any benefits on a prior hospitalization requirement.  Consumers will better understand what triggers coverage (usually the inability to perform a certain number of activities of daily living, or "ADLs"), whether services are covered or excluded, and where covered services are delivered (such as nursing home or home health care).

  6. Require a 30-day free look at the policy with right to return and have the premium refunded.  Consumers will be able to study and review the policy with family or professionals.

  7. Restrict preexisting condition limitations and provide that "preexisting condition" means a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person.

  8. Require the offering of a nonforfeiture benefit.  A nonforfeiture benefit means that if a person drops coverage, for whatever reason, the person will still receive some value for the money already paid into the policy.

  9. Establish an incontestability period.

The law adds two new provisions to the NAIC Model Act by including provisions concerning forms and rate filings for long‑term care policies issued on an individual basis in New Jersey.  Every long-term care insurance policy shall be filed with the commissioner for prior approval.  Any form which is filed with the commissioner and approved or deemed approved may be issued in this State until a subsequent withdrawal of the filing by the commissioner after a hearing.  Rate filings for long-term care insurance issued on an individual basis must receive prior approval.  The rates must not be excessive, inadequate or unfairly discriminatory.

Any insurer or insurance producer found to have violated the provisions of this law or any other laws regulating the sale or marketing of long-term care insurance is subject to a fine of up to three times the amount of any commissions paid for each policy involved in the violation or $10,000, whichever is greater.

To view the new law, click here:  Chapter 207, P.L. 2003 Adobe PDF (120K)

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Links to the New Jersey Legislature and other legislature information.

 
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