Statutes and regulations

Corporate Governance and External Audit Oversight

NJ DOBI Bulletin 2002-25 · New Jersey · Agency guidance

New Jersey Department of Banking and Insurance Bulletins › Corporate Governance and External Audit Oversight

. • Integrity of the members of the Board of Directors and senior management and the possession of the necessary skills and experience. • Appropriate independence of the Board of Directors. reas of corporate … Copies of these reports must be filed with the Department surer in writing any adverse financial condition; that the insurer has materially misstated its financial condition as reported to the Commissioner

Ensuring Transparency in Prior Authorization Act (P.L. 2023, c. 296)

NJ DOBI Bulletin 2024-17 · New Jersey · Agency guidance

New Jersey Department of Banking and Insurance Bulletins › Ensuring Transparency in Prior Authorization Act (P.L. 2023, c. 296)

to a request for prior authorization, the carrier shall notify the provider in writing within the timeframes specified above and shall identify the specific information needed to approve or make the adverse … In determining if a claim involves urgent care, a carrier shall apply the judgement of a prudent layperson who possesses an average knowledge of health and medicine.

Implementation of P.L. 2018, c. 32 (N.J.S.A. 26:2SS-1 to -20) Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act

NJ DOBI Bulletin 2018-14 · New Jersey · Agency guidance

New Jersey Department of Banking and Insurance Bulletins › Implementation of P.L. 2018, c. 32 (N.J.S.A. 26:2SS-1 to -20) Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act

Note that the denial of such request is an adverse benefit determination subject to internal and external appeals as discussed in Attachment A; • If the plan is a preferred provider organization plan … by acute symptoms of sufficient severity including, but not limited to, severe pain; psychiatric disturbances and/or symptoms of Substance Use Disorder such that a prudent layperson, who possesses