New Jersey § 26:2j-43

§ 26:2j-43.

a. Except as otherwise provided in P.L.1992, c. 161 ( C.17B:27A-2 et seq. ) and P.L.1992, c. 162 ( C.17B:27A-17 et seq. ), any health maintenance organization contract or evidence of coverage or related

form subject to the provisions of P.L.1973, c. 337 ( C.26:2J-1 et seq. ), including any application, rider, or endorsement which is made a part of those

contracts or evidences of coverage shall be filed with the Commissioner of Insurance

for approval as provided in this section. Any such contract or evidence of coverage, and any related form, except those certified

pursuant to section 26 of this act, 1 shall be filed with the Commissioner of Insurance for approval pursuant to this section. b. Any contract, evidence of coverage or related form filed with the Commissioner

of Insurance for approval pursuant to this section shall be deemed approved upon the

expiration of 60 days after the submission of the form unless disapproved in writing

by the Commissioner of Insurance within that time. Any such disapproval shall be based only on the specific provisions of applicable

statutes, regulations adopted by the Commissioner of Insurance, or guidelines published

by the Commissioner of Insurance as of the effective date of this act, with regard

to forms of that type. A disapproved contract, evidence of coverage or related form may be resubmitted. c. Any contract, evidence of coverage or related form filed for approval pursuant

to this section and disapproved by the Commissioner of Insurance before the expiration

of 60 days after its submission shall be deemed withdrawn at the expiration of 60

days after the transmittal of the specific objections of the Commissioner of Insurance

unless the filer submits a complete written response to all of the objections of the

Commissioner of Insurance within the 60 day period. d. A contract, evidence of coverage or related form, resubmitted in response to the

objections of the Commissioner of Insurance pursuant to subsection b. of this section,

shall be deemed approved upon the expiration of 30 days after its resubmission unless

disapproved in writing by the Commissioner of Insurance within that time. No disapproval by the Commissioner of Insurance of a resubmission shall be based

on any objection not specified by the Commissioner of Insurance in the initial disapproval

of the filing, except that the Commissioner of Insurance may disapprove that form

based upon any new provisions introduced in the resubmission or if in addressing the

specified objections cited in the disapproval transmission of the Commissioner of

Insurance, the health maintenance organization changes or modifies any substantive

provisions of the form. Any form resubmitted for approval pursuant to this section and disapproved by the

Commissioner of Insurance before the expiration of 30 days after its submission shall

be deemed withdrawn at the expiration of 30 days after the transmittal of the specific

objections of the Commissioner of Insurance, unless the filer submits a complete written

response to all of the objections of the Commissioner of Insurance regarding the submission

within the 30 day period. e. With respect to all types of contracts, evidences of coverage or related forms

required to be filed pursuant to this section and currently on file with and approved

by the Commissioner of Insurance upon enactment of this act, the Commissioner of Insurance

shall propose regulations, which may be amended or modified by the Commissioner of

Insurance from time to time after adoption, concerning any actuarial or form requirements

consistent with applicable statutory provisions but not specified therein, not later

than 180 days after enactment of this act. Any such regulation shall be adopted not later than 180 days after it is proposed. With respect to any type of form not then on file with the Commissioner of Insurance

but filed subsequent to enactment of this act, the Commissioner of Insurance shall

propose regulations, which may be amended or modified by the Commissioner of Insurance

from time to time after adoption, concerning any actuarial or form requirements consistent

with applicable statutory provisions but not specified therein within 120 days after

the form is approved or deemed approved by the Commissioner of Insurance pursuant

to this section. Any such regulation shall be adopted not later than 180 days after it is proposed. The Commissioner of Insurance may issue bulletins which are interpretive of existing

regulations consistent with statutory provisions, with respect to any type of contract

or evidence of coverage form that may be certified pursuant to section 26 of this

act. Nothing in this section shall preclude a health maintenance organization from filing

a certifiable contract or evidence of coverage or related form for approval by the

Commissioner of Insurance. f. Any such form which is filed with the Commissioner of Insurance or deemed filed

may be so delivered or issued for delivery until such time as any subsequent withdrawal

of the filing by the Commissioner of Insurance, following an opportunity for a hearing

held in accordance with the “Administrative Procedure Act,” P.L.1968, c. 410 ( C.52:14B-1 et seq. ) and any rules adopted thereunder, becomes final in accordance therewith. g. For purposes of this section: “ days ” means calendar days, except that when the last day of any specified time period

is a Saturday, Sunday, or State holiday, then the time period shall end on the next

following business day. With respect to any specified time period pertaining to correspondence between a

health maintenance organization and the Commissioner of Insurance, the time period

shall commence on the date that such correspondence is postmarked or submitted to

a private delivery service. h. The Commissioner of Insurance, in consultation with the Commissioner of Health,

pursuant to the “Administrative Procedure Act,” P.L.1968, c. 410 ( C.52:14B-1 et seq. ), shall adopt rules and regulations as may be necessary to effectuate the purposes

of this section. 1

N.J.S.A. § 26:2J-44.