New Jersey § 26:2j-44

§ 26:2j-44.

a. Pursuant to the provisions of this section, a health maintenance organization authorized

to do business in this State may file with the Commissioner of Insurance and use,

in accordance with subsection d. of this section, any health maintenance organization

contract, evidence of coverage or related form that is stipulated by the Commissioner

of Insurance to be of a kind or type eligible for file and use pursuant to subsection

b. of this section. The form shall be accompanied by a certification memorandum which includes a statement

that it is filed in accordance with the provisions of this section, and which is executed

by a responsible officer of the health maintenance organization who certifies that

the form being filed is in conformance with the law and regulation applicable to that

type or kind of form as specified in a certification form to be determined by the

Commissioner of Insurance. If the Commissioner of Insurance determines that the form being filed does not conform

with the law or regulation applicable to that type or kind of form, the Commissioner

of Insurance shall notify the health maintenance organization of his objections in

writing and may disapprove that form for further use in New Jersey. b. Contracts and evidence of coverage forms, including related endorsements, riders

and application forms, eligible for certification pursuant to this section shall include,

but not be limited to, certain categories of individual and group health maintenance

organization contracts and evidences of coverage which the Commissioner of Insurance

shall define by regulation. c. The certification memorandum shall be signed and acknowledged by a responsible

officer of the health maintenance organization. The acknowledgment by that officer shall be done in the same manner in which documents

for recording instruments conveying or affecting interests in real estate in this

State must be acknowledged to be eligible for recording, or in such other manner as

specified by the Commissioner of Insurance by regulation from time to time. d. Upon receipt of an acknowledgment from the Commissioner of Insurance that the form

and a certification memorandum which conforms to the requirements of this section

have been received, the form so submitted may be used by the health maintenance organization. e. (1) Improper certification shall subject a health maintenance corporation submitting

such improper certification to a fine not to exceed $50,000 and, in addition, a maximum

penalty of $1,000 per contract or evidence of coverage issued on a form determined

to be improperly certified pursuant to the provisions of this section. The Commissioner of Insurance shall promulgate a schedule of penalties to be applied

pursuant to this section. In determining the amount of any penalty to be imposed, the Commissioner of Insurance

shall consider the severity of the violation based upon the potential adverse impact

to the public and whether it is the filer's first violation of this section. (2) If, after notice and a hearing pursuant to the “Administrative Procedure Act,”

P.L.1968, c. 410 ( C.52:14B-1 et seq. ), a health maintenance organization is found by the Commissioner of Insurance to

be in violation of this section, the form may be disapproved, and in addition to any

other penalties that may be imposed pursuant to P.L.1973, c. 337 ( C.26:2J-1 et seq. ), the Commissioner of Insurance may bar that health maintenance organization from

participating in the certification process pursuant to this section for a period not

to exceed one year. f. The Commissioner of Insurance shall hold a hearing annually, or more often, for

the purpose of adopting regulations to define the specific forms eligible for certification

pursuant to this section. Initial regulations shall be adopted pursuant to this section no later than 180

days after enactment of this act. g. For purposes of this section: (1) “a responsible officer of the health maintenance organization” means a corporate

officer of the level of vice president or higher, or of equivalent title within the

health maintenance organization's structure, who is either the actuary of the health

maintenance organization with responsibility for the type of form filed, or the individual

with responsibility for managing the form filing process for the health maintenance

organization with regard to the type of form filed; and (2) “ improper certification ” means providing any misrepresentation or false statement material to a certification

form required pursuant to subsection a. of this section.