New Jersey § 26:2s-10

§ 26:2s-10.

a. A carrier which offers a managed care plan shall offer a point-of-service plan

to every contract holder which would allow a covered person to receive covered services

from out-of-network health care providers without having to obtain a referral or prior

authorization from the carrier. The point-of-service plan may require that a subscriber pay a higher deductible

or copayment and higher premium for the plan, pursuant to limits established by the

department, in consultation with the Department of Banking and Insurance, by regulation. b. A carrier shall provide each subscriber in a plan whose contract holder elects

the point-of-service plan, with the opportunity, at the time of enrollment and during

the annual open enrollment period, to enroll in the point-of-service plan option. The carrier shall provide written notice of the point-of-service plan to each subscriber

in a plan whose contract holder elects the point-of-service plan and shall include

in that notice a detailed explanation of the financial costs to be incurred by a subscriber

who selects that plan. c. The requirements of this section shall not apply to a carrier contract which offers

a managed care plan that provides health care services to Medicaid recipients pursuant

to P.L.1968, c. 413 ( C.30:4D-1 et seq. ), or a federally qualified, nonprofit health maintenance organization. d. A carrier which offers a managed care plan utilizing a selective contracting arrangement

approved in accordance with N.J.A.C.11:4-37.1 et seq. that provides benefits for out-of-network providers shall be deemed to be in compliance

with this section. e. A health maintenance organization affiliated with an insurance company authorized

to issue health benefits plans in this State that offers point-of-service benefits

exclusively through a point-of-service plan provided by the affiliated insurance company

using a selective contracting arrangement approved in accordance with N.J.A.C.11:4-37.1 et seq. , shall be deemed to be in compliance with this section if the point-of-service plan

is offered pursuant to the requirements of subsections a. and b. of this section.