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New Jersey Minimum Standards Mandate

September 2010

In July 2009, the New Jersey Department of Banking and Insurance adopted amendments and new rules which address cost sharing provisions for health care companies across in-network and out-of-network services or supplies.

The new rules, known as the New Jersey Minimum Standards mandate, take effect September 8, 2010, and will be applied to most new individual and employer group health plans and to existing individual and employer group health plans upon renewal. Some changes set forth in the mandate include:

  • Limitations on cost-sharing for the following services:
    • preventive and inpatient hospital;
    • outpatient surgery (facility);
    • PCP office visits;
    • specialist office visits;
    • emergency room visits;
    • MRIs, CT scans, and PET scans.
  • Tracking of member expenses toward the out-of-pocket maximum.

If you have any questions regarding the changes to your benefits, please contact Customer Service at the telephone number on your ID card.

Note: This is not a statement of benefits. Benefits may vary based on state requirements, product line, product terms and conditions, and/or employer group. Member coverage may be verified through Customer Service.