17:48E-32.1. Coverage provided by health service corporation for subscriber’s child
5. a. A health service corporation contract which provides hospital or medical expense benefits under which dependent coverage is available shall not deny coverage for a subscriber’s child on the grounds that:
(1) The child was born out of wedlock;
(2) The child is not claimed as a dependent on the subscriber’s federal tax return; or
(3) The child does not reside with the subscriber or in the health service corporation’s service area, provided that, in the case of a managed care plan, the child complies with the terms and conditions of the contract with respect to the use of specified providerS.
b. If a child has coverage through a health service corporation contract of a noncustodial parent, the health service corporation shall:
(1) Provide such information to the custodial parent as may be necessary for the child to obtain benefits through the child’s noncustodial parent’s coverage;
(2) Permit the custodial parent, or the health care provider with the authorization of the custodial parent, to submit claims for covered services without the approval of the noncustodial parent; and
(3) Make payments on claims submitted in accordance with paragraph (2) of this subsection directly to the custodial parent, the health care provider or the Division of Medical Assistance and Health Services in the Department of Human Services which administers the State Medicaid program, as appropriate.
C. When a parent who is the subscriber is eligible for dependent coverage and is required by a court or administrative order to provide health insurance coverage for his child, the health service corporation shall:
(1) Permit the parent to enroll his child as a dependent, without regard to any enrollment season restrictions;
(2) Permit the child’s other parent, or the Division of Medical Assistance and Health Services as the State Medicaid agency or the Division of Family Development as the State IV-D agency, in the Department of Human Services, to enroll the child under the contract if the parent who is the subscriber fails to enroll the child; and
(3) Not terminate coverage of the child unless the parent who is the subscriber provides the health service corporation with satisfactory written evidence that: the court or administrative order is no longer in effect; or the child is or will be enrolled in a comparable health benefits plan whose coverage will be effective on the date of the termination of coverage.
Original Text maintained by the State of New Jersey:
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