N.J.S.A 17:48H-18. Contracts with providers, mandatory terms

17:48H-18. Contracts with providers, mandatory terms

18. All licensed organized delivery system contracts with providers shall contain the following terms and conditions:

a. In the event that the organized delivery system fails to pay or provide for comprehensive or limited health care services for any reason whatsoever, including, but not limited to, insolvency or breach of contract, neither the contract holder nor the covered person shall be liable to the provider for any sums owed to the provider under the contract.

b. No provider, or agent, trustee or assignee thereof may maintain an action at law or attempt to collect from the contract holder or covered person sums owed to the provider by the licensed organized delivery system, except that this subsection shall not be construed to prohibit collection of uncovered charges consented to or lawfully owed to providers by a contract holder or covered person.

L.1999,C. 409,S.18.

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