All states regulate the insurance industry in order to protect consumers and provide access to coverage. In New Jersey, administering the laws and regulations pertaining to insurance is the responsibility of the Department of Insurance and Banking. The department seeks to educate consumers about the insurance industry as well as promote the industry's growth and financial stability, according to its website.
ICH
In 1992 New Jersey created the Individual Health Coverage Program (ICH) to give those without access to employer-based or government funded health care plans the option of purchasing health insurance for themselves or their families. You may purchase this insurance from approved private insurers regardless of your age or health status. However, there is a 12 month waiting period after you purchase during which pre-existing conditions are not covered.
Prompt Pay
New Jersey also has the Prompt Pay regulation, which requires companies issuing health and dental plans to pay "clean claims" within 30 days of a claim received electronically or 40 days for claims received in other ways. A clean claim is one that does not require any special treatment and for which the covered individual gave all of the information concerning the claim required by the insurer. An insurer who does not pay a clean claim within the time limit must pay interest on the amount of the claim at 10 percent a year.
CAIP
All commercial vehicles registered in New jersey must have automobile liability insurance. Owners of commercial vehicles may purchase insurance on their own, but New Jersey has established the Commercial Automobile Insurance Plan (CAIP) for those unable to obtain coverage in the private market. CAIP certifies qualified insurers to cover higher risk commercial vehicles.
Managed Care
Every person enrolled in a managed care plan has the right to file a complaint with the insurer concerning any aspect of his plan. The insurer must respond to the covered individual's complaint within 30 days of receiving the notice. If the individual is not satisfied with how the insurer responds to the complaint, she may appeal to the Office of Managed Care, a division of the Department of Banking and Insurance.
Tags: commercial vehicles, clean claim, covered individual, insurance industry, Managed Care
