New Jersey Statutes Title 17B. Insurance 17B § 27A-10.3

For the purposes of this act:

“Affiliated carrier” means the same as defined in N.J.A.C.11:20-1.2.

“Affordable Care Act” or “PPACA” means the federal Patient Protection and Affordable Care Act, Pub.L.111-148, as amended by the federal “Health Care and Education Reconciliation Act of 2010,” Pub.L.111-152, and any federal rules and regulations adopted pursuant thereto.

“Attachment point” means an amount as provided in subsection h. of section 4 of this act.

“Benefit year” means the calendar year for which an eligible carrier provides coverage through an individual health benefits plan.

“Board” means the board of directors of the New Jersey Individual Health Coverage Program established pursuant to P.L.1992, c. 161 (C.17B:27A-2 et seq.).

“Carrier” means any entity subject to the insurance laws and regulations of this State, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefits plan, including a sickness and accident insurance company, a health maintenance organization, a hospital, medical or health service corporation, or any other entity providing a health benefits plan. For purposes of this act, carriers that are affiliated carriers shall be treated as one carrier.

“Paid claim” means a claim by a covered person for payment of benefits under a health benefits plan for which the financial obligation for the payment of the claim under the contract rests upon and has been paid by the carrier, excluding claims adjustment expenses.

“Coinsurance rate” means the rate as provided in subsection i. of section 4 of this act.

“Commissioner” means the Commissioner of Banking and Insurance.

“Department” means the Department of Banking and Insurance.

“Eligible carrier” means a carrier that offers individual health benefits plans in the State.

“Fund” means the New Jersey Health Insurance Premium Security Fund created pursuant to section 10 of this act.

“Health benefits plan” means the same as that term is defined in section 1 of P.L.1992, c. 161 (C.17B:27A-2).

“Payment parameters” means the attachment point, reinsurance cap, and coinsurance rate for the plan.

“Plan” means the Health Insurance Premium Security Plan established pursuant to section 4 of this act.

“Reinsurance cap” means the threshold amount as provided in subsection j. of section 4 of this act.

“Reinsurance payment” means an amount paid by the board to an eligible carrier under the plan.