{"data":{"id":"us-nj/n.j.-stat.-52-17b-197","jurisdiction":"us-nj","citation":"N.J. Stat. § 52:17B-197","heading":"Definitions relative to joint negotiations by physicians and dentists with carriers.","body":"2.\tAs used in this act:\n\"Carrier\" means an insurance company, health service corporation, hospital service corporation, medical service corporation or health maintenance organization which is authorized to issue health benefits plans in this State and a dental service corporation or dental plan organization authorized to issue dental plans in this State.\n\"Covered person\" means a person on whose behalf a carrier which offers a health benefits or dental plan is obligated to pay benefits or provide services pursuant to the plan.\n\"Covered service\" means a health care or dental service provided to a covered person under a health benefits or dental plan for which the carrier is obligated to pay benefits or provide services.\n\"Dental plan\" means a benefits plan which pays or provides dental expense benefits for covered services and is delivered or issued for delivery in this State by or through a dental carrier.\n\"Dentist\" means a person who is licensed to practice dentistry by the New Jersey State Board of Dentistry in accordance with the provisions of Title 45 of the Revised Statutes.\n\"Health benefits plan\" means a plan which pays or provides hospital and medical expense benefits for covered services, and is delivered or issued for delivery in this State by or through a carrier.  For the purposes of this act, health benefits plan shall not include the following plans, policies or contracts:  Medicare supplement coverage and risk contracts, accident only, specified disease or other limited benefit, credit, disability, long-term care, CHAMPUS supplement coverage, coverage arising out of a workers' compensation or similar law, automobile medical payment insurance, personal injury protection insurance issued pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), dental or vision care coverage only, or hospital expense or confinement indemnity coverage only.\n\"Joint negotiation representative\" means a representative selected by two or more independent physicians or dentists to engage in joint negotiations with a carrier on their behalf.\n\"Physician\" means a person who is licensed to practice medicine and surgery by the State Board of Medical Examiners in accordance with the provisions of Title 45 of the Revised Statutes.\n\"Utilization management\" means a system for reviewing the appropriate and efficient allocation of health care or dental services under a health benefits or dental plan in accordance with specific guidelines, for the purpose of determining whether, or to what extent, a health care or dental service that has been provided or is proposed to be provided to a covered person is to be covered under the health benefits or dental plan.\nL.2001,c.371,s.2; per s.15, act expires April 8, 2008.","path":["TITLE 52 STATE GOVERNMENT, DEPARTMENTS AND OFFICERS"],"source_url":"https://pub.njleg.state.nj.us/statutes/STATUTES-TEXT.zip","current_through":"P.L.2025, c.405, and J.R.22","vintage":"","retrieved_at":"2026-08-27T17:54:13Z","sha256":"5cd8786f783b3a966db1e308c44d890775adf851cac136446257df26f19e3c8b","source_id":"us-nj","stale":true,"prev":"us-nj/n.j.-stat.-52-17b-196","next":"us-nj/n.j.-stat.-52-17b-198"},"notice":"GroundRules: Original legal text. Not legal advice."}