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Section 17:48G-4 - Inapplicability of act relative to certain decisions of insurers, third party administrators.

NJ Rev Stat § 17:48G-4 (2019) (N/A)
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17:48G-4 Inapplicability of act relative to certain decisions of insurers, third party administrators.

7. This act shall not be construed:

a. To regulate insurers' or third party administrators' making any decision, including, but not limited to, a decision concerning benefit or insurance coverage, that does not involve the making of a dental decision;

b. To regulate insurers' or third party administrators' use of a protocol for denying or limiting benefit payments for dental services where the protocol:

(1) has been approved for use by a dentist who is duly licensed in this State or who has been issued a limited registration certificate pursuant to section 4 of this act; and

(2) does not involve evaluation of an individual patient's dental care or condition; or

c. To regulate the application of contract limitations and exclusions, the credentialing of dentists or the conduct of retrospective fraud reviews.

L.2007, c.259, s.7.

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Section 17:48G-3 - Dental decisions made by third party administrator.
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