Update, Summary, and Position Paper – DOBI/SEH/IHC Rule Changes Affecting Voluntary Out-of-Network Reimbursement

On September 21st, 2016, the Department of Banking and Insurance (DOBI) adopted substantial rule changes regarding OON health care benefits available in the individual (IHC) and small group (SEH) markets. Specifically, NJAC 11:20-24.5 and NJAC 11:21-7.13 were repealed. These regulations, initially adopted in 1993, mandated adequate reimbursements to out-of-network providers, based on the 80th percentile of UCR, for the IHC and SEH markets, respectively.

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