"Medical expenses" is as defined in N.J.A.C. 11:3-4.2.
"Medical fee schedule" means that list of services, procedures and supplies to which have been assigned a
maximum fee or percentage of a fee payable by an automobile insurer for expenses incurred as a result of the
rendering to an insured any of those specific services, procedures or supplies for injuries, which list is set forth at
N.J.A.C. 11:3-29.
"Out-of-State automobile insurance coverage" or "OSAIC" means any coverage for medical expenses under an
automobile insurance policy other than PIP, as PIP is defined herein, including automobile insurance policies issued
in another state or jurisdiction.
"PIP" means personal injury protection coverage provided as part of an automobile insurance policy pursuant to
N.J.S.A. 39:6A-4 or 39:6A-3.1, issued in New Jersey, specifically those provisions for medical expenses coverage.
"Plan" means any policy, contract, certificate, booklet, evidence of enrollment, program, or other such term which
evidences the existence of a relationship between a health benefits provider or PIP carrier and an insured with
respect to the provisions of hospital, medical, surgical, dental and/or other health care related benefits, at least in
part.
"Primary coverage" means coverage by any plan which determines its actual benefits payable on allowable
expenses incurred by an insured for treatment of injuries without taking into consideration the existence of any
coverage for which the insured may be eligible provided secondary in accordance with this subchapter. There may
be more than one plan providing the insured primary coverage.
"Secondary coverage" means coverage by any plan which determines its actual benefits payable on all allowable
expenses incurred by an insured for treatment of injuries after all plans providing primary coverage have considered
expenses incurred and paid actual benefits.
11:3-37.3 Health benefits providers
(a) Nothing in this subchapter shall be construed as requiring any health benefits provider to offer, provide, or
continue coverage to or for any individual or group, except as may be set forth by other laws of this State, or of the
Federal government.
(b) Nothing in this subchapter shall be construed as requiring any health benefits provider to provide coverage for
any treatment or service not otherwise covered under the terms of the applicable health benefits plan.
(c) No health benefits contract or policy delivered or issued for delivery in this State, or renewed, continued or
converted on or after January 1, 1991, shall contain any provision, rider, waiver of endorsement or other instrument
which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under
the policy or contract on the grounds that such expenses or services would be covered under an automobile policy
PIP provision for which the insured would be eligible had the named insured on the automobile policy not selected
the PIP-as-secondary coverage option.
(d) No health benefits contract or policy delivered or issued for delivery in this State, or renewed, continued or
converted on or after January 1, 1991, shall contain any provision, rider, waiver or endorsement, or other instrument
which restricts, limits or excludes coverage, directly or indirectly, of services or expenses otherwise eligible under
the policy or contract on the grounds that:
1. Such expenses arise from an automobile-related injury;
2. Such expenses are covered or paid by PIP; or
3. Such expenses are covered or paid by OSAIC except for reductions in benefits when the health benefits