Rutgers Law

New Jersey Statutes, Title: 17B, INSURANCE

    Chapter 30: Declaration of purpose

      Section: 17B:30-36: Issuance of standardized pharmacy identification information, card to primary insured

           2. a. A carrier, multiple employer welfare arrangement or other health benefits plan provider, or its agents, contractors or administrators, including but not limited to a pharmacy benefits manager or third party administrator for a self-insured health benefits plan, that provides, administers or manages coverage for prescription drugs provided on an outpatient basis, shall issue or require the issuance to the primary insured of a card or other technology that includes standardized pharmacy identification information.

b. The card shall comply with the standards set forth in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect at the time of card issuance, or, at a minimum, contain the following information:

(1) the name or identification number of the health benefits plan, when required for proper claims adjudication;

(2) the American National Standards Institute International Identification Number assigned to the administrator or pharmacy benefits manager of the health benefits plan, labeled as RxBIN, when required for proper claims adjudication;

(3) the processor control number, labeled as RxPCN, when required for proper claims adjudication;

(4) the insured's group number, labeled as RxGRP, when required for proper claims adjudication;

(5) the insured's identification number;

(6) the insured's name; except that, if a separate card is issued for another person included under the primary insured's coverage, the name of the covered person to whom the card is issued may be listed instead of the name of the primary insured;

(7) the telephone number that providers may call for pharmacy benefits assistance; and

(8) any other information necessary for proper claims adjudication, except for information provided on the prescription as required by law or regulation.

L.2001,c.200,s.2.



This section added to the Rutgers Database: 2013-06-10 16:36:30.

Older versions of 17b:30-36 (if available):

Court decisions that cite this statute: CLICK HERE.