2023 New Jersey Revised Statutes › Title 17B - Insurance › Section 17B:32A-4 - Definitions

17B:32A-4. Definitions
4. As used in P.L.1991, c.208 (C.17B:32A-1 et seq.):
"Account" means either of the two accounts created under subsection b. of section 5 of P.L.1991, c.208 (C.17B:32A-5).
"Association" means the New Jersey Life and Health Insurance Guaranty Association created in subsection a. of section 5 of P.L.1991, c.208 (C.17B:32A-5).
"Benefit plan" means the benefit plan of a specific employee, union or association of natural persons.
"Called assessment" or "called" when used in the context of assessments means that a notice has been issued by the association to member insurers requiring that an authorized assessment be paid within the timeframe set forth within the notice. An authorized assessment becomes a called assessment when notice is mailed by the association to member insurers.
"Commissioner" means the Commissioner of Banking and Insurance.
"Contractual obligation" means any obligation under a policy or contract or certificate under a group policy or contract, or portion thereof, for which coverage is provided under section 3 of P.L.1991, c.208 (C.17B:32A-3), but does not include unearned premium under a health insurance policy or contract.
"Covered policy" or "covered contract" means any policy or contract within the scope of P.L.1991, c.208 (C.17B:32A-1 et seq.) as provided by section 3 of P.L.1991, c.208 (C.17B:32A-3).
"Department" means the Department of Banking and Insurance.
"Health benefit plan" means any hospital or medical expense policy or certificate, health service corporation contract, hospital service corporation contract, medical service corporation contract, health maintenance organization subscriber contract, or any other similar health contract. "Health benefit plan" does not include accident-only insurance; credit insurance; dental-only insurance; vision-only insurance; Medicare Supplement income; benefits for long-term care, home health care, community-based care, or any combination thereof; liability insurance, including general liability insurance, or coverage issued as a supplement to liability insurance; disability income insurance; coverage for on-site medical clinics; or specified disease, hospital, confinement indemnity, or limited benefit health insurance if the types of coverage do not provide coordination of benefits and are provided under separate policies or certificates.
"Impaired insurer" means a member insurer which, after the effective date of P.L.1991, c.208 (C.17B:32A-1 et seq.): (1) is determined by the commissioner to be potentially unable to fulfill its contractual obligations; or (2) is placed under an order of receivership, rehabilitation or conservation by a court of competent jurisdiction.
"Insolvent insurer" means a member insurer which, after the effective date of P.L.1991, c.208 (C.17B:32A-1 et seq.), is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency.
"Member insurer" means any insurer, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization licensed in this State or which holds a certificate of authority to transact any kind of insurance, health service corporation business, hospital service corporation business, medical service corporation business, or health maintenance organization business in this State for which coverage is provided under section 3 of P.L.1991, c.208 (C.17B:32A-3), and includes any insurer, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization whose license or certificate of authority in this State may have been suspended, revoked, not renewed or voluntarily withdrawn, but does not include:
(1) A dental service corporation established pursuant to the provisions of P.L.1968, c.305 (C.17:48C-1 et seq.);
(2) A dental plan organization established pursuant to the provisions of P.L.1979, c.478 (C.17:48D-1 et seq.);
(3) (Deleted by amendment, P.L.2022, c.98);
(4) A fraternal benefit society established pursuant to the provisions of P.L.1959, c.167 (C.17:44A-1 et seq.);
(5) A mandatory state pooling plan;
(6) A mutual assessment company or any entity that operates on an assessment basis to the extent of the assessment liability of its members;
(7) An insurance exchange;
(8) A licensed organized delivery system licensed pursuant to P.L.1999, c.409 (C.17:48H-1 et seq.);
(9) A captive insurer, established pursuant to P.L.2011, c.25 (C.17:47B-1 et seq.); or
(10) An entity similar to any of the above.
"Moody's Corporate Bond Yield Average" means the Monthly Average Corporates as published by Moody's Investors Service, Inc., or any successor thereto.
"Owner" of a policy or contract and "policyholder," "policy owner," and "contract owner" means the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner of the books of the member insurer. The terms owner, contract owner, policyholder, and policy owner do not include persons with a mere beneficial interest in a policy or contract.
"Person" means an individual or natural person, corporation, partnership, association or voluntary organization.
"Plan sponsor" means:
(1) the employer in the case of a benefit plan established or maintained by a single employer;
(2) the employee organization in the case of a benefit plan established or maintained by an employee organization; or
(3) in a case of a benefit plan established or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan.
"Premiums" means amounts or considerations received in any calendar year on covered policies or contracts less premiums, considerations and deposits returned thereon, and less dividends and experience credits thereon. "Premiums" shall not include any amounts or considerations received for any policies or contracts or for the portions of any policies or contracts for which coverage is not provided under subsection b. of section 3 of P.L.1991, c.208 (C.17B:32A-3) except that assessable premium shall not be reduced as the result of the application of: paragraph (3) of subsection c. of section 3 relating to interest limitations; or paragraph (2) of subsection d. of section 3 relating to limitations with respect to any one insured or enrolled individual. "Premiums" shall not include any premiums in excess of $2,000,000 per contract on any unallocated annuity contract.
"Resident" means a person who resides in this State at the time a member insurer is an impaired insurer or insolvent insurer and to whom a contractual obligation is owed. For the purposes of P.L.1991, c.208 (C.17B:32A-1 et seq.), a person may be a resident of only one state, which in the case of a person other than a natural person shall be its principal place of business. A citizen of the United States that is a resident of a foreign country or of a United States possession, territory, or protectorate that does not have an association similar to the association created by P.L.1991, c.208 (C.17B:32A-1 et seq.) shall be deemed a resident of the state of domicile of the member insurer that issued the policies or contracts.
"State" means a state, the District of Columbia, Puerto Rico, and a United States possession, territory, or protectorate.
"Structured settlement annuity" means an annuity purchased in order to fund periodic payments for a plaintiff or other claimant in payment for or with respect to personal injury suffered by the plaintiff or other claimant.
"Supplemental contract" means an agreement entered into for the distribution of policy or contract proceeds.
"Unallocated annuity contract" means: (1) an annuity contract or group annuity certificate which is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under that contract or certificate; or (2) any unallocated life insurance or health insurance funding agreement, where insurance certificates or contracts are not issued to and owned by individuals, except to the extent of any life insurance or health insurance benefits guaranteed to an individual by an insurer under such funding agreement.
L.1991,c.208,s.4; amended 2022, c.98, s.3.