New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Actuary" in the case of health insurance means a Fellow in good standing of the Society of Actuaries or the Casualty Actuarial Society with at least three years recent experience in health insurance pricing and reserving; "actuary" in the case of life insurance means a Fellow in good standing of the Society of Actuaries with at least three years recent experience in life insurance pricing and reserving.
"Administrator" means a person, partnership, corporation or other legal entity engaged by the joint insurance fund trustees, as defined in this section, to act as executive director to carry out the policies established by the joint insurance fund trustees and to otherwise administer and provide day-to-day management of the joint insurance fund. The administrator may also be the lead agency, an employee of the fund, a fund member or an independent contractor.
"Chairman" means the chairman of the board of trustees as may be elected or designated by the trustees.
"Commissioner" means the Commissioner of the Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Dependent" means dependent as defined pursuant to 18A:18B-2.
"Fiscal year" or "fund year" means the fiscal year July 1 through June 30.
"Health insurance" means health insurance as defined pursuant to 17B:17-4; service benefits as provided by health service corporations, hospital service corporations or medical service corporations authorized to do business in this State, including basic health care services and/or supplemental health care services provided by health maintenance organizations; or dental care services provided by dental plan organizations and dental service corporations.
"Indemnity and trust agreement" means a written contract signed by the members of the joint insurance fund under which each agrees to jointly and severally assume and discharge the liabilities of each and every party to the agreement arising from their participation in the fund.
"Insolvent fund" means a joint insurance fund which has been determined by a court of competent jurisdiction to be unable to pay its outstanding lawful obligations as they mature in the regular course of business, as may be shown either by an excess of its required reserves and other liabilities over its assets or by its not having sufficient assets to reinsure all of its outstanding liabilities after paying all accrued claims owed by it, or for which, or for the assets of which, a receiver or liquidator, however entitled, has been appointed by a court of competent jurisdiction and authority, after the effective date of this subchapter.
"Joint insurance fund" or "fund" means a group established by two or more school boards to create a self-insurance fund for the sole purposes of providing contributory or non-contributory group health insurance or group term life insurance to their employees or dependents and to any other person eligible for coverage by a member school board pursuant to law, approved by the Department pursuant to 18A:18B-1 et seq. and this subchapter.
"Life insurance" means life insurance as defined pursuant to 17B:17-3.
"Member" means a school board which is a member of a school board joint insurance fund formed pursuant to this subchapter.
"Net current surplus" or "surplus" means the excess of the fund's unencumbered assets over its reserves and liabilities.
"Producer" means any person engaged in the business of an insurance agent, insurance broker or insurance consultant as defined in N.J.S.A. 17:22A-1 et seq.
"Risk management program" means a plan and activities carried out under that plan, by a joint insurance fund to reduce risk of loss with respect to a particular line of insurance protection or coverage provided by a fund pursuant to 18A:18B-1 et seq. Risk management program also includes the administration of one or more funds, including the processing and defense of claims brought against or on behalf of members of the fund.
"Run-in liability" means liability for claims incurred but not reported by a prospective member in connection with the provision of health benefits during the period prior to joining the fund.
"Run-out liability" means liability for claims incurred but not reported by a former fund member during the period it was a member.
"Secretary" means the secretary of the board of trustees as may be designated by the trustees.
"Servicing organization" or "program manager" means an individual, partnership, association or corporation, other than the administrator, that has contracted with the fund to provide, on the fund's behalf, any functions as designated by the fund trustees including, but not limited to, actuarial services, claims administration, cost containment services, legal services, auditing services, financial services, compilation and maintenance of the fund's underwriting file, coordination and preparation of plan documents, employee booklets and other documents, risk selection and pricing, stop-loss or reinsurance producer services which include producer negotiations on behalf of the fund for stop-loss or reinsurance from an insurer, member assessment and fee development, report preparation pursuant to 18A:18B-1 et seq. or this subchapter, and such other duties as designated by the fund.
"Stop-loss insurance" or "reinsurance" means insurance, purchased from an insurer authorized or admitted in the State of New Jersey to transact life or health insurance, as applicable, covering losses in excess of an amount established between the joint insurance fund and the insurer up to the limits of coverage set forth in the insurance contract on a specific per occurrence, per individual or annual aggregate basis.
"Trustees" means the board of trustees established pursuant to the bylaws of the joint insurance fund to govern or manage the risk management programs, joint self-insurance fund or funds and related services of the group.