New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 40 - LIFE/HEALTH/ANNUITY FORMS › Section 11:4-40.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Annuity" means a contract not included within the definitions of life insurance or health insurance as set forth in this section, under which an insurer obligates itself to make periodic payments for a specified period of time, such as for a number of years, or until the happening of an event, or for life or for a period of time determined by any combination thereof. A contract which includes extra benefits of the kinds set forth in the definitions of life insurance or health insurance set forth in this section shall nevertheless be deemed to be an annuity if such extra benefits constitute a subsidiary or incidental part of the entire contract.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Contract on a variable basis" or "variable contract" means any separate account contract providing for the dollar amount of life insurance or annuity benefits or other contractual payments or values thereunder to vary so as to reflect investment results of one or more separate accounts in which amounts with respect to any such contracts shall have been placed.
"Department" means the New Jersey Department of Banking and Insurance.
"Form" or "policy form" or "life/health/annuity form or contract" means any individual or group policy form or contract providing life insurance, health insurance or annuity benefits; any application for such a policy, contract or certificate if a written application is required and is to be made part of that policy or contract; any rider or endorsement for use with such a policy or contract; certificates of such insurance; any evidence of such insurability form; any health maintenance organization contract; and any evidence of such coverage or related form delivered or issued for delivery in this State.
"Funeral insurance policy" means a policy as defined at 17B:17-5.1.
"Health insurance" means a contract or agreement whereby an insurer is obligated to pay or allow a benefit of pecuniary value with respect to the bodily injury, disablement, sickness, death by accident or accidental means of a human being, or because of any expense relating thereto, or because of any expense incurred in prevention of sickness, and includes every risk pertaining to any of the enumerated risks. Health insurance does not include workers' compensation coverage or stop-loss coverage.
"Insurer" means a hospital service corporation operating pursuant to 17:48-1 et seq.; a medical service corporation operating pursuant to 17:48A-1 et seq.; a health service corporation operating pursuant to 17:48E-1 et seq.; a life, health or annuity company operating pursuant to 17B:17-1 et seq.; and a fraternal benefit society operating pursuant to N.J.S.A. 17:44A-1 et seq. to the extent that it issues certificates or evidence of coverage forms containing accident or health benefits. A fraternal benefit society that issues certificates containing life insurance benefits is not considered an insurer for purposes of this subchapter.
"Life insurance" means a policy or contract whereby an insurer is obligated to pay or allow a benefit of pecuniary value with respect to the cessation of human life. Life insurance also includes the granting of endowment benefits and optional modes of settlement of proceeds of life insurance, as well as provisions for additional benefits in the event of death by accident or accidental means or in the event of dismemberment or loss of sight; or safeguarding such insurance against lapse or giving a special surrender value, or special benefit or annuity in the event that the insured shall become totally and permanently disabled, whether such provisions are incorporated in a policy or contract of life insurance or in a policy or contract supplemental thereto. Life insurance does not include worker's compensation coverage.
"Limited death benefit policy" means a policy as defined at N.J.A.C. 11:4-21.
"Private placement form" means an individual variable life insurance form or individual variable annuity form where the purchaser meets the definition of "accredited investor" set forth in Rule 501 of Regulation D under the Securities Act of 1933, 15 U.S.C. §
										77b.(15) or "qualified purchaser" set forth in Section 2(a)(51) of the Investment Company Act of 1940, 15 U.S.C. § 80a- 2(a)(51).
"Published guidelines" means guidelines published by the Commissioner on or before April 10, 1995.
"Responsible officer of the insurer" means a corporate officer of the level of vice president or higher, or of an equivalent title within the insurer's corporate structure, who is either an actuary of the insurer with responsibility for the type of form filed, or the individual with responsibility for managing the form filing process for the insurer with regard to the type of form filed.
"Separate account" means any segregated portfolio of investment or designated account of an insurer established pursuant to 17B:28-1 et seq.
"State" means the State of New Jersey.
"Stop loss or excess risk insurance," unless a small employer subject to the stop loss or excess risk insurance definition at N.J.S.A. 17B:27A-17, means insurance designed to reimburse a self-funded arrangement for catastrophic and unexpected expenses exceeding specified per person retention limits of no less than $ 20,000 per year and/or aggregate retention limits of no less than 110 percent of expected claims per year, wherein neither the employees nor other individuals are third-party beneficiaries under the policy, contract or plan.
"Universal flexible-factor form" means any life insurance policy, rider or endorsement, whether participating or nonparticipating, which permits the insurer to reserve the right to modify (upward or downward) premiums, premium factors (interests, mortality, expenses), or benefits (death benefits, cash or loan values) on the basis of future anticipated or emerging experience.