reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 34 - LONG-TERM CARE INSURANCE › Section 11:4-34.28 - Requirement to deliver shopper$DQ$s guide

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the Commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate.
1. In the case of agent solicitations, an agent must deliver the shopper's guide prior to the presentation of an application or enrollment form.
2. In the case of direct response solicitations, the shopper's guide must be presented in conjunction with any application or enrollment form.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 34 - LONG-TERM CARE INSURANCE › Section 11:4-34.29 - Training requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No individual producer licensed on or after February 17, 2009 may sell, solicit or negotiate long-term care insurance unless the individual is licensed as an insurance producer for accident and health or sickness or life insurance pursuant to 17:22A-26 et seq. and has completed a one-time initial training course as set forth in (b) and (c) below. The training shall meet the requirements set forth in (b) below.
1. An individual already licensed and selling, soliciting or negotiating long-term care insurance on February 17, 2009 may not continue to sell, solicit or negotiate long term care insurance after July 1, 2009 unless the individual completes a one-time initial training course as set forth in (b) and (c) below by no later than July 1, 2009.
2. In addition to the one-time initial training course, an individual who sells, solicits or negotiates long-term care insurance shall complete ongoing training as set forth in (b) and (c) below.
3. The training requirements of (b) and (c) below shall be approved in accordance with course approval standards found in N.J.A.C. 11:17-3.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 34 - LONG-TERM CARE INSURANCE › Section 11:4-34.30 - Partnership Policies-general requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order to qualify for New Jersey's Long-Term Care Partnership Program, a long-term care insurance policy shall satisfy the following requirements:
1. The policy shall cover an insured who was a New Jersey resident at the time coverage first became effective under that policy;
2. The policy is a qualified long-term care insurance policy as defined in 26 U.S.C. §
											7702B(b);
3. The policy is issued on or after November 23, 2007 (the effective date of the State plan amendment by the Centers for Medicare and Medicaid Services regarding the Partnership Policy Program);
4. If the policy is sold to an individual under the age of 61, it must provide compound annual inflation protection at a rate of at least three percent, or at a rate based on changes in the consumer price index for all urban consumers, U.S. city average, all items, as determined by the Bureau of Labor Statistics of the U.S. Department of Labor;
5. If the policy is sold to an individual aged 61 through 75, the policy must provide inflation protection at least equivalent to a guaranteed purchase option of additional coverage each year in an amount equal to three percent simple growth rate of the original benefits provided under the policy, or at a rate based on changes in the consumer price index for all urban consumers, U.S. city average, all items, as determined by the Bureau of Labor Statistics of the U.S. Department of Labor; and
6. If the policy is sold to an individual aged 76 or older, the insurer is required to offer inflation protection which meets the requirements for a partnership policy sold to an individual 61 through 75.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 34 - LONG-TERM CARE INSURANCE › Section 11:4-34.31 - Form filings

Current through Register Vol. 56, No. 14, July 15, 2024
Long-term care insurance policies that are to be delivered or issued for delivery in this State, and certificates and riders for use with such policies, shall be submitted to the Department for review and approval prior to use pursuant to the procedures in N.J.A.C. 11:4-40.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 34 - LONG-TERM CARE INSURANCE › Section 11:4-34.32 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
In addition to any other penalties provided by the laws of this State, any carrier and any agent found to have violated any requirement of this State relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to three times the amount of any commissions paid for each policy involved in the violation or up to $ 10,000, whichever is greater.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 34 - LONG-TERM CARE INSURANCE › Appendix A

Current through Register Vol. 56, No. 14, July 15, 2024
RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE STATE OF ___________________ FOR THE REPORTING YEAR ___________________
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 34 - LONG-TERM CARE INSURANCE › Appendix H

Current through Register Vol. 56, No. 14, July 15, 2024
NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE
Click here to view image.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to implement N.J.S.A. 17B:30B-1et seq., governing viatical settlements.
(b) This subchapter applies to persons who enter into agreements with New Jersey residents to purchase their life insurance policies for less than the current death benefit.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.3 - General licensing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to implement N.J.S.A. 17B:30B-1et seq., governing viatical settlements.
(b) A viatical settlement license issued by the Commissioner shall be valid for a term of one year with a commencement date of July 1 and an expiration date of June 30 of the succeeding year as indicated on the license. The license shall be a limited license that allows the licensee to operate only within the scope of the license.
(c) Individual applicants seeking licensure as viatical settlement brokers or viatical settlement representatives shall be required to pass Part 1 of the State licensing examination, "Life--General Product Knowledge," that is required of life insurance producers before a license may be issued. Applicants also wishing to become licensed as life insurance producers shall, in addition, be required to pass the law part of the examination. The examination requirements shall be waived with regard to non-residents who are licensed in states with substantially similar viatical settlement licensing standards or can provide proof that they have passed their state's life product portion of the life insurance agent's examination.
(d) The Department may request that licensed viatical settlement brokers and viatical settlement representatives and licensed applicants submit their social security numbers to the Department. All such requests shall either include or be accompanied by a notice stating:
1. The purpose or purposes for which the Department intends to use the social security numbers;
2. That disclosure made pursuant to the request that it is either voluntary or mandatory; and
3. That the request is authorized by this section and by such other law as may be applicable.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.5 - Viatical settlement broker$DQ$s or representative's license application

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A first time applicant for an individual viatical settlement broker's license or viatical settlement representative's license shall submit the following:
1. A properly executed and dated application requesting issuance of a viatical settlement broker's or representative's license which shall contain the applicant's legal name; trade name, if any; home address; date of birth; business mailing address and location address; home and business telephone numbers; the applicant's social security number; and responses to questions concerning the applicant's character and fitness for licensing. This information together with all requested attachments shall be certified as being accurate by the applicant;
2. Proof that the applicant has passed Part 1 of the State licensing examination, "Life--General Product Knowledge," required for a life producer or proof that the applicants have passed its state's life product portion of the life insurance agent's examination;
3. Information on other related licenses held by the applicant including a list of states where the applicant is licensed as a viatical settlement broker or representative, certifications of current license status in those states, and a list of viatical settlement providers with which the applicant is associated;
4. Any documents or statements required to verify or explain responses to questions concerning the applicant's character, fitness or financial responsibility;
5. Fingerprint impressions taken on New Jersey State Police and Federal Bureau of Investigation fingerprint cards, together with the fees required for processing;
6. A plan of operation that includes the following: target markets and geographic locations; marketing and advertising strategies to attract potential viators; broker training procedures and a detailed description of the procedures used to keep medical information confidential;
7. Any additional information which the applicant chooses to provide or which the Commissioner may find relevant to clarify any of the information in (a)1 through 6 above; and
8. A check or money order made payable to State of New Jersey--General Treasury for the following nonrefundable fees:
i. License fee: $ 75.00.
ii. Application processing fee: $ 20.00.
iii. Fingerprint processing fee: $ 49.00.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.6 - License renewals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following shall apply to license renewal:
1. Where a current licensee seeks to renew a license, the licensee shall, at least 15 days before June 30, submit a properly completed renewal application signed, dated and certified to be correct by the licensee or a licensed officer, partner or member of a licensed organization. The licensee shall certify that he, she or it continues to be qualified in accordance with the Act and this subchapter. The renewal application shall be accompanied by a check or money order made payable to State of New Jersey--General Treasury for the following nonrefundable fees:
i. Provider's license renewal fee: $ 250.00.
ii. Broker's or representative's license renewal fee: $ 75.00.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.7 - Denial of license

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Where it appears from an application, the attached documents or Department records that an applicant has not demonstrated the qualifications prescribed in the Act or this subchapter, the Department shall advise the applicant in writing that the license request is denied; shall specify the reasons for the denial; and shall advise the applicant of the right to request a hearing, and of the procedures for filing the request.
1. A request for a hearing shall be filed within 20 days of receipt of the letter denying the request for a license.
2. The request for a hearing by a viatical settlement provider shall be forwarded to:
Assistant Commissioner
Life and Health
New Jersey Department of Banking and Insurance
20 West State Street
PO Box 325
Trenton, NJ 08625-0325
3. The request for a hearing by a viatical settlement broker or viatical settlement representative shall be forwarded to:
Director of Licensing and Insurance Education
New Jersey Department of Banking and Insurance
20 West State Street
PO Box 325
Trenton, NJ 08625-0325
4. The request for a hearing shall include a statement of the legal and factual basis upon which the applicant disagrees with the denial of a license and all documentation in support thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.8 - Appointment requirements for viatical settlement representatives

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A person shall not act as a viatical settlement representative without first obtaining an appointment from a licensed viatical settlement provider or licensed viatical settlement broker.
1. The appointment shall be made on a form required by the Commissioner and accompanied by a fee of $ 100.00.
2. If the appointment is revoked by either party, the appointing viatical settlement provider or viatical settlement broker shall notify the Commissioner of the revocation within 30 days.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.9 - Approval of contracts and disclosure statements; right of rescission

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A person shall not use a viatical settlement contract or provide to a viator a disclosure statement form in this State unless filed with and approved by the Commissioner. Contract filings shall include the methodology for determining the viatical settlement proceeds. A viatical settlement contract or disclosure statement form shall be deemed approved by the Commissioner if not disapproved within 60 days from submission. The Commissioner shall disapprove a viatical settlement contract or disclosure statement form if, in the Commissioner's opinion, the contract, provisions contained therein, or the methodology for determining proceeds are unreasonable, contrary to the interests of the public, or otherwise misleading or unfair to the viator. At the Commissioner's discretion, the Commissioner may require, as part of the approval process, the submission of advertising material.
(b) All viatical settlement contracts entered into in this State shall provide the viator with an unconditional right to rescind the contract for at least 15 calendar days from the receipt of the viatical settlement proceeds. If the insured dies during the rescission period, the viatical settlement contract shall be deemed to have been rescinded, subject to repayment to the viatical settlement provider of all viatical settlement proceeds.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.10 - Standards for evaluation of reasonable viatical settlement proceeds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Viatical settlement providers and viatical settlement brokers are prohibited from entering into viatical settlements with viators who are insured policyowners or certificateholders of individual or group life insurance policies containing accelerated death benefit provisions or riders that enable the insurer to pay more to the policyowner or certificateholder than would be paid pursuant to the viatical settlement except as provided in (b) below.
(b) Viatical settlement providers and viatical settlement brokers shall obtain from viators a signed statement that the viators have contacted their life insurer and that their policy does not include an accelerated death benefits clause as provided in N.J.A.C. 11:4-30; or that they had the opportunity to contact their life insurer and chose not to do so, even after it was explained to them that their policy may contain a clause that would enable them to receive more money than the viatical settlement provider is offering.
(c) A viatical settlement provider or broker shall not enter into a viatical settlement that provides a payment to the viator that is unreasonable or unjust. In determining whether a payment is unreasonable or unjust, the Commissioner may consider, among other factors, the estimated life expectancy of the viator, the premiums due under the policy, the availability of loan or other values to reduce the cost of providing the settlement to the viator, reasonable costs of capital and expenses of doing business, and provisions for refund of premiums or payment of interest on death benefits.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.11 - Reporting requirement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) On or before March 1 of each year, each viatical settlement provider licensed in this State shall make and file with the Commissioner a report of all viatical settlement transactions where the viator is a resident of this State and for all states in the aggregate containing the following information for the previous calendar year:
1. For viatical settlements contracted during the reporting period:
i. The date of viatical settlement contract;
ii. The viator's state of residence at the time of the contract;
iii. The mean life expectancy of the insured at time of contract in months;
iv. The face amount of policy viaticated;
v. The net death benefit viaticated;
vi. The estimated total premiums to keep policy in force for mean life expectancy;
vii. The net amount paid to viator;
viii. The payment type (lump sum or fixed annuity);
ix. The source of policy (B-Broker; D-Direct Purchase; SM-Secondary Market);
x. The type of coverage (I-Individual or G-Group);
xi. Whether the policy is within the contestable or suicide period, or both, at the time of viatical settlement (yes or no);
xii. The primary ICD Diagnosis Code, in numeric format, as defined by the international classification of diseases, as published by the U.S. Department of Health and Human Services; and
xiii. The type of funding (I-Institutional; P-Private);
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.12 - Payment of the proceeds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) With respect to policies containing a provision for double or additional indemnity for accidental death, the additional payment shall remain payable to the beneficiary last named by the viator prior to entering into the viatical settlement contract, or to such other beneficiary, other than the viatical settlement provider, as the viator may thereafter designate, or in the absence of a beneficiary, to the estate of the viator.
(b) Payment of the proceeds of a viatical settlement pursuant to N.J.S.A. 17B:30B-9dshall be by means of wire transfer to the account of the viator or by certified check or cashier's check.
(c) Payment of the proceeds to the viator pursuant to a viatical settlement shall be made in a lump sum except where single premium fixed annuity has been purchased from an insurance company for the benefit of the viator. The viatical settlement provider cannot be the owner of the annuity. The terms of the payment agreement, including the ownership of the annuity, the insurance company insuring the annuity and the amount of and form of payments under the annuity, shall be reasonable. The viator shall always be offered the option of a lump sum payment. Retention of a portion of the proceeds by the viatical settlement provider or escrow agent is not permissible.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.13 - Viatical settlement provider/broker/representative conduct

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A viatical settlement provider, viatical settlement broker or viatical settlement representative shall not discriminate in the making or solicitation of viatical settlements on the basis of race, age, sex, national origin, creed, religion, occupation, marital or family status or sexual orientation, or discriminate between viators with dependents and without.
(b) A viatical settlement provider, viatical settlement broker or viatical settlement representative shall not pay or offer to pay any finder's fee, commission or other compensation to any insured's physician, or to an attorney, accountant or other person providing medical, legal or financial planning services to the viator, or to any other person acting as an agent of the viator with respect to the viatical settlement.
(c) A viatical settlement provider shall not knowingly solicit investors who have treated or have been asked to treat the illness of the insured whose coverage would be the subject of the investment.
(d) A license viatical settlement provider or broker corporation may conduct its business only through its members, officers, designated employees or appointed representatives and is responsible for the activities of such members, officers, designated employees and appointed representatives.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.14 - Viatical settlement provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If a viatical settlement provider enters into a viatical settlement that allows the viator to retain an interest in the policy, the viatical settlement contract shall contain the following provisions:
1. A provision that the viatical settlement provider will effect the transfer of the amount of the death benefit only to the extent or portion of the amount viaticated. Benefits in excess of the amount viaticated shall be paid directly to the viator's beneficiary by the insurer;
2. A provision that the viatical settlement provider will, upon acknowledgment of the perfection of the transfer, send to the viator a copy of the instrument sent from the insurer to the viatical settlement provider that acknowledges the viator's interest in the policy; and
3. A provision that apportions the premiums to be paid by the viatical settlement provider and the viator. It is permissible for the viatical settlement contract to specify that all premiums shall be paid by the viatical settlement provider. The contract may also require that the viator reimburse the viatical settlement provider for the premiums attributable to the retained interest.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.15 - Advertising standards

Current through Register Vol. 56, No. 14, July 15, 2024
Advertising related to the viatical settlement shall be truthful and not misleading by fact or implication. If the advertiser emphasizes the speed with which the viatication will occur, the advertising shall disclose the average time frame from completed application to the date of offer and from acceptance of the offer to receipt of the funds by the viator. If the advertising emphasizes the dollar amounts available to viators, the advertising shall disclose the average purchase price as a percent of face value obtained by viators contracting with the advertiser during the six months prior to the advertising.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.16 - Disclosure

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A disclosure document containing the disclosures required in N.J.S.A. 17B:30B-8 and this subchapter shall be provided to the viator before or concurrent with taking an application for a viatical settlement contract.
(b) The disclosure document shall contain the following language: "All medical financial or personal information solicited or obtained by a viatical settlement provider or viatical settlement broker about a viator and insured, including the viator and insured's identity or the identity of family members, a spouse or a significant other, is confidential." The information shall not be disclosed in any form to any person, unless disclosure:
1. Is necessary to effect the viatical settlement between the viator and the viatical settlement provider; and
2. Prior written consent to the disclosure has been provided by the viator or the insured, or both, depending upon whom the disclosure affects.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.17 - Prohibited practices

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A viatical settlement provider, viatical settlement broker or viatical settlement representative shall not provide patient identifying information to any person, unless the insured and viator provide written consent to the release of the information.
(b) A viatical settlement provider, viatical settlement broker or viatical settlement representative shall obtain from a person that is provided with patient identifying information a signed affirmation that the person or entity will not further divulge the information without procuring the express, written consent of the insured for the disclosure. Notwithstanding the foregoing, if a viatical settlement provider, viatical settlement broker or viatical settlement representative is served with a subpoena and, therefore, compelled to produce records containing patient identifying information, it shall notify the viator and the insured in writing at their last known addresses within five business days after receiving notice of the subpoena.
(c) A viatical settlement provider shall not act also as a viatical settlement broker, whether entitled to collect a fee directly or indirectly, in the same viatical settlement.
(d) A viatical settlement broker shall not act as the viatical settlement broker regarding a life insurance policy if the broker is the life insurance producer that produced or receives commissions from the policy being viaticated.
(e) A viatical settlement broker shall not, without the written agreement of the viator obtained prior to performing any services in connection with a viatical settlement, seek or obtain any compensation from the viator.
(f) A viatical settlement provider shall not use a longer life expectancy than is realistic in order to reduce the payout to which the viator is entitled.
(g) No person shall enter into a viatical settlement contract the subject of which is a life insurance policy that the person knows was obtained by means of a false, deceptive, or misleading application for the life insurance policy.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Section 11:4-35.18 - Imposition of administrative penalties/suspension/revocation of license

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A violation of the Act or these rules shall be considered an unfair practice pursuant to 17B:30-1 et seq. and shall be subject to the penalties contained in 17B:30-17.
(b) Before an administrative penalty is imposed, the Department shall direct a notice by certified mail and regular mail, or by personal delivery, to the last known business or mailing address of the alleged violator. The notice shall include:
1. A reference to the statute, rule and/or administrative order alleged to be violated;
2. A concise statement of the facts on which the violation is based;
3. A statement of the administrative penalty, penalties or other relief sought to be imposed; and
4. A statement advising the alleged violator of the right to a hearing and the procedure for requesting a hearing.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 35 - VIATICAL SETTLEMENTS › Appendix - APPENDIX

Current through Register Vol. 56, No. 14, July 15, 2024
Mortality Experience Table
By Number of
Contracts
.................
Life Expectancy
In Force
Contracts added
Expected
Actual
at Issue
01/01/----
during year
Deaths
Deaths
.................
< 6 months
.................
6 to 12 months
.................
12 to 18 months
.................
18 to 24 months
.................
24 months or more
.................
By Amount of
Insurance
.................
Life Expectancy
In Force
Contracts added
Expected
Actual
at Issue
01/01/----
during year
Deaths
Deaths
.................
< 6 months
.................
6 to 12 months
.................
12 to 18 months
.................
18 to 24 months
.................
24 months or more
.................
In column 1, enter the number of contracts in force or amount of insurance in
force under viatical settlements as of the beginning of the year, broken down
by the life expectancy on which the original consideration was based.
In column 2, enter the number of contracts added during the year.
In column 3, enter expected deaths (number or amount) from columns 1 and 2,
as estimated by the provider's actuary and based on life expectancy
assumptions.
In column 4, enter the actual deaths (number or amount) from columns 1 and 2.
...........................................
.................................
Signature of Member of the American Academy
Date
of Actuaries
...........................................
Print Name
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 37 - SELECTIVE CONTRACTING ARRANGEMENTS OF INSURERS › Section 11:4-37.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to set forth standards and procedures whereby a carrier shall obtain approval from the Commissioner of its offering of health benefits plans utilizing selective contracting arrangements that promote health care cost containment while adequately preserving quality of care.
(b) This subchapter applies to all carriers operating pursuant to Title 17B of the New Jersey statutes, and issuing health benefits plans utilizing selective contracting arrangements in this State. This subchapter shall not apply to the following: hospital service corporations operating pursuant to 17:48-1 et seq.; medical service corporations operating pursuant to 17:48A-1 et seq.; hospital and medical service corporations operating pursuant to 17:48B-1 et seq.; dental service corporations operating pursuant to 17:48C-1 et seq.; dental plan organizations operating pursuant to 17:48D-1 et seq.; or health service corporations operating pursuant to 17:48E-1 et seq.
(c) The provisions of these rules shall apply except where in conflict with any policy or contract issued pursuant to the New Jersey Individual Health Coverage Act at 17B:27A-1 et seq. or the New Jersey Small Employer Health Coverage Act at 17B:27A-17 et seq. If such a conflict exists, all remaining provisions of these rules determined not to be in conflict shall remain in effect.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 37 - SELECTIVE CONTRACTING ARRANGEMENTS OF INSURERS › Section 11:4-37.3 - Standards for selective contracting arrangements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A selective contracting arrangement that involves direct contracting between the carrier and network providers or that involves a contract between the carrier and a PPO shall contain an adequate number of network providers by specialty to render the particular covered services in the geographic service area where it operates. A selective contracting arrangement that involves direct contracting between the carrier and a licensed or certified ODS, or under which an HMO makes its network available to a carrier, shall be presumed to have an adequate provider network.
(b) Health benefits plans utilizing selective contracting arrangements shall meet the following criteria:
1. The health benefits plan utilizing a selective contracting arrangement shall provide that covered persons shall not be financially liable for payments to network providers for any sums, other than required co-payments, coinsurance or deductibles, owed for covered services, if the carrier fails to pay for the covered services for any reason;
2. The health benefits plan shall provide that the cost sharing applied to the covered person for emergency care shall be the same regardless of whether the services were rendered by network or out-of-network providers;
3. The health benefits plan shall provide that the carrier shall provide each covered person with a current evidence of coverage within 30 days of enrollment and no later than 30 days after any policy or contract changes;
4. The health benefits plan shall provide that covered persons shall be permitted to change their selection of primary care physician, and such changes shall be effective no later than 15 days after receipt of a request to change a primary care physician;
5. The health benefits plan shall provide that covered persons shall be provided with a current directory of network providers in the licensed or certified ODS, HMO, or PPO, or who have directly contracted with the carrier, including addresses and telephone numbers, and a listing of the providers who speak languages other than English. The directory may be made available online provided that covered persons can obtain a hard copy of the directory upon request;
6. The benefit design of health benefits plans utilizing selective contracting arrangements shall be subject to N.J.A.C. 11:22-5; and
7. Carriers shall not calculate benefits for services provided by out-of-network providers by using negotiated fees agreed to by network providers.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 37 - SELECTIVE CONTRACTING ARRANGEMENTS OF INSURERS › Section 11:4-37.5 - Denial, suspension and revocation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The approval of a selective contracting arrangement issued by the Department under this subchapter may be denied, suspended or revoked if the Commissioner determines that:
1. The selective contracting arrangement criteria set forth in this subchapter are not being met;
2. Payment for covered services provided under the selective contracting arrangement is not in accordance with the terms of the approved arrangement;
3. The arrangement for the payment of covered services fails to meet the requirements of these rules; or
4. Any false or misleading information is submitted by the carrier seeking approval.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 37 - SELECTIVE CONTRACTING ARRANGEMENTS OF INSURERS › Section 11:4-37.8 - Filing and review fees

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every carrier shall pay a $ 1,500 filing fee for filing each of the following with the Department:
1. A selective contracting arrangement approval application pursuant to 11:4-37.4; and
2. A triennial renewal application of a selective contracting arrangement pursuant to 11:4-37.4(g).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 37 - SELECTIVE CONTRACTING ARRANGEMENTS OF INSURERS › Section 11:4-37.9 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Carriers failing to comply with the requirements of this subchapter may be subject to penalties authorized by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 40 - LIFE/HEALTH/ANNUITY FORMS › Section 11:4-40.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to implement P.L. 1995, c.73 (the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act) by setting forth standards and procedures whereby all life insurance, health insurance, and annuity forms, and rates where applicable, other than forms approved pursuant to the Interstate Insurance Product Regulation Compact established by P.L. 2010, c. 120, are to be submitted to the Commissioner for his or her approval prior to use. This subchapter also establishes a file and use system for certain forms deemed eligible by the Commissioner provided that a certification is filed that the particular form complies with the law and rules applicable to it.
(b) This subchapter shall apply to all life insurance, health insurance and annuity forms issued pursuant to 17B:17-1 et seq.; all hospital service corporation contracts issued pursuant to 17:48-1 et seq.; all medical service corporation contracts issued pursuant to 17:48A-1 et seq.; all health service corporation contracts issued pursuant to 17:48E-1 et seq.; and all health maintenance organization contracts, evidence of coverage and related forms issued pursuant to 26:2J-1 et seq. This subchapter shall not apply to any forms issued pursuant to 17B:27A-2 et seq. or 17B:27A-17 et seq., but shall apply to all forms issued pursuant to 17B:27A-7 and 17B:27A-19. This subchapter shall not apply to individual and group annuity, life insurance and disability income forms approved by the Interstate Insurance Product Regulation Commission created pursuant to the Interstate Insurance Product Regulation Compact established by P.L. 2010, c. 120.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 40 - LIFE/HEALTH/ANNUITY FORMS › Section 11:4-40.3 - Life/health/annuity form approval standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All life, health and annuity forms shall comply with the standards set forth in this subchapter and in any other applicable statutes, rules and published guidelines before being delivered or issued for delivery in this State.
(b) No form delivered or issued for delivery in this State shall contain provisions which are unjust, unfair, inequitable, misleading or contrary to law or to the public policy of this State.
(c) The following types of contracts and forms are exempt from compliance with this subchapter:
1. Annuity contracts, other than individual contracts and synthetic guaranteed investment contracts;
2. Annuity contracts used solely for structured settlements that are purchased by an insurer or an obligor for the purpose of funding defined periodic payments pursuant to a court order or an out of court settlement of a tort liability claim, or for periodic payments in settlement of a workers compensation claim; and
3. Individual variable life forms and individual variable annuity forms sold exclusively as private placement forms.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 40 - LIFE/HEALTH/ANNUITY FORMS › Section 11:4-40.4 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All insurers submitting forms or other correspondence to the Department pursuant to this subchapter shall comply with the following general procedures:
1. All individual health, group health, blanket, prepaid legal contracts, group life and service corporation forms, individual life, credit life and health, mortgage guaranty, separate account, variable contract and annuity, group credit, synthetic guaranteed investment contract forms and other related correspondence pursuant to this subchapter submitted or resubmitted for approval or for file and use shall be submitted to the Department through the use of the National Association of Insurance Commissioners electronic filing system known as System for Electronic Rate and Form Filing (SERFF). As of July 19, 2010, the Office of Life and Health will no longer accept any rate or policy form filings other than through SERFF. Any such filings received after July 19, 2010 in any method other than through SERFF will be closed with no action taken and returned to the company without review. Insurers shall submit a paper copy of any materials submitted via SERFF if requested by the Department.
2. For purposes of computing time limits in this subchapter, "days" shall mean calendar days, except that when the last day of any specified time period is a Saturday, Sunday or State holiday, then the time period shall end on the next following business day. A day shall end as of 5:00 P.M. Eastern Standard Time (EST).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 40 - LIFE/HEALTH/ANNUITY FORMS › Section 11:4-40.5 - Life/health/annuity form approval procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No insurer shall deliver or issue for delivery in this State any form unless the form has been approved by the Commissioner pursuant to the procedures set forth in this subchapter, except for those forms eligible for submission to the Commissioner pursuant to the file and use system described in this subchapter at 11:4-40.9 and 40.10 or specifically exempt from compliance with this subchapter.
(b) An insurer seeking approval of a form shall transmit a complete form filing to the Department, which shall include the items set forth below:
1. A properly completed Initial Submission Data Form as set forth on the Department's website at:
www.state.nj.us/dobi/division_insurance/pdfs/lhfmsub.pdf
;
2. A specimen copy of the form;
3. A cover letter, which shall include the following:
i. The insurer's identity;
ii. The form number(s) of the form(s) being submitted. If several forms are being submitted, the form numbers may be included as an attachment to the cover letter;
iii. A general description of the nature of the form(s), including, but not limited to, the specific market and issue ages;
iv. The identity of one individual authorized as the insurer's contact person for the form(s) being filed;
v. A statement as to whether the form was previously submitted to the Department, including the date and status of any such submission;
vi. For rider forms or endorsements, an explanation of the manner in which the rider or endorsement affects the mortality basis or premiums for the base policy; and
vii. The contents of the cover letter in (b)3i through vi above shall be included in the Filing Description Field within SERFF or as a separate line entry attached to the Supporting Documentation tab;
4. A certification signed by a responsible officer of the insurer that the forms comply with all laws, rules, bulletins and published guidelines applicable to the particular type of form. The certification may be included in the text of the cover letter described in (b)3 above if the cover letter is signed by a responsible officer of the insurer;
5. A readability certification if required pursuant to N.J.S.A. 17B:17-21d;
6. An actuarial memorandum which complies with the requirements of any applicable statutes, rules or published guidelines, and premium rates if required by this subchapter or other law or rule, for the particular type of form being submitted;
7. Any additional items required to be submitted for forms as specifically set forth at other sections of this subchapter;
8. Where the form submitted is a rider, endorsement, insert page or supplemental form, a listing of the policy form number(s) and approval date(s) of the policy form(s) with which the form submitted is to be used and a specimen copy of an approved policy form; and
9. All forms and attachments should be in a PDF format.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 40 - LIFE/HEALTH/ANNUITY FORMS › Section 11:4-40.6 - Individual life and annuities variable form approval procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to those items set forth at 11:4-40.5, insurers seeking approval of individual life and annuities variable forms shall include, if applicable, the following items in the submission to the Department:
1. A prospectus; and
2. An actuarial memorandum which discusses the derivation of cash values and all current and maximum charges deducted in determining the separate account values.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 40 - LIFE/HEALTH/ANNUITY FORMS › Section 11:4-40.7 - Valuation and non-forfeiture interest rates form approval procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to those items set forth at 11:4-40.5, insurers seeking approval of valuation and non-forfeiture interest rate changes to previously filed forms shall include, if applicable, the following items in the submission to the Department:
1. If the interest rate and/or non-forfeiture values appearing on the form change as a result of the new interest rate, the submission shall include the new page(s) bearing distinct identifying form numbers for filing;
2. A revised actuarial memorandum reflecting the change in interest rate or a statement that the new rate does not affect the memorandum currently on file;
3. Pursuant to N.J.S.A. 17B:25-19h(x), an insurer is not required to refile other provisions of the form to file the changes described in (a)1 and 2 above; and
4. The interest rate and non-forfeiture values may be filed as variable to the extent they are equal to or determinable from the maximum interest rate, and cash values calculated using that rate, as described in 17B:25-19. Insurers shall place variable brackets around the appropriate item(s) on the revised policy page(s).