New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.5 - General provisions for market withdrawal

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No carrier with in force individual plans, whether or not affiliated with other carriers doing business in the individual plan market in New Jersey, shall refuse to issue or refuse to renew an individual plan, except in accordance with 17B:27A-6, or in accordance with 11:20-18.4 or 18.6, unless the carrier receives approval from the Commissioner to withdraw all of its individual plans and pre-reform plans in accordance with the provisions of this subchapter.
(b) A carrier that seeks to withdraw shall file with the Department an application for market withdrawal in the format described in (c) below. A carrier with more than one affiliated carrier doing business in the individual plan market in New Jersey may apply for market withdrawal on behalf of one or more affiliated carriers. Until the withdrawal process is complete, the withdrawing carrier shall continue to be governed by 17B:27A-2 et seq. and all rules promulgated thereunder, including, but not limited to, the minimum loss ratio and policyholder refund requirements and liability for a proportionate share of assessments for reimbursable losses and administrative expenses.
(c) The application for market withdrawal shall be sent to the Department at Department of Banking and Insurance, Life and Health, IHC Withdrawal, 20 West State Street, P.O. Box 325, Trenton, New Jersey 08625, and shall include the following information:
1. The name of the carrier seeking to withdraw;
2. The name, address, telephone number, and fax number of the carrier's representative responsible for the application for market withdrawal;
3. A statement, describing with specificity, the carrier's reasons for withdrawing from the individual market in this State;
4. A statement of the carrier's percentage market share in the individual plan market, if known, including its most recent policy or contract count and annual amount of direct premium earned and written;
5. A statement indicating whether the carrier has applied for an exemption pursuant to N.J.A.C. 11:20-9 in the two-year calculation period during which the application for market withdrawal was filed;
6. A copy of the carrier's most recent loss ratio filing submitted pursuant to N.J.A.C. 11:20-7;
7. A copy of the carrier's most recent enrollment status report filed pursuant to N.J.A.C. 11:20-17;
8. A statement indicating whether the carrier has any affiliated carriers writing any health benefits plans in this State, the names of such affiliated carriers and the lines of insurance written, and whether any such affiliated carriers will continue to offer individual plans after the carrier's withdrawal;
9. A statement indicating whether the carrier is withdrawing from other lines of business in this State, and if so, the lines from which it is withdrawing, its authority do so, and whether it has sought and obtained approval for such withdrawal;
10. A statement indicating whether the carrier has guaranteed rates to its policyholders and for what period of time;
11. A copy of the proposed nonrenewal notices the applicant intends to send to its policy or contractholders if the application for market withdrawal is approved. Nonrenewal notices for policy or contractholders shall contain the following information:
i. That the carrier has elected to withdraw;
ii. The date upon which the policy or contract shall be nonrenewed;
iii. That the policy or contract is being nonrenewed under the authority of this subchapter;
iv. The name, address and telephone number of the employee or agent of the carrier who may be contacted for assistance and information regarding the plan nonrenewal;
v. A statement that the policy or contractholder may contact his or her producer, if any, for additional information regarding the plan nonrenewal;
vi. A statement that a person who fails to obtain subsequent individual coverage within 31 days of the nonrenewal may be subject to a pre-existing condition exclusion period of 12 months; and
vii. A statement that, pursuant to 17B:27A-6, all carriers offering individual plans must issue coverage to any individual who requests coverage, meets the eligibility requirements, and pays the required premium for the coverage;
12. Copies of the proposed nonrenewal notices the applicant intends to send to its producers if the application for market withdrawal is approved. Nonrenewal notices for producers shall contain the following information:
i. That the carrier has elected to withdraw;
ii. The date upon which the policies or contracts shall be nonrenewed;
iii. That the policies or contracts are being nonrenewed under the authority of this subchapter;
iv. The name, address and telephone number of the employee of the carrier who may be contacted for assistance and information regarding the plan nonrenewal;
v. A statement that a person who fails to obtain subsequent individual coverage within 31 days of the nonrenewal may be subject to a pre-existing conditions exclusion period of 12 months;
vi. A statement that, pursuant to 17B:27A-6, all carriers offering individual plans must issue coverage to any individual who requests coverage, meets the eligibility requirements, and pays the required premium for the coverage; and
vii. The date upon which the carrier will begin to nonrenew all individual plans and pre-reform plans;
13. An explanation of whether the carrier has any in-force small employer health benefits plans and, if so, a statement of whether the carrier has filed a notice of intent to withdraw from the small employer market with the Department; and
14. Any additional information which the carrier believes is relevant for the Department to review the carrier's application for market withdrawal.