New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 2 - INSURANCE GROUP › Subchapter 39A - INCREASE IN CAPITAL AND SURPLUS REQUIREMENTS FOR HEALTH ORGANIZATIONS › Section 11:2-39A.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.
"Adjusted RBC report" means an RBC report which has been adjusted by the Commissioner in accordance with N.J.A.C. 11:2-39A.3(d).
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Corrective order" means an order issued by the Commissioner specifying corrective actions that the Commissioner has determined are required pursuant to N.J.A.C. 11:2-39A.5(b).
"Department" means the New Jersey Department of Banking and Insurance.
"Domestic health organization" means a health organization formed under the laws of this State.
"Foreign health organization" means a health organization that is licensed to do business in this State but is not domiciled in this State.
"Health organization" means a health maintenance organization licensed pursuant to
26:2J-1
et seq., hospital service corporation licensed pursuant to
17:48-1
et seq., medical service corporation licensed pursuant to
17:48A-1
et seq., dental service corporation licensed pursuant to
17:48C-1
et seq., dental plan organization licensed pursuant to
17:48D-1
et seq., health service corporation licensed pursuant to
17:48E-1
et seq., prepaid prescription services organization licensed pursuant to
17:48F-1
et seq., and licensed organized delivery system authorized pursuant to
17:48H-1
et seq. This definition shall not include an organization that is licensed as either a life and health insurer or a property and casualty insurer under Titles 17 or 17B of the New Jersey Statutes and that is otherwise subject to either the life and health or property and casualty RBC requirements pursuant to N.J.A.C. 11:2-39.
"NAIC" means the National Association of Insurance Commissioners.
"RBC instructions" means the RBC report including risk-based capital instructions adopted by the NAIC, as these RBC instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC.
"RBC level" means a health organization's Company Action Level RBC, Regulatory Action Level RBC, Authorized Control Level RBC, or Mandatory Control Level RBC where:
1. "Company Action Level RBC" means, with respect to any health organization, the product of 2.0 and its Authorized Control Level RBC;
2. "Regulatory Action Level RBC" means the product of 1.5 and its Authorized Control Level RBC;
3. "Authorized Control Level RBC" means the number determined under the risk-based capital formula in accordance with the RBC Instructions; and
4. "Mandatory Control Level RBC" means the product of .70 and the Authorized Control Level RBC.
"RBC plan" means a comprehensive financial plan containing the elements specified in N.J.A.C. 11:2-39A.4(b). If the Commissioner rejects the RBC plan, and it is revised by the health organization, with or without the Commissioner's recommendation, the plan shall be called the "revised RBC plan."
"RBC report" means the report required in N.J.A.C. 11:2-39A.3.
"Total adjusted capital" means the sum of:
1. A health organization's statutory capital and surplus (that is, net worth) as determined in accordance with the statutory accounting applicable to the annual financial statements required to be filed under
17:48-1
et seq, 17:48A-1 et seq., 17:48C-1 et seq., 17:48D-1 et seq., 17:48E-1 et seq., 17:48F-1 et seq, 17:48H-1 et seq., and 26:2J-1 et seq.; and
2. Such other items, if any, as the RBC instructions may provide.