New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 3 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENT UNITS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-3.2 - 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 commissioners or executive committee, as defined herein, to act as executive director to carry out the policies established by the joint insurance fund commissioners or executive committee 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 fund commission elected by the commission pursuant to 40A:10-37.
"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 40A:10-16.
"Executive committee" means the committee of insurance fund commissioners, as provided in 40A:10-36 et seq.
"Fiscal year" or "fund year" means the calendar year January 1 through December 31.
"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 July 19, 1993.
"Joint insurance fund" or "fund" means a group established by two or more local units of government to create a self-insurance fund for the sole purpose of providing contributory or non-contributory group health insurance or group term life insurance to their employees or dependants and to any other person eligible for coverage by a member local unit pursuant to law, approved by the Department pursuant to 40A:10-36 et seq. and this subchapter.
"Joint insurance fund commissioners" means local unit representatives chosen to represent those units in the fund, as provided in 40A:10-36 et seq.
"Lead agency" means a member of the joint insurance fund responsible for the custody and maintenance of the assets of the fund and such other duties as may be designated by the joint insurance fund commissioners. The duties performed by a lead agency may include duties that may be performed by an administrator or servicing organization.
"Life insurance" means life insurance as defined pursuant to 17B:17-3.
"Local unit of government," "local unit" or "member" means a county, municipality, county vocational school (pursuant to 18A:18B-8 and 40A:10-50 ), county college (pursuant to 18A:64A-25.4 0 and 40A:10-51 ), board of education or any contracting unit as defined in 40A:11-2.
"Member" means a local unit which is a member of a local unit 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.
"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 fund commission elected by the commission pursuant to 40A:10-37.
"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 commissioners 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 40A:10-36 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.