reglab/statecodes huggingface dataset:
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 11:15-3.7 - Disapproval of bylaws and plan of risk management

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the Commissioner determines that the bylaws or plan of risk management of the fund and all other information required pursuant to 11:15-3.6, or any subsequent amendments or changes thereto, do not contain all of the information set forth in N.J.A.C. 11:15-3.6, is not submitted in the proper format set forth in 11:15-3.5, or otherwise do not meet the requirements of 40A:10-36 et seq. or this subchapter, the Commissioner shall disapprove the bylaws or plan of risk management and shall notify the fund in writing, which notice shall contain the specific reasons for disapproval, and the requirements to be met before approval may be granted.
(b) If, after submission of all of the information set forth in N.J.A.C. 11:15-3.6, the bylaws and plan of risk management containing all of the information required by N.J.A.C. 11:15-3.6, in the format required by N.J.A.C. 11:15-3.5, are not disapproved by the Commissioner within 30 working days of receipt of the supplemental information set forth in 11:15-3.6(e), the bylaws and plan shall be deemed approved, pursuant to N.J.S.A. 40A:10-41c. Such approval shall become effective 60 days after the date of approval pursuant to 11:15-3.3(c).
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 11:15-3.8 - Suspension, termination, assumption of control, or other action by Commissioner

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, the Commissioner may suspend or terminate the authority of any joint insurance fund, or direct or take any action deemed necessary for good cause, to enable a fund to meet its obligations, cover its expected losses, or to liquidate, rehabilitate or otherwise modify its affairs if a fund:
1. Is found to be insolvent or has experienced a deterioration in financial condition to the extent that it causes an adverse effect upon the ability of the fund to pay expected losses;
2. Fails to timely pay any fee or assessment, as required under this subchapter;
3. Fails to comply with any of the provisions of 40A:10-36 et seq. or this subchapter, or with any lawful order of the Commissioner within the time prescribed; or
4. Fails to follow its approved bylaws or plan of risk management.
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 11:15-3.9 - Approval of non-member local units

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prospective new members of the fund shall submit an application for membership to the fund's commission, or executive committee, as applicable, on a form acceptable to the Commissioner. The application shall include a copy of the resolution of participation and executed indemnity and trust agreement. The commission or executive committee may approve or disapprove the application for additional members, pursuant to the admissions criteria and bylaws of the fund.
(b) Any application approved by the fund shall within 15 days of approval by the fund be filed with the Department and Department of Community Affairs, and shall be accompanied by a revised budget with assessment detail, if the addition of the new member changes the total budget five percent from the original budget or the latest filed amended budget, as well as any amendments to fund's bylaws or plan of risk management as may be necessary. The fund shall file only the specific changes to the bylaws or plan of risk management in effect for the current fund year. In addition, the fund shall file the following information in the form of Exhibit D in the Appendix incorporated herein by reference, with the Department within 15 days after approval of a new member:
1. The name and address of the new member;
2. The effective date of coverage;
3. The name of the new member's risk manager;
4. The name of the new member's insurance fund commissioners and alternates in accordance with 11:15-3.6(e);
5. The lines of coverage for which the new member participates;
6. The amount of assessment, if not otherwise provided; and
7. An affirmative statement from the fund that in accepting the new member, an application has been filed, the fund has adhered to its bylaws and plan of risk management, and the agreement to participate and indemnity and trust agreement have been filed with the fund.
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 11:15-3.10 - Termination and/or withdrawal of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A member of the fund may remain a member for the full term of membership, as provided in the fund's bylaws, unless terminated by the fund for nonpayment of assessments, noncompliance with risk management or underwriting standards, or for other reasons subject to the prior approval by the Commissioner as reasons for termination. However, a member shall not be deemed terminated for any reason until:
1. After 30 days written notice of the intention to terminate the member has been given by the fund to the member, which notice shall state the reasons for termination and shall be given by registered mail or certified mail, return receipt requested;
2. Like notice shall have been filed with the Department and Department of Community Affairs, together with a certified statement that the notice provided for by (a)1 above has been given; and
3. Thirty days have elapsed after the filing required by (a)2 above has been made.
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 11:15-3.11 - Insolvency and/or bankruptcy of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
The insolvency or bankruptcy of a member does not relieve the fund or any other member of joint and several liability for the payment of any liability incurred by the member during the period of its membership, including, but not limited to, being subject to and liable for supplemental assessments.
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 11:15-3.12 - Voluntary dissolution of a fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A fund may not voluntarily dissolve, or otherwise cease to do business and distribute its assets to its members, unless and until it satisfies the following requirements:
1. A majority of the fund's members must have voted in favor of a resolution to dissolve the fund, pursuant to the written plan adopted pursuant to the procedures set forth in the fund's bylaws, at a meeting duly called for such purposes;
2. The plan of dissolution must provide for the payment of all incurred losses of the fund and its members, including all incurred but not reported losses, as certified by an actuary, before any assets of the fund or the trust fund accounts may be used for any other purpose;
3. The plan of dissolution shall contain a statement of the fund's current financial condition computed on a statutory basis and computed according to generally accepted accounting principles as attested to by an independent certified public accountant; and
4. The plan of dissolution, and such other information as may be required, must be filed with and approved in writing by the Commissioner and the Commissioner of the Department of Community Affairs. The plan shall be filed with the Commissioner and the Commissioner of the Department of Community Affairs no later than 90 days prior to the proposed effective date of dissolution.
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 11:15-3.13 - Establishment of trust fund accounts; transfers or withdrawals prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to the terms of the indemnity and trust agreement, each fund shall establish a separate trust fund account in accordance with 11:15-3.6(b)6  from which monies shall be disbursed solely for the payment of claims, allocated claim expenses and stop-loss insurance or reinsurance premiums retained jointly on a self-insured basis. The accounts shall be designated as claims or loss retention fund accounts.
1. Other than for the purposes specified in (a) above, or as otherwise authorized by this subchapter, no withdrawals may be effected for a claim or loss retention fund without prior written approval of the Commissioner.
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 11:15-3.14 - Administrative account

Current through Register Vol. 56, No. 14, July 15, 2024
Each fund shall establish an administrative account for each fund year which shall be utilized for payment of the fund's general operating expenses, including, but not limited to, cost containment activities, data processing services and general legal expenses. A fund shall not be required to establish a separate administrative account by fund year, provided the fund provides a plan in its bylaws which provides for the accounting of all transactions by fund year.
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 11:15-3.15 - Assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each participating member of a joint insurance fund shall appropriate and pay to the fund its assessments as required by the joint insurance fund. Assessments for contributory or non-contributory group health insurance and term life insurance may be paid in monthly installments.
(b) Each member's assessment shall consist of an amount allocated for the administrative account, contingency trust fund account when appropriate, plus a specific assessment to establish and/or replenish the claim or loss retention trust fund account for each type of coverage provided by the fund and in which the member participates.
(c) The total amount of each member's assessments to the joint insurance fund shall be certified by the joint insurance fund commissioners to the governing body of each participant at least one month prior to the next fiscal quarter. As a condition of continued participation in the joint insurance fund, each member shall pay the amount certified at the time and in the manner provided in the fund's bylaws.
(d) Nothing contained in this section shall preclude the assessment and payment of supplemental assessments as provided in 11:15-3.1 6.
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 11:15-3.16 - Supplemental assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each fund shall levy upon its members an additional assessment whenever needed or so ordered by the Commissioner, to supplement the fund's claim or loss retention accounts or administrative accounts to assure payment of the fund's obligations.
1. The fund shall assess each participating member an additional proportionate amount, as provided in the fund's bylaws and plan of risk management or as directed by the Commissioner, to replenish claims or loss retention or administrative accounts.
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 11:15-3.17 - Failure or refusal to provide required assessments

Current through Register Vol. 56, No. 14, July 15, 2024
Should any member of a joint insurance fund fail or refuse to pay as directed its assessment(s) to the fund or to pay as directed any supplemental assessment(s), or should the fund commissioners fail to assess funds required to meet the obligations of the fund, the chairman of the joint insurance fund commission or in the event of his or her failure to do so, the custodian of the fund's assets shall notify in writing the Commissioner and the Commissioner of the Department of Community Affairs. Upon such notification, the Commissioner shall order the fund or member to take such remedial action as he or she deems necessary.
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 11:15-3.18 - Certification of funds

Current through Register Vol. 56, No. 14, July 15, 2024
Prior to any commitment or agreement requiring the expenditures of funds by the joint insurance fund, the custodian of the fund's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted.
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 11:15-3.19 - Investments; application of investment income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The free balance of any account maintained by a joint insurance fund, whether for administrative, contingency or claims or loss purposes, shall be invested to obtain the maximum interest return practicable. All investments shall be in accordance with the fund's cash management plan and consistent with the statutes and rules governing the investment of public funds of local governments and pursuant to N.J.S.A. 40A:10-10b. In addition, the fund commissioners may transfer monies held to the Director of the Division of Investment in the Department of the Treasury for investment on behalf of the fund in accordance with standards governing the investment of other funds which are managed under the rules of the State Investment Council, N.J.A.C. 17:16. Any monies transferred to the Director for investment may not thereafter be withdrawn except under the conditions set forth in N.J.S.A. 40A:10-38b.
(b) The investment and interest income earned by the investment of the assets of each claim or loss retention fund account shall be allocated to each account by fund year.
(c) The investment and interest income earned by investment of the assets of the administrative and contingency accounts shall be credited to each such account.
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 11:15-3.20 - Refunds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A fund may seek to make refund payments from a claims or loss retention account remaining from any year which has been completed for at least 12 months by filing a notification of its intent to do so with the Department with appropriate documentation, including, but not limited to, an actuarial certification that the loss and expense reserves are adequate and that monies are available for release.
(b) A refund for any fiscal year shall be paid only in proportion to the member's participation in the fund for the fiscal year. Payment of a refund on a previous year shall not be contingent on the member's continued membership in the fund after that year.
(c) At the option of the member, the refund may be retained by the fund and applied toward the member's next assessment payment.
(d) The commissioners or executive committee may appropriate a portion of any refund to the appropriate contingency account subject to the provisions of 11:15-3.1 3(b).
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 11:15-3.21 - Disbursements and/or payment of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All disbursements, payments of claims settlements or other expenditure of funds of the joint insurance fund whether for administrative expenses or for claims purposes must be approved by a majority of the joint insurance fund commissioners or the executive committee thereof, unless approved pursuant to (b) below.
(b) To allow the expeditious resolution of certain claims, the fund commissioners may designate the fund's administrator or servicing organization as a "certifying and approving officer" pursuant to 40A:5-17. The certifying and approving officer may be authorized by the fund commissioners to approve for payment any or specified types of claims not to exceed an amount approved by the Commissioner in the plan of risk management. The authority of the certifying and approving officer may be conditioned or restricted by the fund commissioners to require prior consultation, limitation as to the types or total amount of claims or payments which may be approved, or other procedures or restrictions as the fund commissioners may deem appropriate. The authority of the certifying and approving officer may be revoked or modified at any time by the fund commissioners.
1. Upon approval, the certifying and approving officer shall certify the amount and particulars of the approved claims to the official having custody of the fund's assets, directing that a check for payment be prepared.
2. The certifying and approving officer shall prepare a report of all claims approved by him or her since the last report, detailing the nature and amount of the claim, the payee, the reasons supporting payment and any other pertinent information. This report shall be submitted to the fund commissioners at their next scheduled meeting. The fund commissioners shall review and approve the actions of the certifying and approving officer. In the event a claim approved and paid by the certifying and approving officer is not approved by the fund commissioners, they shall direct appropriate action to be taken.
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 11:15-3.22 - Confidentiality of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Employee claims information is privileged and confidential and shall not be included as a part of any open public record.
(b) Fund commissioners and the officials of the member shall not have access to any employee claim information which reveals the identity of any individual plan participant.
(c) All claims are to be filed, and all inquiries are to be handled, directly by the designated claims' administrator. All employees of the administrator shall execute a non-disclosure statement to protect the identity of the plan participants.
(d) Only executive committee members and necessary fund professionals shall participate in any closed session discussion of claims. These claims discussions, whether general or specific to a coverage dispute, shall at all times be confidential and anonymous so that the identity of the municipality and claimant cannot be ascertained. The anonymity of the claimant shall be accomplished by assigning a blind claim number and deleting all references to the individual's name and place of employment. Only the claimant may demand, by written notice, that the matter be handled with disclosure of his identity.
(e) Documents identifying the employee, or from which the employee's identity might be deduced, shall not be accessible to any persons other than the administrator, program manager, fund attorney, or appointed claim auditors when such records are needed to verify the accuracy of claim data as part of an audit.
(f) Any person having access to claim information must sign a written non-disclosure statement.
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 11:15-3.23 - Stop-loss insurance and/or reinsurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each fund providing primary or underlying coverage on a self-insured basis shall secure stop-loss insurance or reinsurance in a form and amount acceptable to the Commissioner from an insurer authorized or admitted to transact life or health insurance, as applicable, in the State.
(b) Certificates of stop-loss insurance and/or reinsurance showing policy limits and other information shall be available for the inspection of each member and shall be filed with the Commissioner.
(c) Losses in excess of the established self-insurance retention amount shall be borne by the stop-loss carrier(s) according to the terms and conditions of the stop-loss contract(s).
(d) Any proposed change in the terms or limits of stop-loss insurance and/or reinsurance shall be submitted to the Department and the Department of Community Affairs for approval at least 30 days prior to the effective date of the proposed change.
(e) The Commissioner shall waive the requirement set forth in (a) above if such stop-loss insurance or reinsurance is not commercially available or is unreasonably priced, as determined by the fund's executive committee for each fund year, and as approved by the Department and the Department of Community Affairs, and the fund otherwise demonstrates to the Commissioner that it has made adequate provision for excess losses.
1. Any approval by the Department pursuant to (a) above shall be for a period not to exceed either the longer of 12 months from the date of approval or the end of the next succeeding fund year. Any fund seeking to extend the period of the approval shall notify the Department not later than 45 days prior to the expiration of the term of the approval. The notification shall specify the basis upon which the executive committee has determined that stop-loss insurance or reinsurance required pursuant to (a) above is not commercially available or is not reasonably priced, and shall include all actions taken by the fund to obtain required stop-loss insurance or reinsurance. The notification shall also describe actions taken by the fund to provide for excess losses, including, but not limited to, the establishment of contingency reserves, and funding above the level of expected losses.
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 11:15-3.24 - Financial statement and reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A sworn annual report in a form acceptable to the Commissioner shall be prepared by each fund, filed currently with the Department and Department of Community Affairs and made available to each fund member not later than 120 days after the end of the immediately preceding fiscal year. The report shall include:
1. An annual audited statement of the financial condition of the fund prepared by an independent certified public accountant or registered municipal accountant and performed in accordance with generally accepted accounting principles and 40A:10-46, which shall include a statement of the organization of the fund, including its balance sheet and receipts and disbursements for the preceding year;
2. Reports of outstanding liabilities by line of coverage showing the number of claims, amounts paid to date and current reserves for losses, claims and unearned assessments as certified by a qualified actuary;
3. Reports of all incurred but not reported liabilities certified by a qualified actuary;
4. Any material changes in information from that previously submitted;
5. The number of covered individuals by line of coverage; and
6. Such other information, as may be requested by the Department from a particular fund.
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 11:15-3.25 - Examination of funds possibly in financial condition detrimental to the public

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner may conduct an examination of any fund as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the fund may be insolvent or in a financial condition detrimental to its members or to the public. It shall be the duty of the fund members, commissioners or executive committee to notify the Commissioner of any information indicating that any fund may be insolvent or in a financial condition detrimental to the fund's members or the public.
(b) The fund's members, commissioners or executive committee, if any, may, upon majority vote, request that the Commissioner order an examination of the fund, or any fund member, which they, in good faith, believe may be in a financial condition detrimental to other fund members or to the public.
(c) Any examination made pursuant to 40A:10-36 et seq. and this subchapter shall be conducted in accordance with the procedures set forth in 11:15-3.6(f).
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 11:15-3.26 - Servicing organizations; administrator

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No servicing organization or program manager of a fund, or producer appointed by a fund pursuant to 11:15-3.6(e)15, or their employees, officers or directors shall have either a direct or indirect financial interest in the administrator of that fund, or be an employee, officer or director of the administrator, unless written notice of such interest has been provided to the fund commissioners and members.
(b) No administrator of a fund, or its employees, officers or directors shall be an employee, officer or director of, or have either a direct or indirect financial interest in, a servicing organization or program manager of that fund, or the insurance producer appointed by that fund pursuant to 11:15-3.6(e)15, unless written notice of such interest has been provided to the fund commissioners and members.
(c) Each contract with a servicing organization or program manager shall include a clause stating, "Unless the fund commissioners otherwise permit, the servicing organization (or program manager, as applicable) shall handle to their conclusion all claims and other obligations incurred during the contract period."
(d) The fund commissioners shall notify the Department within 10 days of any determination to terminate or nonrenew any agreement with a servicing organization. The notification shall include a detailed statement that sets forth the manner and method by which claims handling and other obligations performed by the servicing organization will be provided or a statement that sets forth the reasons why the fund commissioners believe that the particular service is no longer necessary.
(e) The fund commissioners or the executive committee, if any, may designate an administrator or lead agency to carry out the policies established by the commissioners or the executive committee, if any, and to provide day-to-day management of the fund. The minutes of the commissioners or executive committee meetings, if any, shall detail the areas of authority delegated to the administrator.
(f) Any employee, officer or director of an administrator, servicing organization, program manager or insurance producer appointed pursuant to 11:15-3.6(e)15  shall disclose to the fund commissioners or executive committee, as applicable, any direct or indirect financial interest such employee, officer or director has in any other administrator, servicing organization, program manager or insurance producer.
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 11:15-3.27 - Conflict of interest

Current through Register Vol. 56, No. 14, July 15, 2024
All officials or employees of a participating local unit or any members of the family of such officials or employees shall comply with 40A:9-22.1 et seq., (the "Local Government Ethics Law").
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 11:15-3.28 - Notice and hearings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall give prior written notice of any proposed suspension of authority, revocation, cease and desist order, or other enforcement action to the fund commissioners, its executive committee or member local unit as the case may be, or to any person to whom the proposed enforcement action applies specifically. The notice shall be served personally or by certified or registered mail upon all interested parties, shall set forth the grounds for the proposed enforcement action, and shall inform the interested party of their right to request a hearing on the proposed enforcement action.
(b) The interested party involved shall have 20 days from the mailing of the notice to request a hearing on the proposed enforcement action. Such a hearing shall be conducted in accordance with the Administrative Procedure Act, 52:14B-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1. Failure to mail a request for a hearing within the time prescribed shall result in the suspension, revocation, monetary penalty or cease and desist order becoming effective 30 days from issuance of the original notice. In no event shall any revocation become effective prior to the date that a hearing is scheduled.
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 11:15-3.29 - Orders

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, as provided in 11:15-3.2 8, the Commissioner may issue an order revoking or suspending a fund's authority or requiring a person or fund to cease and desist from engaging in an act or practice found to be in violation of any provision of 40A:10-36 et seq. or this subchapter.
(b) Upon a finding, after notice and opportunity for a hearing, as provided in 11:15-3.2 8, that a fund has violated any cease and desist order, the Commissioner may revoke his or her approval of the fund.
(c) Upon a finding, after notice and opportunity for a hearing, as provided in 11:15-3.2 8, the Commissioner may issue an order requiring the joint insurance fund commissioners, or the executive committee, if any to dismiss an administrator, servicing organization or program manager or terminate the contract of an administrator, servicing organization or program manager because of any fraud, material misrepresentation, incompetence or untrustworthiness, misappropriation or conversion of monies or violation of any fiduciary responsibilities by the administrator, servicing organization or program manager, or any of the employees, officers or directors thereof.
(d) A copy of any notice issued pursuant to this section shall be furnished to the Commissioner of the Department of Community Affairs.
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 11:15-3.30 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
The rules contained in this subchapter and any of the provisions thereof shall be severable, and if any of its provisions shall be held to be unconstitutional or otherwise invalid, the decision of the court shall not affect the validity of the remaining rules and regulations or any of the provisions thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The subchapter sets forth the filing requirements and approval procedures for school board joint insurance funds pursuant to 18A:18B-1 et seq.
(b) This subchapter applies to all school board joint insurance funds formed pursuant to 18A:18B-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.6 - Bylaws and risk management program; contents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The trustees shall prepare and, after the approval by resolution of the governing body of each participating member, shall adopt bylaws for the joint insurance fund. The bylaws shall:
1. Set forth a statement of purpose of the group;
2. Set forth provisions for organization of the group, including governance by a board of trustees;
3. Provide for the delivery of a risk management program in conjunction with any joint self-insurance fund or funds which the board of trustees shall establish;
4. Set forth procedures to enforce the collection of any contributions or payments in default;
5. Set forth membership standards as required in 18A:18B-3;
6. Require that, for each joint self-insurance fund, a contract or contracts of specific and aggregate excess insurance or reinsurance is maintained;
7. Set forth procedures for:
i. Withdrawal from the group and a fund by a member, including any requirement that a terminated or withdrawing member provide security in a form and amount acceptable to the Commissioner or trustees, as applicable, as a guarantee for the continued payment of the member's obligations pursuant to 11:15-4.1 0(c);
ii. Termination of the group or fund and disposition of assets; and
iii. Determining the obligations, if any, of a member in the event that the group is unable to pay indemnification obligations and expenses payable from a fund administered by it;
8. Require an annual certified audit and an actuarial opinion statement on loss reserves pursuant to the Loss Reserve Opinions rules, N.J.A.C. 11:1-21, to be prepared and filed with the Commissioner;
9. Require an annual, supplemental semi-annual, and quarterly financial reporting schedule, as applicable, to be filed on a form prescribed by the Commissioner;
10. Require that any joint self-insurance fund or funds be developed and operated in accordance with accepted and sound actuarial practices;
11. Provide that any expenditure of moneys in a fund be in furtherance of the purpose of the fund;
12. Provide for expulsion of a member;
13. Provide procedures governing trust fund accounts, including transfers, withdrawals and distribution surplus therefrom and supplemental assessments; and
14. Set forth other provisions as desired for operation and governance of the group.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.7 - Disapproval of bylaws and risk management program

Current through Register Vol. 56, No. 14, July 15, 2024
If the Commissioner determines that the bylaws or risk management program of the fund or any subsequent amendments thereto do not contain all of the information set forth in 11:15-4.6, are not submitted in the proper format set forth in 11:15-4.5, or otherwise do not meet the requirements of 18A:18B-1 et seq. or this subchapter, the Commissioner shall disapprove the bylaws or risk management program and notify the fund in writing, which notice shall contain the specific reasons for disapproval, and the requirements to be met before approval may be granted. If not disapproved by the Commissioner within 60 days of receipt of the bylaws and risk management program or any amendments or changes thereto, which contain all of the information and documentation set forth in N.J.A.C. 11:15-4.6, in the format set forth in N.J.A.C. 11:15-4.5, and which meet the requirements of 18A:18B-1 et seq. and this subchapter, the bylaws and program shall be deemed approved.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.8 - Revocation of approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, the Commissioner may suspend or terminate the authority of any fund, or direct or take any action deemed necessary for good cause, to enable a fund to meet its obligations, cover its expected losses, or to liquidate, rehabilitate or otherwise modify its affairs if a fund:
1. Is found to be insolvent or has experienced a deterioration in financial condition to the extent that it causes or may cause an adverse affect upon the ability of the fund to pay expected losses;
2. Fails to timely pay any fee or assessment;
3. Fails to pay any claim within 30 days after a final judgment is rendered against the fund or the fund's obligation for such claim otherwise becomes final;
4. Fails to comply with any of the provisions of 18A:18B-1 et seq. or this subchapter, or with any lawful order of the Commissioner within the time prescribed; or
5. Fails to follow its approved bylaws or risk management program.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.9 - Approval of non-members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prospective new members of the fund shall submit an application for membership to the fund's board of trustees on a form acceptable to the Commissioner. The application shall include a copy of the resolution of participation and executed indemnity and trust agreement. The trustees may approve or disapprove the application for additional members, pursuant to the bylaws of the fund.
(b) Any application approved by the fund shall, within 15 days of approval by the fund, be filed with the Department and shall be accompanied by a revised budget with assessment detail, if otherwise required pursuant to N.J.A.C 11:15-4.4(e), an actuarial statement regarding the adequacy of the member's assessment to cover anticipated losses, and any amendments to the fund's bylaws and risk management program as may be necessary. The fund shall file only the specific changes to the bylaws or risk management program in effect for the current fund year. Where a fund purchases direct insurance, or where an actuary has determined a "per capita" rate for the member's assessment to cover anticipated losses which has been previously filed with the Department, actuarial certification of the adequacy of these same rates for each new member is not required. The Commissioner may nevertheless require actuarial certification of a per capita rate for the new member's assessment to cover anticipated losses if, in his or her opinion, the new member will impose an extraordinary impact on the exposure of the fund. In addition, the fund shall file the following information in the form of Exhibit D in the Appendix incorporated herein by reference with the Department within 15 days after approval of a new member:
1. The name and address of the new member;
2. The effective date of coverage;
3. The name of the new member's risk manager;
4. The name of the new member's trustee;
5. The lines of coverage for which the new member participates;
6. The amount of assessment, if not otherwise provided; and
7. An affirmative statement from the fund that in accepting the new member, an application has been filed, the fund has adhered to its bylaws and risk management program, and the agreement to participate and indemnity and trust agreement have been filed with the fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.10 - Termination and/or withdrawal of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A member of the fund must remain a member for the full term of membership, as provided in the fund's bylaws, unless earlier terminated by the fund for nonpayment of assessments, noncompliance with risk management or underwriting standards, or for other reasons subject to prior approval by the Commissioner as causes for expulsion. However, such member shall not be deemed terminated for any reason until:
1. After 30 days, written notice of the intention to terminate the member has been given by the fund to the member, which notice shall state the reasons for termination and shall be given by registered mail or certified mail, return receipt requested;
2. Like notice shall have been filed with the Department, together with a certified statement that the notice provided for by (a)1 above has been given; and
3. 30 days have elapsed after the filing required by (a)2 above has been made.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.11 - Insolvency and/or bankruptcy of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
The insolvency or bankruptcy of a member does not relieve the fund or any other member of joint and several liability for the payment of any claims incurred by the member during the period of its membership, including, but not limited to, being subject to and liable for supplemental assessments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.12 - Voluntary dissolution of a fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A fund may not voluntarily dissolve or otherwise cease to do business and distribute its assets to its members, unless and until it satisfies the following requirements:
1. A majority of the fund's members must have voted in favor of a resolution to dissolve the fund, pursuant to a written plan adopted pursuant to the procedures set forth in the fund's bylaws, at a meeting duly called for such purposes;
2. The plan of dissolution must provide for the payment of all unpaid losses of the fund and its members, including all incurred but not reported losses, as certified by an actuary, before any assets of the fund or the trust fund accounts may be used for any other purpose;
3. The plan of dissolution shall contain a statement of the fund's current financial condition computed both on a statutory basis and according to generally accepted accounting principles as attested to by an independent certified public accountant; and
4. The plan of dissolution, and such other information as may be required, must be filed with and approved in writing by the Commissioner. The plan shall be filed with the Commissioner not later than 90 days prior to the proposed effective date of dissolution.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.13 - Establishment of trust fund accounts; transfers or withdrawals prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to the terms of the indemnity and trust agreement, each fund shall establish a separate trust fund account in accordance with 11:15-4.6(c)10  from which monies shall be disbursed solely for the payment of claims, allocated claim expenses and excess insurance or reinsurance premiums for each type of liability or risk retained jointly on a self-insured basis. Such accounts shall be designated as claims or loss retention fund accounts.
1. Other than for the purposes specified in (a) above, or as otherwise authorized by this subchapter, no withdrawal may be effected from a claim or loss retention fund without the prior written approval of the Commissioner, except for intertrust fund transfers. Intertrust fund transfers, within a fund's fiscal year, may be conducted by the fund at any time, by providing 30 days prior written notification to the Commissioner. If the Commissioner does not disapprove of the transfer, in writing, within 30 days after receiving such written notification, the request for intertrust fund transfer(s) shall be deemed approved. Any intertrust fund transfer request must be supported by appropriate assessment and claim and expense documentation, and be accompanied by a certification signed by an actuary that the amount remaining in the trust fund account after the intertrust fund transfer will be at a level which is reasonable in relation to that account's unpaid losses, along with all documentation in support of such certification. Intertrust fund transfers may be conducted only where each member participates in each and every claim or loss retention fund account during that fund year. The Commissioner shall waive the full participation requirement provided the fund demonstrates to the Department that it maintains records of each member's pro rata share of each claim or loss retention fund account for that year, and that the transfer shall be made so that any potential dividend shall not be reduced for a member that did not participate in the account receiving the transfer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.14 - Administrative account

Current through Register Vol. 56, No. 14, July 15, 2024
Each fund shall establish an administrative account for each fund year which shall be utilized for payment of the fund's general operating expenses, including, but not limited to, loss prevention activities, data processing services and general legal expenses. A fund shall not be required to establish a separate administrative account by fund year, provided the fund provides a plan in its bylaws which provides for the recording and accounting of all transactions by fund year.