reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 15 - RELIEF FROM OBLIGATIONS IMPOSED UNDER THE SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Section 11:21-15.5 - Confidentiality of request for relief

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All data or information contained in the request for relief filed pursuant to this subchapter shall be confidential and shall not be subject to public disclosure or copying pursuant to the "Right to Know" law, 47:1A-1 et seq., except for the following items, but only upon written, specified request and following 10 days written notice by the Department to the member/applicant:
1.
										11:21-15.4(a)1  i and ii--cover letter with name of applicant and describing relief sought;
2.
										11:21-15.4(a)1  iv--name, title, telephone number and telefax number of person familiar with the filing;
3.
										11:21-15.4(a)3  --most recent financial examination report;
4.
										11:21-15.4(a)5  i and ii--list of members of holding company system and intercompany transactions for period preceding date of filing;
5.
										11:21-15.4(a)8  --annual statement filed immediately preceding date of filing;
6.
										11:21-15.4(a)12  --non-refundable filing fee; and
7.
										11:21-15.4(a)13  --additional information required by the Commissioner to evaluate a particular filing.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 15 - RELIEF FROM OBLIGATIONS IMPOSED UNDER THE SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Section 11:21-15.6 - Disposition of request for relief

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When the Commissioner determines pursuant to N.J.S.A. 17B:27A-26b or 17B:27A-38 as applicable, that the member is or would be placed in a financially impaired condition through fulfillment of a coverage or assessment obligation or obligations, the Commissioner shall notify the member that its duty to fulfill the applicable obligation shall be waived, or deferred in whole or in part, as appropriate. If the Commissioner defers in whole or in part a member's obligation to pay assessments pursuant to 17B:27A-38, the member shall remain liable to the SEH Program for the amount deferred and shall be prohibited from reinsuring any individuals or groups in the SEH Program if it fails to pay assessments.
(b) The Commissioner shall find that a member is or would be financially impaired if:
1. The member has been placed in rehabilitation or conservation pursuant to 17B:32-31 et seq. or such similar law of the member's state of domicile;
2. The Commissioner finds that the member is in a hazardous financial condition, as determined pursuant to N.J.A.C. 11:2-27; or
3. The Commissioner finds that fulfillment of the obligation(s) from which relief is sought would place the member in a hazardous financial condition, as determined pursuant to N.J.A.C. 11:2-27.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 15 - RELIEF FROM OBLIGATIONS IMPOSED UNDER THE SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Section 11:21-15.7 - Hearings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the Commissioner denies a member's request for relief made pursuant to this subchapter, or if the member objects to the terms of the relief granted, the member may request a hearing on the Commissioner's determination within seven days from the date of receipt of such determination as follows:
1. A request for a hearing shall be in writing and shall include:
i. The name, address, and daytime telephone number of a contact person familiar with the matter;
ii. A copy of the Commissioner's determination;
iii. A statement requesting a hearing; and
iv. A concise statement describing the basis for which the member believes that the Commissioner's findings of fact are erroneous.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 15 - RELIEF FROM OBLIGATIONS IMPOSED UNDER THE SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Section 11:21-15.8 - Notice of the SEH Program

Current through Register Vol. 56, No. 14, July 15, 2024
Members requesting relief pursuant to this subchapter shall concurrently provide notice of all such requests to the SEH Program through the Interim Administrator or Administrator, as appropriate. Members shall also provide notice to the SEH Program of all dispositions of such requests by the Commissioner, within 15 days of such disposition.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 15 - RELIEF FROM OBLIGATIONS IMPOSED UNDER THE SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Section 11:21-15.9 - Exceptions for health maintenance organizations due to lack of capacity

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any member HMO asserting that it is not required to offer coverage or accept applications pursuant to the requirements of the Act because it reasonably anticipates that it will not have the capacity in its network of providers within the service area to deliver service adequately to the members of the additional small employer groups, pursuant to N.J.S.A. 17B:27A-26a, shall file the following information with the Commissioner:
1. A cover letter stating:
i. The name of the member HMO;
ii. A statement that the member is not required to offer coverage or accept applications pursuant to the Act because it anticipates that it will not have the capacity in its network of providers within the service area to deliver service adequately to the members of the additional small employer groups, and the basis for that assertion, with supporting documentation, certified by the president or duly authorized officer of the member; and
iii. The number of the member's current individual and group members, listed by provider and classified by the provider's specialty, which shall be updated annually each year the member asserts a waiver pursuant to N.J.S.A. 17B:27A-26a.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 15 - RELIEF FROM OBLIGATIONS IMPOSED UNDER THE SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Section 11:21-15.10 - Other actions by the Commissioner

Current through Register Vol. 56, No. 14, July 15, 2024
Nothing in this subchapter shall be construed as limiting the Commissioner's authority to take such action with respect to insurers, health service corporations, medical service corporations, hospital service corporations or health maintenance organizations as may be authorized by law, including, but not limited to, placing an insurer, health service corporation, medical service corporation, hospital service corporation or health maintenance organization in rehabilitation, liquidation or conservation pursuant to 17B:32-31 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 15 - RELIEF FROM OBLIGATIONS IMPOSED UNDER THE SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Section 11:21-15.11 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with this subchapter, including all notice requirements set forth herein, may result in the denial of relief requested and imposition of penalties pursuant to 17B:27A-43 and the SEH Program Plan of Operation as codified at N.J.A.C. 11:21-2, including, but not limited to, imposition of an interest penalty for assessments due from the member and a recommendation by the Board to remove the member's authority to issue any health benefits plans in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 16 - WITHDRAWALS FROM THE SMALL EMPLOYER HEALTH BENEFITS PLANS MARKET AND WITHDRAWALS OF PLANS, PLAN OPTIONS AND COPAYMENT/ DEDUCTIBLE OPTIONS › Section 11:21-16.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to establish the requirements and procedures by which carriers may cease doing business in the small employer market in this State. Additionally, this subchapter establishes the requirements and procedures by which carriers may cease issuing and nonrenew: a specific standard plan issued using a particular delivery option; a plan option; a specific standard benefit rider; or a specific copayment/deductible option available under the standard plans. The subchapter applies to all small employer carriers issuing or renewing policies or contracts after November 30, 1992. Pursuant to the provisions of 17B:27A-17 et seq., every policy or contract issued to a small employer in this State shall be renewable with respect to all eligible employees or dependents at the option of the policy or contractholder or small employer, except under the circumstances prescribed by N.J.S.A. 17B:27A-23a, c, d, e, f, h, and i. One of the circumstances delineated therein is where a carrier ceases to do business in the small employer health benefits plans market in New Jersey pursuant to N.J.S.A. 17B:27A-23e.
(b) This subchapter applies to all small employer carriers as defined in this subchapter that seek to cease doing business in the small employer market.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 16 - WITHDRAWALS FROM THE SMALL EMPLOYER HEALTH BENEFITS PLANS MARKET AND WITHDRAWALS OF PLANS, PLAN OPTIONS AND COPAYMENT/ DEDUCTIBLE OPTIONS › Section 11:21-16.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
Words and terms, when used in this subchapter, shall have the meanings set forth in the Act or at 11:21-1.2 unless defined below or unless the context clearly indicates otherwise:
"Affiliate" or "affiliated company" means a carrier that directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, the carrier that initiates a withdrawal.
"Cease doing business" for purposes of these rules means withdraw or withdrawal.
"Market withdrawal" means the nonrenewal on the anniversary date of all inforce nonstandard health benefits plans or small employer health benefits plans, or both as appropriate, issued to small employers without offering replacement with a small employer health benefits plan (or a nonstandard health benefits plan, if offered through an association, multiple employer arrangement or out-of-State trust that continues to market its nonstandard health benefits plans pursuant to 17B:27A-17 et seq.), except where such action is taken pursuant to N.J.S.A. 17B:27A-23a, c, d, f, h and i or is approved by the Commissioner in accordance with N.J.A.C. 11:21-11.
"Nonstandard health benefits plan" means a health benefits plan policy or contract form under which policies, contracts or certificates were issued on or before December 31, 1993 to small employers or to one or more employees of a small employer by virtue of the employment arrangement.
"Plan option withdrawal" means a carrier's cessation of the issuance of a standard health benefits plan option and the nonrenewal on the anniversary date of all inforce standard small employer health benefits plans issued with that option.
"Plan withdrawal" means a carrier's cessation of the issuance of a standard health benefits plan and the nonrenewal on the anniversary date of all inforce small employer health benefits plans of that plan type.
"State" means the State of New Jersey.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 16 - WITHDRAWALS FROM THE SMALL EMPLOYER HEALTH BENEFITS PLANS MARKET AND WITHDRAWALS OF PLANS, PLAN OPTIONS AND COPAYMENT/ DEDUCTIBLE OPTIONS › Section 11:21-16.3 - General provisions for market withdrawal

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No small employer carrier shall nonrenew except in accordance with N.J.S.A. 17B:27A-23a, c, d, f, h and i or refuse to issue any small employer health benefits plan unless the small employer carrier withdraws from the small employer market in New Jersey in accordance with the provisions of this subchapter.
(b) Any small employer carrier which seeks to withdraw from the small employer market in the State shall provide the Commissioner with written notification of its intent to withdraw not later than eight months prior to the nonrenewal on the anniversary date of each in force policy or contract.
1. Until such time as the withdrawal shall be completed, the withdrawing carrier shall continue to be governed by 17B:27A-17 et seq. and all rules promulgated thereunder.
2. A withdrawing carrier shall cease issuing new policies no more than two months after filing a notice of intent to withdraw with the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 16 - WITHDRAWALS FROM THE SMALL EMPLOYER HEALTH BENEFITS PLANS MARKET AND WITHDRAWALS OF PLANS, PLAN OPTIONS AND COPAYMENT/ DEDUCTIBLE OPTIONS › Section 11:21-16.4 - Restrictions on writings following a market withdrawal

Current through Register Vol. 56, No. 14, July 15, 2024
Any small employer carrier that ceases to do business pursuant to this subchapter shall be prohibited from writing new business in the New Jersey small employer market for a period of five years from the date of termination of the last health benefits plan nonrenewed under this subchapter and shall be prohibited from writing new business in the New Jersey individual health coverage market for a period of five years from the date of termination of the last individual health coverage plan nonrenewed.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 16 - WITHDRAWALS FROM THE SMALL EMPLOYER HEALTH BENEFITS PLANS MARKET AND WITHDRAWALS OF PLANS, PLAN OPTIONS AND COPAYMENT/ DEDUCTIBLE OPTIONS › Section 11:21-16.5 - General provisions for withdrawal of plan, plan option and copayment/deductible option

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No carrier shall cease to issue or nonrenew a standard small employer health benefits plan, plan option or copayment/deductible option required or permitted to be offered pursuant to N.J.A.C. 11:21-3 until the carrier submits a notice of intent to withdraw a plan, plan option or copayment/deductible option with the Commissioner in accordance with the provisions of this subchapter.
(b) A carrier may cease to issue and nonrenew a standard small employer health benefits plan pursuant to this section only if:
1. The copayment/deductible option is not required to be offered pursuant to 11:21-3.1(b) or (c); or
2. In the case of a copayment/deductible option required to be offered pursuant to 11:21-3.1, the carrier meets its obligation to offer the standard small employer plans and required copayment/deductible options either by offering the plans as indemnity plans or by making the plan or plans available through or in conjunction with a selective contracting arrangement to all New Jersey small employer groups.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 16 - WITHDRAWALS FROM THE SMALL EMPLOYER HEALTH BENEFITS PLANS MARKET AND WITHDRAWALS OF PLANS, PLAN OPTIONS AND COPAYMENT/ DEDUCTIBLE OPTIONS › Section 11:21-16.6 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with the requirements of this subchapter shall result in the imposition of penalties pursuant to 17B:27A-43 and any and all other penalties provided by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 16 - WITHDRAWALS FROM THE SMALL EMPLOYER HEALTH BENEFITS PLANS MARKET AND WITHDRAWALS OF PLANS, PLAN OPTIONS AND COPAYMENT/ DEDUCTIBLE OPTIONS › Section 11:21-16.7 - Other policyholder rights unaffected

Current through Register Vol. 56, No. 14, July 15, 2024
Nothing in this subchapter shall be construed to contravene any rights of policyholders concerning cancellation requirements or obligations set forth in a policy or contract issued by a small employer carrier.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 16 - WITHDRAWALS FROM THE SMALL EMPLOYER HEALTH BENEFITS PLANS MARKET AND WITHDRAWALS OF PLANS, PLAN OPTIONS AND COPAYMENT/ DEDUCTIBLE OPTIONS › Section 11:21-16.8 - Revocation of a notice of intent to withdraw

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A carrier may revoke its notice of intent to withdraw, filed with the Commissioner pursuant to 11:21-16.3, prior to the date that its withdrawal is complete, by submitting a statement to the Department at the address specified at 11:21-16.3(c)  and to the Board at the address specified at 11:21-1.2 revoking its notice of intent to withdraw. The revocation shall be signed by a duly authorized officer, and shall include the following:
1. A statement agreeing to reinstate any small employer that was nonrenewed by the carrier pursuant to the provisions of N.J.S.A. 17B:27A-23e and this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 17 - FAIR MARKETING STANDARDS › Section 11:21-17.1 - Plan identification and marketing materials

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each small employer carrier which issues marketing and/or promotional materials in conjunction with the standard health benefits plans may attach its own name or identification to each of the plans, but shall also identify each of those standard health benefits plans by the alphabetical designation (B, C, D, E, HMO, HMO POS) assigned to it in 11:21-3.1. The alphabetical designation shall be clearly identified in the designation of each of the small employer carrier's standard health benefits plans.
(b) All eligibility, coverage and exclusions described in the small employer carrier's marketing and/or promotional material shall be consistent with the Act and this chapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 17 - FAIR MARKETING STANDARDS › Section 11:21-17.2 - Retention of marketing and promotional materials

Current through Register Vol. 56, No. 14, July 15, 2024
Small employer carriers shall maintain a complete file of all marketing and promotional material specific to the health benefits plans, which it disseminates to consumers, producers, or otherwise publicly disseminates. Small employer carriers shall retain each piece of promotional and marketing materials for a period of three calendar years from the last date the material is publicly disseminated, which shall be deemed its complete file for the purposes of this subchapter. Upon written request of the Board, a small employer carrier shall, within three business days, make available for inspection its complete file of marketing and promotional material to the Board.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 17 - FAIR MARKETING STANDARDS › Section 11:21-17.3 - Certification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each small employer carrier disseminating marketing and promotional material shall certify that its marketing and promotional material conforms with the requirements of this subchapter. The certification, set forth in Part 2 of Exhibit BB of the Appendix, incorporated herein by reference, shall be signed by a duly authorized officer of the small employer carrier. Each small employer carrier shall file its initial certification with the Board no later than the first day upon which the small employer carrier disseminates promotional or marketing materials for the health benefits plans to consumers, producers or the public in general.
(b) Small employer carriers shall continue to file a certification as required in (a) above on an annual basis, on or before March 1 of each year following the filing of its initial certification.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 17 - FAIR MARKETING STANDARDS › Section 11:21-17.5 - Producer contracts

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A small employer carrier may select those insurance producers, as defined by N.J.S.A. 17:22A-2j, with whom it chooses to contract. No small employer carrier shall terminate or refuse to renew the contract of its insurance producers because of health status-related factors of full-time employees or dependents, the average number of full-time employees or the average number of employees enrolled in small employer plans placed by the producer with the carrier, or the occupation or geographic location of the small employer groups placed by the insurance producer with the small employer carrier.
(b) No small employer carrier shall, directly or indirectly, enter into any contract, agreement or arrangement with an insurance producer that provides for or results in any consideration provided to an insurance producer for the issuance or renewal of a small employer health benefits plan that varies on account of health status-related factors of eligible employees or dependents, the number of eligible employees or the number of employees enrolled, or the industry, occupation or geographic location of a small employer covered by a small employer health benefits plan.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 18 - PETITIONS FOR RULES › Section 11:21-18.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter shall apply to all petitions made by interested persons for the promulgation, amendment or repeal of any rule by the Board, pursuant to 52:14B-4(f).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 18 - PETITIONS FOR RULES › Section 11:21-18.2 - Procedure for petitioner

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person who wishes to petition the Board to promulgate, amend or repeal a rule shall submit to the Board, in writing, the following information:
1. Name and address of the petitioner;
2. The substance or nature of the rulemaking which is requested;
3. The reasons for the request and the petitioner's interest in the request;
4. References to the statutory authority of the Board to take the requested action; and
5. A caption at the top of the document identifying it as a petition for rulemaking pursuant to 52:14B-4(f)  and this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 18 - PETITIONS FOR RULES › Section 11:21-18.3 - Procedure of the Board

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon receipt of a petition in compliance with 11:21-18.2 the Board shall, within 15 days, file a notice of petition with the Office of Administrative Law for publication in the New Jersey Register. The notice shall include:
1. The name of the petitioner;
2. The substance or nature of the rulemaking action which is requested;
3. The problem or purpose which is the subject of the request; and
4. The date the petition was received.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 19 - SEH PROGRAM PREMIUM COMPARISON SURVEY › Section 11:21-19.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter requires the annual submission of data by small employer carriers to the Department, and establishes the format for the submission of such data, regarding premiums charged for the five standard health benefits plans, the HMO plan, the HMO/POS plan, and any standard rider packages established by the Board, so that the Department may develop and publish an annual SEH Program Premium Comparison Survey, pursuant to N.J.S.A. 17B:27A-33g.
(b) This subchapter shall apply to all small employer carriers.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 19 - SEH PROGRAM PREMIUM COMPARISON SURVEY › Section 11:21-19.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the meanings as defined at 17B:27A-17 and 11:21-1.2, unless defined below or the context clearly indicates otherwise.
"Standard health benefits plan" means a health benefits plan promulgated by the SEH Board subject to review and approval by the Commissioner.
"Standard rider" means a rider promulgated by the SEH Board to be offered with one or more of the standard health benefits plans.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 19 - SEH PROGRAM PREMIUM COMPARISON SURVEY › Section 11:21-19.3 - SEH Program premium comparison survey

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every small employer carrier shall prepare and file with the Department a premium survey reflecting premiums charged for each of the five standard small employer health benefits plans, the HMO plan, the HMO/POS plan, and for any standard rider packages, as set forth in Exhibit FF of the Appendix to this chapter, incorporated herein by reference.
(b) Every small employer carrier shall complete the survey in the format set forth in Exhibit FF in accordance with the instructions set forth therein, and shall not vary the information solicited in Exhibit FF.
(c) Completed survey forms shall be filed no later than November 1 of each year, and shall reflect the monthly premiums to be charged for each of the standard health benefits plans, the HMO plans and the HMO/POS plans as of January 1 of the year immediately following.
(d) All filings shall be accompanied by the following certification signed by the person who completed the survey: "I ______ certify that the information set forth in the attached SEH Program Premium Comparison Survey is true and accurate, and hereby further certify that I am authorized to execute this certification on behalf of the carrier named in the survey."
(e) Completed survey forms and signed certification shall be filed with the Department pursuant to this subchapter at the following address: SEH Program Premium Comparison Survey
Life & Health Division
New Jersey Department of Banking and Insurance
20 West State Street
PO Box 325
Trenton, New Jersey 08625-0325
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 19 - SEH PROGRAM PREMIUM COMPARISON SURVEY › Section 11:21-19.4 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with the requirements of this subchapter may result in the imposition of penalties as authorized by 17B:27A-43.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 20 - WITHDRAWALS OF STANDARD SEH PLAN OPTIONAL BENEFIT RIDERS › Section 11:21-20.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to establish standards and procedures for carriers to withdraw standard SEH plan optional benefit riders.
(b) This subchapter applies to all riders to a standard SEH plan filed with the Commissioner or the SEH Board pursuant to N.J.S.A. 17B:27A-19i(1).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 20 - WITHDRAWALS OF STANDARD SEH PLAN OPTIONAL BENEFIT RIDERS › Section 11:21-20.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
Words and terms, when used in this subchapter, shall have the meanings as defined at 17B:27A-17 or 11:21-1.2 unless defined below or the context clearly indicates otherwise.
"Optional benefit rider" means a rider to a standard SEH plan or plans filed with the Commissioner and/or the SEH Board pursuant to N.J.S.A. 17B:27A-19i(1).
"Small employer health benefits program" or "SEH" means the New Jersey Small Employer Health Benefits Program established pursuant to section 12 of P.L. 1992, c.162 (17B:27A-28 ).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 20 - WITHDRAWALS OF STANDARD SEH PLAN OPTIONAL BENEFIT RIDERS › Section 11:21-20.3 - Withdrawal of optional benefit riders

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A carrier seeking to withdraw an optional benefit rider to a standard SEH plan that has been filed with the Commissioner and/or the Board pursuant to N.J.S.A. 17B:27A-19i(1) shall first obtain the Commissioner's approval by complying with all of the requirements of this subchapter.
(b) A carrier seeking to withdraw an optional benefit rider shall prior to withdrawal of the optional benefit rider submit a written application to the Commissioner as follows:
1. The written application shall include the following:
i. The name of the carrier;
ii. The name, address, telephone number and fax number of the carrier's representative responsible for the application to withdraw the optional benefit rider;
iii. The reason(s) the carrier is withdrawing the optional benefit rider;
iv. The number of inforce plans affected by the withdrawal;
v. A copy of the nonrenewal notice the carrier shall provide to policyholders or contractholders as described in (c) below;
vi. A copy of the nonrenewal notice the carrier shall provide to producers as described in (d) below; and
vii. A copy of the optional benefit rider the carrier is withdrawing, along with evidence of approval of the rider by the Department or acknowledgment of the rider by the SEH Board.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 21 - SMALL EMPLOYER PURCHASING ALLIANCES › Section 11:21-21.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter implements P.L. 2001, c. 225 by establishing rules for the formation and operation of small employer purchasing alliances.
(b) This subchapter shall apply to eligible groups of small employers as defined in P.L. 1992, c.162 (17B:27A-17 ).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 21 - SMALL EMPLOYER PURCHASING ALLIANCES › Section 11:21-21.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise:
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department of Banking and Insurance" means the New Jersey Department of Banking and Insurance.
"Small employer purchasing alliance," "purchasing alliance" or "alliance" means a small employer purchasing alliance as established pursuant to 17B:27A-25.3.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 21 - SMALL EMPLOYER PURCHASING ALLIANCES › Section 11:21-21.3 - Filing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Within 30 days of formation, a small employer purchasing alliance shall file the following with the Commissioner:
1. A certification of an officer or director of the purchasing alliance, which shall include:
i. The name of the purchasing alliance;
ii. The members of the purchasing alliance;
iii. The names of the board of directors, chairman, treasurer and secretary of the purchasing alliance;
iv. The New Jersey mailing address at which communications for the purchasing alliance are to be received;
v. The toll free telephone number for prospective members to use to contact the purchasing alliance;
vi. The eligibility requirements for membership in the purchasing alliance;
vii. The fees charged to members of the purchasing alliance; and
viii. A description of the SEH standard plans, and any optional benefit riders, for which the purchasing alliance negotiates or intends to negotiate premiums for its members;
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 21 - SMALL EMPLOYER PURCHASING ALLIANCES › Section 11:21-21.4 - Eligibility requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No purchasing alliance shall use as a basis for exclusion from membership in the alliance any of the following characteristics of any small employer group as a whole, or any person eligible for coverage in that group:
1. Health status;
2. Medical condition, including both physical and mental illness;
3. Claims experience;
4. Receipt of health care;
5. Medical history;
6. Genetic information;
7. Evidence of insurability, including conditions arising out of acts of domestic violence;
8. Partial or total disability;
9. Group size;
10. Age;
11. Gender; or
12. Any other health status-related factor.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 21 - SMALL EMPLOYER PURCHASING ALLIANCES › Section 11:21-21.5 - Termination of membership in a purchasing alliance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employer may discontinue purchasing coverage as a member of a purchasing alliance at any time.
(b) A purchasing alliance may include a requirement in its bylaws or joint contract that employers provide no more than 30 days notice of discontinuance to the alliance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 21 - SMALL EMPLOYER PURCHASING ALLIANCES › Section 11:21-21.6 - Violations and penalties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Failure to comply with any of the requirements of this subchapter shall be a violation of P.L. 2001, c. 225 (17B:27A-25.1 et seq.). If the Commissioner, after notice and a hearing pursuant to the Administrative Procedure Act, 52:14B-1 et seq., finds that such a violation exists, the premium reduction permitted by 17B:27A-25 shall not be applied, and the undiscounted applicable SEH rate shall be applied retroactive to the effective date of the discount.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 23 - RULEMAKING; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:21-23.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to establish the procedures that the Board uses in providing notice of proposed rulemaking, receiving public comments regarding existing rules and proposed rulemaking, extending the public comment period, conducting a public hearing, and providing notice of public meetings.
(b) This subchapter shall apply to all rulemaking of the Board.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 23 - RULEMAKING; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:21-23.2 - Public notice regarding proposed rulemaking

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Unless the Board proposes a rule pursuant to the special procedures set forth at
17B:27A-51
, the Board shall provide for the following four types of public notice for rule proposals in accord with the New Jersey Administrative Procedure Act,
52:14B-1
et seq., and the Office of Administrative Law Rules for Agency Rulemaking,
N.J.A.C. 1:30
:
1. The rule proposal shall be filed with the Office of Administrative Law for publication in the New Jersey Register;
2. The notice of the rule proposal, as filed with the Office of Administrative Law, or a statement of the substance of the proposed rulemaking, shall be posted and made available electronically on the Department of Banking and Insurance website at:
www.dobi.nj.gov
;
3. The news media maintaining a press office in the State House Complex shall be provided notice of the rule proposal, as posted and made available electronically on the New Jersey Department of Banking and Insurance website; and
4. The notice of the rule proposal, as filed with the Office of Administrative Law, or a statement of the substance of the proposed rulemaking, shall be made available to the Board's list of "interested persons" by e-mail or hard copy. Interested persons are those who have informed the Board in writing that they wish to receive notice of the Board's proposed regulations, as well as those people or entities that the Board determines are the subject of or significantly related to the rulemaking so that the persons most likely to be affected by or interested in the intended action receive notice.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 23 - RULEMAKING; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:21-23.3 - Extension of the public comment period

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Board, in accordance with the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, may extend the time for submission of public comments on a proposed rulemaking, at its discretion, without the need for a specific request or the demonstration of sufficient public interest.
(b) The Board, in accordance with the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, shall extend the time for submission of public comments for an additional 30-day period, if, within 30 days of the publication of a notice of proposal, sufficient public interest is demonstrated in an extension of time to submit comments.
(c) The Board shall determine that a sufficient public interest for the purpose of extending the public comment period has been demonstrated if any of the following has occurred:
1. Comments received indicated a previously unrecognized impact on a regulated entity or persons; or
2. Comments received raise unanticipated issues related to the notice of proposal.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 23 - RULEMAKING; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:21-23.4 - Conducting a public hearing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Board, in accordance with the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, may conduct a public hearing on a proposed rulemaking, at its discretion, without the need for a specific request or the demonstration of sufficient public interest.
(b) The Board, in accordance with the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, shall conduct a public hearing if sufficient public interest has been demonstrated.
(c) A person interested in having a public hearing held on a notice of proposal shall submit an application within 30 days following the publication of the notice of proposal in the New Jersey Register in a form prescribed by the Board, to the Executive Director at the address listed in 11:21-1.3. The application shall contain the following information:
1. The person's name, address, telephone number, agency or association (if applicable);
2. The citation and title of the proposed rule and the date the notice of proposal was published in the New Jersey Register; and
3. The reasons a public hearing regarding the notice of proposal is considered necessary pursuant to (d) below.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 23 - RULEMAKING; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:21-23.5 - Public notice regarding board meetings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Board shall adopt an annual schedule of regular meetings to be held by it the following calendar year.
(b) The Board may schedule meetings in addition to those set forth in the annual schedule.
(c) The Board shall provide public notice for all meetings by:
1. Posting of a notice at the office of the Secretary of State;
2. Posting of a notice at the office of the Board at the address set forth at 11:21-1.3;
3. Posting of a notice on the Department of Banking and Insurance website at:
www.dobi.nj.gov
;
4. Posting of the notice in two newspapers of general circulation designated by the Board; and
5. Mailing, either by hard copy or electronically, of the notice to a distribution list of those persons who have requested in writing to be informed of the Board's meeting schedule.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 23 - RULEMAKING; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:21-23.6 - Board mailing list of interested parties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the purpose of disseminating information about the SEH Program, including information about rulemaking and meeting dates, the Board shall maintain a mailing list of carriers and other interested parties.
1. The mailing list of members shall be based upon the member carriers' addresses filed with its most recently filed Exhibit CC Market Share Report.
i. Upon any change in name or mailing address, a member carrier shall notify the Board in writing no later than 10 days from the date the new name or address becomes effective.
ii. Unless the Board is notified otherwise as provided above, the name and mailing address of a member carrier shall be deemed correct and communications mailed to the name and address on file shall be deemed received by the member carrier.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Appendix - APPENDIX › Exhibit F

Current through Register Vol. 56, No. 14, July 15, 2024
Click here to view Image
The amended version of this Section by 53 N.J.R. 1738(a), effective 8/27/2021 is not yet available.
The amended version of this exhibit 55 N.J.R. 196(a), effective 1/1/2023 is not yet available
The amended version of this exhibit 56 N.J.R. 214(a), effective 1/1/2024 is not yet available
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Appendix - APPENDIX › Exhibit G

Current through Register Vol. 56, No. 14, July 15, 2024
Click here to view Image
The amended version of this Section by 53 N.J.R. 1738(a), effective 8/27/2021 is not yet available.
The amended version of this exhibit 55 N.J.R. 196(a), effective 1/1/2023 is not yet available
The amended version of this exhibit 56 N.J.R. 214(a), effective 1/1/2024 is not yet available
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Appendix - APPENDIX › Exhibit W

Current through Register Vol. 56, No. 14, July 15, 2024
Click here to view Image
The amended version of this Section by 53 N.J.R. 1738(a), effective 8/27/2021 is not yet available.
The amended version of this exhibit 55 N.J.R. 196(a), effective 1/1/2023 is not yet available
The amended version of this exhibit 56 N.J.R. 214(a), effective 1/1/2024 is not yet available
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Appendix - APPENDIX › Exhibit Y

Current through Register Vol. 56, No. 14, July 15, 2024
Click here to view Image
The amended version of this Section by 53 N.J.R. 1738(a), effective 8/27/2021 is not yet available.
The amended version of this exhibit 55 N.J.R. 196(a), effective 1/1/2023 is not yet available
The amended version of this exhibit 56 N.J.R. 214(a), effective 1/1/2024 is not yet available
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Appendix - APPENDIX › Exhibit FF

Current through Register Vol. 56, No. 14, July 15, 2024
STATE OF NEW JERSEY
SEH PROGRAM PREMIUM COMPARISON SURVEY
Submit this completed survey no later than December 1 of each year to:
Click to view image
Part 1
COMPANY AND RESPONDENT INFORMATION
Click to view image
CERTIFICATION
I certify that the information set forth in this SEH Premium Comparison Survey is true and accurate, and hereby further certify that I am authorized to execute this certification on behalf of the above-named carrier.
Click to view image
Part 2
TOLL-FREE INFORMATION
Click to view image
Part 3
DIRECTIONS FOR COMPLETING THE PREMIUM SURVEY
A. Give monthly premium, rounded to the nearest dollar, for a
standard
policy issued on
the next
January 1 to an employer described in paragraph C below, for each plan in accordance with paragraph D below. The following abbreviations and instructions apply:
-- SCA: Selective Contracting Arrangement (An arrangement for the payment of predetermined fees or reimbursement levels for covered services by the carrier to preferred providers or preferred provider organizations (see N.J.A.C. 11:4-37.2 )) offered in conjunction with Plan(s) B, C, D, or E.
-- POS: A standard HMO Point of Service Plan (HMO/POS plan) (N.J.A.C. 11:21-3.1(h)  ) or standard non-HMO Point of Service Plan (POS plan) (N.J.A.C. 11:21-3.1(g)  ).
-- Standard Premium: The standard plan is offered or purchased without optional riders.
This premium must include all standard benefits, including standard prescription drug (Rx) benefits, and must
not
reflect any non-standard riders which increase or decrease benefits. The standard Rx plan for any plan other than an in-network only HMO plan is Rx covered subject to the indemnity or out-of-network cost sharing.
-- Rx: For HMO (in-network-only) Plan, the standard Rx benefit is 50%. (Pursuant to N.J.A.C. 11:21-3.1(c)3  iii carriers are allowed the option of a $ 15 copay, but this option does not appear to be used.)
B. Use "NA" to indicate when any plan variation is not being offered.
C. For purposes of completing the survey, assume the policyholder is a small employer, located in one of the following counties: Bergen, Camden, and Middlesex, with six employees as follows:
1. Single Female - age 27
2. Single Male - age 37
3. Female Parent - age 47, with two children
4. Male Employee and Spouse - both age 57
5. Male Employee - age 27; Spouse - age 24; two children - both under age 18
6. Female Employee - age 47; Spouse - age 50; two children - both under age 18