reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 43 - INDIVIDUAL ANNUITY CONTRACT FORM STANDARDS › Section 11:4-43.4 - Individual immediate annuities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Individual immediate annuity contracts which include surrender benefits, partial withdrawals or indeterminate annuity payments other than commutation rights shall meet or exceed the requirements of the Standard Nonforfeiture Law for Individual Deferred Annuities at 17B:25-20. Submissions of such forms shall include a demonstration of compliance with this requirement.
(b) The premium for an immediate annuity shall be paid in a lump sum, and shall not be funded on an installment basis.
(c) If an immediate annuity provides a commutation privilege for the owner, the commutation interest rate shall be within one percent of the rate used in calculating the single premium.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 43 - INDIVIDUAL ANNUITY CONTRACT FORM STANDARDS › Section 11:4-43.5 - Individual deferred annuities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Insurers shall include a provision in all individual flexible premium annuity forms specifying any upper and/or lower dollar limits on premium payments, which the insurer may waive in a uniform and nondiscriminatory manner upon written notice of any new limits to the owner. Forms shall describe the initial limits and the required written notice of any new limits. Insurers shall not arbitrarily refuse premium payments.
(b) An annuity form shall only be identified as a flexible premium annuity and use the corresponding formula for the derivation of the minimum nonforfeiture amount for a contract providing flexible considerations set forth at N.J.S.A. 17B:25-20g(1) if the owner is permitted to pay premiums for a period of no less than five years. Notwithstanding this requirement, insurers may issue individual flexible premium deferred annuities that require annuitization at a fixed age to persons who are less than five years from such fixed age. Any annuity contract providing flexible premiums for less than five years shall use the formula for derivation of the minimum nonforfeiture amount for a contract providing a single consideration set forth at N.J.S.A. 17B:25-20g(3).
(c) An annuity form shall not be identified as a single premium contract if it contains a provision for additional premiums.
(d) An annuity form shall not permit a single premium annuity to be paid in installments.
(e) Insurers shall provide written notice to all prospective purchasers of individual flexible premium annuities at or before application. The notification form shall be submitted to the Department upon filing any individual flexible premium annuity form. The written notice shall include the following:
1. A statement that cash values under a flexible premium annuity where only one premium is paid can be lower than those under a single premium annuity, and that purchase of a flexible premium annuity may be inappropriate in such a case; and
2. A signature by the purchaser.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 43 - INDIVIDUAL ANNUITY CONTRACT FORM STANDARDS › Section 11:4-43.6 - Waiver of surrender charges

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An individual annuity form which includes a waiver of surrender charges upon confinement to a nursing home or similar institution shall comply with the following requirements:
1. The benefit shall be limited to the confinement of the owner, the annuitant, the owner's spouse or civil union partner or the annuitant's spouse or civil union partner. Confinement of any other family member not identified in the contract shall not qualify for the benefit.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 43 - INDIVIDUAL ANNUITY CONTRACT FORM STANDARDS › Section 11:4-43.7 - Surrender charges for individual deferred annuities

Current through Register Vol. 56, No. 14, July 15, 2024
Submissions of all individual deferred annuity contracts having a separate surrender charge associated with each premium payment shall include an actuarial certification that surrender charges in later years comply with 17B:25-20.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 44 - STANDARDS FOR CONTRACTS ON A VARIABLE BASIS › Section 11:4-44.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to implement the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act, P.L. 1995, c.73, by setting forth the Department's standards for approval of life insurance and annuity contracts issued on a variable basis.
(b) This subchapter shall apply to all life insurance and annuities contracts on a variable basis and any certificate evidencing variable benefits pursuant to such contracts, which are issued pursuant to 17B:28-1 et seq. and delivered or issued for delivery in this State. This subchapter shall not apply to variable life insurance and annuities forms approved by the Interstate Insurance Product Regulation Commission created pursuant to the Interstate Insurance Product Regulation Compact established by P.L. 2010, c. 120.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 44 - STANDARDS FOR CONTRACTS ON A VARIABLE BASIS › Section 11:4-44.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Contract on a variable basis" or "variable contract" means any separate account contract providing for the dollar amount of life insurance or annuity benefits or other contractual payments or values thereunder to vary so as to reflect investment results of one or more separate accounts in which amounts with respect to any such contracts have been placed. Market value adjusted annuities are included within this definition, and are not fixed annuities.
"Department" means the New Jersey Department of Banking and Insurance.
"Separate account" means any segregated portfolio of investments or designated account of an insurer established pursuant to 17B:28-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 44 - STANDARDS FOR CONTRACTS ON A VARIABLE BASIS › Section 11:4-44.3 - Standards for variable contracts

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All individual life insurance and annuities contracts on a variable basis shall include the following:
1. A provision describing the periodic reports;
2. A provision specifying any rights for deferral. Any deferral of a minimum guaranteed death benefit for an individual variable life insurance contract shall comply with 17B:25-11; and
3. A provision describing any conditions for partial withdrawals, partial surrenders, loans, transfers and new deposits. Any required minimum amount for a partial withdrawal, partial surrender, loan or transfer shall not exceed $ 1,000.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 44 - STANDARDS FOR CONTRACTS ON A VARIABLE BASIS › Section 11:4-44.4 - Prohibited provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following restrictions shall apply to all individual life insurance and annuities contracts on a variable basis:
1. The insurer shall not reserve the right to unilaterally terminate or discontinue transfer privileges. Suspension of such privilege for a reasonable period is permitted if administered in a nondiscriminatory manner.
2. The insurer shall not require a signature guarantee of the owner for withdrawals, surrenders, loans or transfers.
3. The insurer shall not reserve the right to terminate the contract for suspension in premium activity or for failure to maintain minimal amounts in the separate account, unless the reduction in values in the separate account is the direct result of partial withdrawal or surrender activity. However, an insurer may automatically transfer all monies to one fund or division of the separate account if the value of the separate account falls below a stated minimum. Any conditions for the transfer shall be described in the contract form. This paragraph shall not require an insurer to continue a scheduled, required premium contract beyond any grace period or nonforfeiture benefit provided by the contract or required by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 45 - PERIODIC REPORTS › Section 11:4-45.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) These rules set forth the standards and requirements for periodic reports required to be provided to policyholders or contract holders in connection with flexible-factor life insurance forms, individual variable annuity forms, and variable life insurance forms to be filed by the Commissioner for use and delivery in this State pursuant to 17B:25-18, 17B:25-18.1, 17B:25-18.2, 17B:27-25, and 17B:28-5. These rules also set forth periodic report requirements for all forms for which illustrations are used pursuant to N.J.A.C. 11:4-52.
(b) These rules shall apply to any insurer seeking to deliver or issue for delivery in this State a flexible-factor form, individual variable annuity form or variable life insurance form; or any other form for which illustrations are used pursuant to N.J.A.C. 11:4-52 as set forth in 11:4-45.7.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 45 - PERIODIC REPORTS › Section 11:4-45.3 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No form to which this subchapter applies may be delivered or issued for delivery in this State unless submitted to the Commissioner for review and filed by the Commissioner pursuant to all applicable law, including, but not limited to, N.J.A.C. 11:4-40.
(b) For any form to which these rules apply, the insurer shall provide the policyholder with a report or notice, as set forth in this subchapter, which provides the information and complies with the standards set forth in this subchapter.
(c) The form of periodic report or form of notice (that is, amendment, letter or transaction or confirmation notice) may be manually generated.
(d) The terms utilized in the report or notice shall correspond to the terms used in the policy to describe the same values, charges, transactions or benefits.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 45 - PERIODIC REPORTS › Section 11:4-45.5 - Individual variable annuity forms; reporting requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any periodic report for use with an individual variable annuity shall satisfy, at a minimum, the following requirements:
1. The report shall be provided at least annually, and shall show the values by fund, sub-account and division (including, but not limited to, dollar and unit values) applicable at both the beginning and end of the period covered by the report;
2. The report shall list the number of units and dollar value of a unit not more than two months prior to the date of the mailing of the report;
3. For the period prior to annuitization, the report shall list the number of units and the unit value by fund, sub-account or division. The units and unit value shall not be listed in the aggregate;
4. Except as provided in (a)5 below, for the period prior to annuitization, the report shall record the following transactions by date:
i. Premium receipt;
ii. Loans, incurred and repaid;
iii. Partial surrenders or withdrawals;
iv. Transfers; and
v. Charges;
5. Alternatively to (a)4, for any transactions for which transaction or confirmation notices are sent, the report may show an aggregate amount for each such type of transaction, except that transfers need not be shown;
6. For forms that provide a fixed account or other interest option, all interest credits, rates, and the amounts to which such rates apply for the period covered by the report shall be recorded in a periodic report, or transaction or confirmation notice.
i. In the case of policies with "buckets" or "generations" of interest, the Commissioner shall waive the requirement set forth in (a)6 above if:
(1) The report states that the insurer will provide interest rates and crediting methodology to the owner upon request and free of charge; and
(2) The information available upon request shall record all interest rates, together with the amounts to which such rates apply.
ii. Notwithstanding any waiver granted pursuant to (a)6i above, the report shall record the interest rates and credits applied to monies newly allocated to a fixed account option during the reporting period, unless such interest rates and credits are provided by the insurer in a transaction or confirmation notice at the time of allocation; and
7. The report sent after annuitization for variable payments shall provide a reconciliation of annuity payments. The annuity unit values shall be listed by fund, sub-account or division. The units and unit values shall not be listed in the aggregate. For annuitization to fixed payments, no report is required.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 45 - PERIODIC REPORTS › Section 11:4-45.6 - Variable life insurance; periodic report requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any periodic report for use with a variable life form shall satisfy, at a minimum, the following requirements:
1. The report shall be provided at least annually, and shall show values by fund, sub-account and division (including, but not limited to, dollar and unit values, if the product has unit values) applicable at both the beginning and end of the period covered by the report;
2. The report shall show the policy status as of a date no more than two months prior to the date of the mailing the report and shall show all increments and decrements to values and benefits since the date as of which the last previous report provided value and benefit information;
3. The report shall state that, in accordance with the investment experience of the separate account, the cash values and variable death benefit may increase or decrease;
4. If the report shows projected values, it shall describe the assumptions (premiums, charges, and net return) used to calculate the projections; and
5. If, as of the reporting date, any projected value shown in the report is less than zero, the report shall include a caution that the policy may be in danger of terminating without value in the next 12 months unless additional premium is paid.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 45 - PERIODIC REPORTS › Section 11:4-45.7 - Illustrated forms

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In the case of a policy for which illustrations shall be used pursuant to N.J.A.C. 11:4-52, the insurer shall provide each policyholder or contractholder with a periodic report on the status of the policy, which shall satisfy the following requirements:
1. The report shall be provided at least annually;
2. For fixed premium account value policies, if assuming guaranteed interest, mortality and expense loads and continued scheduled premium payments, the policy's net cash surrender value is such that it would not maintain insurance in force until the end of the next reporting period, a notice to this effect shall be included in the report;
3. For flexible premium account value policies, if assuming guaranteed interest, mortality and expense loads, the policy's net cash surrender value will not maintain insurance in force until the end of the next reporting period unless further premium payments are made, a notice to this effect shall be included in the report;
4. For all other policies, the report shall show, where applicable:
i. Current death benefit;
ii. Annual contract premium;
iii. Current cash surrender value;
iv. Current dividend;
v. Application of current dividend; and
vi. Amount of outstanding loan.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 46 - SYNTHETIC GUARANTEED INVESTMENT CONTRACT FORMS › Section 11:4-46.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to implement P.L. 1995, c.73 (the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act) by setting forth the terms and conditions under which life insurance companies may issue synthetic guaranteed investment contracts, the essential operational features of the segregated portfolio of assets required to issue such contracts and the reserve requirements for such contracts.
(b) This subchapter shall apply to all synthetic guaranteed investment contract forms delivered or issued for delivery in the State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 46 - SYNTHETIC GUARANTEED INVESTMENT CONTRACT FORMS › Section 11:4-46.6 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The insurer shall monitor the market value record for each contract. Upon each recalculation of the crediting rate, but no less frequently than quarterly, the insurer shall update the market value record to reflect the market value of the segregated portfolio.
(b) No contract shall be delivered or issued for delivery in this State unless the assets which it supports and for which a contract value is established are maintained in a segregated portfolio of a custodian.
(c) The investment guidelines shall be submitted to the insurer for underwriting review prior to the effective date of the contract.
(d) The investment guidelines shall permit investments of the segregated portfolio to be only in instruments for which market values are ascertainable pursuant to 17B:28-10.
(e) No contract shall obligate the insurer to purchase any assets at greater than market value or assets that would not be permitted investments pursuant to 17B:20-1 et seq.
(f) For group annuity contracts that make available to the contractholder the purchase of immediate or deferred annuities for the benefit of individual members of the group, no annuity shall be purchased without the delivery of the agreed consideration to the insurer for allocation to the insurer's general account or separate account as appropriate.
(g) In the case of unilateral termination of a contract pursuant to 11:4-46.5(a)9, the insurer shall refund any unearned risk premium or investment management fees, which shall terminate all future liability of the insurer or obligation to provide further benefits.
(h) In the case of an insurer's waiver of its right to terminate a contract when a termination event occurs, the Department shall require the insurer to submit a report describing the corrective action taken by the insurer.
(i) The insurer shall acknowledge in its submission that it shall maintain adequate reserves and collect adequate consideration for the cost of annuities purchased under contract option by transfer from the segregated portfolio.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 46 - SYNTHETIC GUARANTEED INVESTMENT CONTRACT FORMS › Section 11:4-46.7 - Reserves

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Reserves shall be held by the insurer in the general account and shown on Exhibit 10 of the Annual Statement. The assets supporting those reserves, together with the assets in the segregated portfolio, shall be sufficient to mature the liabilities under moderately adverse conditions. Annual asset adequacy analysis shall be performed and reported on by the appointed actuary in the annual actuarial opinion submitted pursuant to the Standard Valuation Law. Asset adequacy analysis must consider the nature of the assets and liabilities, and the anticipated effect on contract value crediting rates of possible future changes in the interest rate environment.
(b) Following is one method of reserve calculation that may be set forth in the plan of operation. The Department shall also consider alternative methods that have been adopted by the NAIC or otherwise supported by detailed actuarial analysis.
1. Project future liability cash flows using the guaranteed rate(s) of interest. For contracts that do not have defined maturity structures (such as "evergreen" or constant duration contracts), use the maturity structure of the assets as a proxy for the maturity structure of the liabilities.
2. Discount the liability cash flows at spot rates of interest that do not exceed 105 percent of Treasury spot yields, and that are adjusted, if necessary, so that the internal rate of return on the liabilities does not exceed the internal rate of return on the assets.
3. Hold reserve equal to the excess, if any, of the sum of the discounted liability cash flows calculated in (b)2 above over the market value of the assets.
4. Hold as additional reserves whether reserves are indicated by asset adequacy analysis in the opinion of the appointed actuary.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 46 - SYNTHETIC GUARANTEED INVESTMENT CONTRACT FORMS › Section 11:4-46.8 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the subchapter and the application of such provision(s) to other persons or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 47 - ACTUARIAL REQUIREMENTS FOR FLEXIBLE-FACTOR POLICY FORMS › Section 11:4-47.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) These rules set forth requirements regarding actuarial reports and memorandum which are to be developed in connection with flexible-factor life insurance forms for such forms to be filed by the Commissioner for use and delivery for use in this State pursuant to 17B:25-18, 17B:27-25, 17B:28-5 and P.L. 1995, c.73.
(b) These rules shall apply to any insurer seeking to deliver, or issue for delivery, a policy of life insurance under a flexible-factor form in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 47 - ACTUARIAL REQUIREMENTS FOR FLEXIBLE-FACTOR POLICY FORMS › Section 11:4-47.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Experience factors" means a factor experienced by the company that is variable in nature and impacts the profitability of the policy. Depending on the policy design, experience factors may include, but are not limited to, investment earnings, mortality, persistency, and expenses, because these factors can vary and the profitability of the policy is normally affected.
"Flexible factors" means premiums, premium factors (for example, interest credits, mortality charges, or expense charges) or benefits (for example, death benefits, cash or surrender values) or benefit charges (for example, surrender charges) that the insurer reserves the right to modify, subject to a flexible-factor guarantee, on the basis of future anticipated or emerging experience. Flexible factors do not include: interest or investment credits based on an external index, investment increments based on performance of assets in a variable account contract, the mortality and expense risk charge deducted in determining the investment return on a separate account, or dividends based on the principle of distributable surplus.
"Flexible-factor form" means any life insurance policy, rider or endorsement, whether participating or nonparticipating, where the insurer reserves the right to modify one or more flexible factors as defined in this section. The right to modify is subject to a flexible-factor guarantee and the modification must be based upon future anticipated or emerging experience.
"Flexible-factor guarantee" means a statement in the contract which guarantees the upper or lower limits of specific flexible factors.
"Insurer" means any person or persons, corporation, partnership, or company authorized or admitted to transact the business of life insurance in this State pursuant to Title 17B of the New Jersey Statutes.
"Qualified actuary" means an individual who is a member in good standing of the American Academy of Actuaries and who is qualified to provide a Public Statement of Actuarial Opinion in accordance with standards set forth by the Actuarial Standards Board of the American Academy of Actuaries.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 47 - ACTUARIAL REQUIREMENTS FOR FLEXIBLE-FACTOR POLICY FORMS › Section 11:4-47.3 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All forms with any flexible factors shall include a flexible-factor guarantee.
(b) All forms to which this subchapter applies shall specify the experience factors upon which changes to flexible factors could be based.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 47 - ACTUARIAL REQUIREMENTS FOR FLEXIBLE-FACTOR POLICY FORMS › Section 11:4-47.4 - Modification of flexible factors

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any modification to flexible factors on an in-force policy made by an insurer shall be subject to the following requirements:
1. The modification shall be made only to flexible factors identified as such in the contract;
2. The modification shall be based upon future anticipated or emerging experience and on experience factors only as identified in the contract; and
3. The modification shall be made to all individuals of the same class or equal expectation of life in compliance with the requirements of N.J.S.A. 17B:30-12c.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 47 - ACTUARIAL REQUIREMENTS FOR FLEXIBLE-FACTOR POLICY FORMS › Section 11:4-47.5 - Nonforfeiture benefits-actuarial certification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each form submitted for filing shall be accompanied by a certification by a qualified actuary that the nonforfeiture benefits provided are in compliance with 17B:25-19 or are exempt from providing guaranteed nonforfeiture benefits as described in 17B:25-19.
1. Nonforfeiture compliance for supplementary term insurance benefits that create a "target" death benefit based upon the combined coverage provided by the base policy forms and supplementary benefit shall be based upon the total coverage provided by the base plan and supplementary benefit combination.
2. All other term insurance benefits shall be tested for nonforfeiture compliance as stand-alone insurance coverage.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 47 - ACTUARIAL REQUIREMENTS FOR FLEXIBLE-FACTOR POLICY FORMS › Section 11:4-47.6 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with this subchapter shall result in the imposition of any penalties as may be authorized by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 48 - UNFAIR DISCRIMINATION › Section 11:4-48.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth standards and requirements that all life and health insurance policy forms and annuity contract forms are required to meet in order to comply with the prohibition against unfair discrimination as provided at 17B:30-12.
(b) These rules shall apply to all insurers delivering or issuing for delivery life insurance and health insurance policies or annuity contracts in this State. This subchapter shall not apply to life insurance and annuities forms approved by the Interstate Insurance Product Regulation Commission created pursuant to the Interstate Insurance Product Regulation Compact established by P.L. 2010, c. 120.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 48 - UNFAIR DISCRIMINATION › Section 11:4-48.2 - 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.
"Annuity" means a contract not coming within the definition of life insurance as set forth in 17B:17-3, or health insurance as set forth in 17B:17-4, under which an insurer obligates itself to make periodic payments for a specified period of time, such as for a number of years, or until the happening of an event, or for life, or for a period of time determined by any combination thereof.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Health insurance" is as defined at 11:4-40.2.
"Insurer" means any person or persons, corporation, partnership, or company authorized or admitted to transact the business of life insurance, health insurance or annuities in this State pursuant to Title 17 and 17B of the New Jersey statutes.
"Life insurance" is as defined at 11:4-40.2.
"Tiered factors" means accumulation account factors, such as interest rates, cost of insurance or mortality charges, and expense charges, which vary by a policy amount, such as accumulation account value, cash surrender value, face value, or net amount at risk, or which differ for various components or tiers of a policy amount. Tiered factors reflect economies of scale or other economies so that credits will increase with size and charges will decrease with size. Tiered factors do not include factors which vary by policy duration.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 48 - UNFAIR DISCRIMINATION › Section 11:4-48.3 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No insurer shall make or permit any unfair discrimination between individuals of the same class and equal expectation of life in the rates charged, dividends or other benefits payable thereon, or in any other of the terms and conditions for any policy of life insurance or contract of annuity.
(b) No insurer shall make or permit any unfair discrimination between individuals of the same class and of essentially the same hazard in the amount of premium policy fees, or rates charged for any policy or contract of health insurance or in the benefits payable thereunder, or in any of the terms or conditions of such policy or contract, or in any other manner whatsoever.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 48 - UNFAIR DISCRIMINATION › Section 11:4-48.4 - Conversion credits

Current through Register Vol. 56, No. 14, July 15, 2024
The Department shall approve life insurance policy forms that provide conversion credits pursuant to N.J.S.A. 17B:30-14e.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 48 - UNFAIR DISCRIMINATION › Section 11:4-48.5 - Non-smoker only coverage

Current through Register Vol. 56, No. 14, July 15, 2024
The Department shall not approve life insurance policy forms intended for sale to non-smokers. Insurers may decline or not offer insurance to smokers if underwriting considerations based on mortality risk exposure would result in such smokers being ineligible. Insurers shall not decline or refuse to offer insurance to smokers if non-smokers having elevated mortality at least equal to that of smokers are accepted.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 48 - UNFAIR DISCRIMINATION › Section 11:4-48.6 - Policy benefits determined by ownership

Current through Register Vol. 56, No. 14, July 15, 2024
The Department shall not approve provisions in life insurance policy forms under which the level of premiums or benefits varies depending solely upon who retains the ownership rights of the policy.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 48 - UNFAIR DISCRIMINATION › Section 11:4-48.7 - Forgiveness of surrender charge

Current through Register Vol. 56, No. 14, July 15, 2024
A policy shall not provide credits for a surrender charge imposed under another contract for the reason that such credits unfairly discriminate among contractholders based on the source of funding.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 48 - UNFAIR DISCRIMINATION › Section 11:4-48.8 - Discounts and reductions in premium in individual health insurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to the discounts based solely on savings in expenses due to the method of premium collection as permitted by N.J.S.A. 17B:30-14d and the discounts based solely on the amount of insurance issued to a particular insured as permitted by N.J.S.A. 17B:30-14e, reductions in premiums for individual health insurance policies based on class as described below are permitted if either of the following conditions are met:
1. A reduced premium may be charged under one individual health policy form based on savings in expenses, improved morbidity or increased persistency resulting from differing marketing or underwriting methods utilized for a particular class of individuals who present the same underlying hazard. Such classes may include associations, employers and large cases. Savings in expenses may include a reduction in commissions or other compensation as applied to all policies within the particular class. Each reduction in premium shall be considered a separate class (for example, 10 percent, 15 percent and 20 percent employer-based reductions in premium shall each be considered a separate class); or
2. The reduction in premium is based on additional requirements applied to the discounts allowed by N.J.S.A. 17B:30-14d and 17B:30-14e. For example, list bill discounts with minimum premium requirements, or list bill discounts which vary based on level of participation are considered a separate class subject to the requirements of this section. Each reduction in premium shall be considered a separate class.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 49 - MANDATED DIABETES BENEFITS › Section 11:4-49.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to implement P.L. 1995, c.331 by specifically setting forth the benefits required to be provided pursuant to P.L. 1995, c.331, and by identifying the particular health insurance policy or contract responsible for payment of such benefits.
(b) This subchapter shall apply to all policies and contracts providing hospital or medical expense benefits that are delivered, issued, executed or renewed in this State as follows: all hospital service corporation contracts issued pursuant to 17:48-1 et seq.; all medical service corporation contracts issued pursuant to 17:48A-1 et seq.; all health service corporation contracts issued pursuant to 17:48E-1 et seq.; all health insurance policies issued pursuant to 17B:26-1 et seq., and 17B:27-26 et seq.; and all health maintenance organization (HMO) contracts issued pursuant to 26:2J-1 et seq.
(c) This subchapter shall not apply to any health benefits plans issued pursuant to 17B:27A-2 et seq., or 17B:27A-17 et seq., or to any dental only or vision only policy or contract.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 49 - MANDATED DIABETES BENEFITS › Section 11:4-49.2 - 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 Department of Banking and Insurance.
"Dental only policy or contract" means a policy or contract providing only benefits for dental services.
"Health benefits plan" means any hospital or medical expense insurance policy or contract; health, hospital, or medical service corporation contract; or health maintenance organization subscriber contract delivered or issued for delivery in this State by any carrier. For purposes of this subchapter, "health benefits plan" excludes the following plans, policies, or contracts: accident only, credit health, disability, long-term care, coverage for Medicare services pursuant to a contract with the United States government, Medicare supplement, dental only, vision only, insurance issued as a supplement to liability insurance, coverage arising out of a workers' compensation or similar law, hospital confinement, automobile medical payment insurance, or personal injury protection coverage issued pursuant to P.L. 1972, c.70 (39:6A-1 et seq.) and stop loss or excess risk insurance.
"Vision only policy or contract" means a policy or contract providing only benefits for vision services.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 49 - MANDATED DIABETES BENEFITS › Section 11:4-49.3 - Benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The diabetes benefits set forth in this subsection shall be included in all health benefits plans.
1. All equipment and supplies for the treatment of diabetes if recommended or prescribed by a physician or nurse practitioner/clinical nurse specialist as follows:
i. Blood glucose monitors and blood glucose monitors for the legally blind;
ii. Test strips for glucose monitors and visual reading and urine testing strips;
iii. Insulin;
iv. Injection aids;
v. Cartridges for the legally blind;
vi. Syringes;
vii. Insulin pumps and appurtenances thereto;
viii. Insulin infusion devices; and
ix. Oral agents for controlling blood sugar; and
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 49 - MANDATED DIABETES BENEFITS › Section 11:4-49.4 - Payment of benefits under multiple coverage plans

Current through Register Vol. 56, No. 14, July 15, 2024
All group health insurance policies or contracts providing hospital or medical expense benefits, except for policies or contracts providing prescription drug benefits, may provide that the benefits required to be provided pursuant to this subchapter are excluded if the benefits are included under another group health insurance policy or contract issued to the same policyholder or contractholder.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS › Section 11:4-50.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In conformance with 30:7E-1 et seq., the purpose of this subchapter is to establish rules for the reimbursement of costs incurred in the provision of medical care, hospitalization, surgery, dental care and vision care to inmates that are covered by a health coverage plan and are incarcerated or detained in a State or county institution.
(b) These rules shall not apply to those self-funded health care plans which are subject to the Employee Retirement Income Security Act of 1974 (ERISA).
(c) Pursuant to P.L. 1997, c. 216, section 3, the Administrative Office of the Courts, in accordance with these rules, shall be permitted to file claims for reimbursement, subject to the terms of coverage, for the psychological evaluation of convicted persons.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS › Section 11:4-50.2 - 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 text clearly indicates otherwise:
"Confinement" means incarceration, detention or commitment to any institution.
"Correctional medical services subcontractor" and "correctional medical services health care provider" are those private associations, agencies or companies hired or contracted by the State or counties to provide medical care, services, or products to inmates.
"Covered person" means any person who is covered by a health coverage plan but not as an enrollee.
"Enrollee" means a person who receives or subscribes to a policy, contract, certificate, evidence of coverage or other proof of coverage from the health coverage plan that covers that person for health benefits and expenses.
"Health coverage plan" means any hospital or medical expense insurance policy; health, hospital or medical service corporation contract or certificate; or health maintenance organization ("HMO") subscriber contract or evidence of coverage; dental plan organization, contract or certificate ("DPO"); dental service corporation, contract or certificate ("DSC"); or vision plan.
"Inmate" means any person sentenced to confinement or held in pretrial detention in an institution.
"Institution" refers to any State correctional facility, State contracted half-way house, county jail, county correctional or detention facility.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS › Section 11:4-50.3 - Liability for medical care

Current through Register Vol. 56, No. 14, July 15, 2024
Inmates are liable for the cost of any medical care, surgery, medical service, nursing care, prescription drugs, nonprescription drugs, durable medical equipment, hospitalization, therapy treatment, dental care, vision care provided to them while in confinement.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS › Section 11:4-50.4 - Amount of inmate liability

Current through Register Vol. 56, No. 14, July 15, 2024
Pursuant to 30:7E-2, the amount of inmate liability for medical care shall be the usual, customary and reasonable charges incurred for the inmate's medical care as determined by the State and county treasurers in accordance with the guidelines promulgated by the Commissioner of Corrections or the County Adjuster.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS › Section 11:4-50.5 - Health coverage plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In accordance with 30:7E-3, State and County Treasurers shall file a claim for reimbursement of the value of the usual, customary and reasonable charges incurred for an inmate's medical care upon any health coverage plan providing benefits to an inmate as an enrollee or as a covered person.
(b) Subject to the terms of coverage of the policy or plan, health coverage plans shall be required to reimburse the State or county for costs expended in providing medical care to any inmate covered under the plan.
(c) Notwithstanding the provisions of N.J.A.C. 11:24-1.2 and 11:24A-1.2(definition of "emergency"), it shall be presumed that inmates are in need of emergency medical care and are not located in a place where it can be rendered by any network health care provider. The institutional medical health care provider is deemed to be the inmate's only available source of medical care.
(d) Where practicable, the institutional health care provider shall confer with the health coverage plan to preserve the right of said plans to negotiate fees for testing, specialists and hospitalization.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS › Section 11:4-50.6 - Filing of claims for reimbursement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Where the inmate is an enrollee, he or she shall provide a signed and completed assignment of benefits form in favor of the treasurer of the State or county institution, a claims form and a medical release. These forms shall be obtained from the inmate's plan. The assignment of benefit form shall designate the State or County Treasurer as the assignee for the reimbursement of benefits. Such forms shall be used by the institution to process claims for reimbursement.
(b) Where the inmate is a covered person under a policy or plan of health insurance, the enrollee shall complete the assignment of benefits form designating the State or county treasurer of the institution as the recipient for the reimbursement of benefits. Thereafter, the inmate shall execute all claims and medical release forms.
(c) The forms and claims filing procedures established by the health care plan shall, in so far as practicable, be followed by the institution to facilitate the reimbursement of benefits. All health care plans shall cooperate in the expeditious processing of claims for reimbursement received from institutions rendering medical services, care and products to inmates.
(d) All health care plans shall be obligated, notwithstanding their approved policy terms and procedures, to accept any assignment of benefits executed by or on behalf of an inmate for medical care and services provided to the inmate while institutionalized.
(e) All reimbursement payments for medical care provided to an inmate shall be made payable to the State or county treasurer of the institution designated on the assignment of benefits form.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS › Section 11:4-50.7 - Coordination of benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The determination of primary coverage responsibility shall be governed by N.J.A.C. 11:4-28 to determine the priority of reimbursement in the event of multiple coverages of an inmate.
(b) For the purpose of the coordination of benefits, the medical services provided by the institution, the correctional medical service subcontractor and the correctional medical service health care provider shall not be considered a "plan" as defined in N.J.A.C. 11:4-28.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 50 - REIMBURSEMENT OF INMATE HEALTH CARE COSTS › Section 11:4-50.8 - Policy forms

Current through Register Vol. 56, No. 14, July 15, 2024
Health coverage plans shall not contain any provision which would limit or restrict the ability of the State or county treasurers to seek reimbursement for the cost of medical services provided to inmates under 30:7E-1 et seq.