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New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.22 - Confidentiality of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Employee claims information is privileged and confidential and shall not be included as a part of any open public record.
(b) The trustees and the officials of the member shall not have access to any employee claim information which reveals the identity of any individual plan participant.
(c) All claims are to be filed, and all inquiries are to be handled, directly by the designated claims' administrator. All employees of the administrator shall execute a non-disclosure statement to protect the identity of the plan participants.
(d) Only trustees and necessary fund professionals shall participate in any closed session discussion of claims. These claims discussions, whether general or specific to a coverage dispute, shall at all times be confidential and anonymous so that the identity of the school board and claimant cannot be ascertained. The anonymity of the claimant shall be accomplished by assigning a blind claim number and deleting all references to the individual's name and place of employment. Only the claimant may demand, by written notice, that the matter be handled with disclosure of his or her identity.
(e) Documents identifying the employee, or from which the employee's identity might be deduced, shall not be accessible to any persons other than the administrator, program manager, fund attorney, or appointed claim auditors when such records are needed to verify the accuracy of claim data as part of an audit.
(f) Any person having access to claim information must sign a written non-disclosure statement.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.23 - Stop-loss insurance and/or reinsurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each fund providing primary or underlying coverage on a self-insured basis shall secure stop-loss insurance or reinsurance in a form and amount acceptable to the Commissioner from an insurer authorized or admitted to transact life or health insurance, as applicable, in the State.
(b) Certificates of stop-loss insurance and/or reinsurance showing policy limits and other information shall be available for the inspection of each member and shall be filed with the Commissioner.
(c) Losses in excess of the established self-insurance retention amount shall be borne by the stop-loss carrier(s) according to the terms and conditions of the stop-loss contract(s).
(d) Any proposed change in the terms or limits of stop-loss insurance and/or reinsurance shall be submitted to the Department for approval at least 30 days prior to the effective date of the proposed change.
(e) The Commissioner shall waive the requirement set forth in (a) above if such stop-loss insurance or reinsurance is not commercially available or is unreasonably priced, as determined by the fund's trustees for each fund year, and as approved by the Commissioner, and the fund otherwise demonstrates to the Commissioner that it has made adequate provision for excess losses.
1. Any approval by the Department pursuant to (a) above shall be for a period not to exceed either the longer of 12 months from the date of approval or the end of the next succeeding fund year. Any fund seeking to extend the period of the approval shall notify the Department not later than 45 days prior to the expiration of the term of the approval. The notification shall specify the basis upon which the trustees have determined that stop-loss insurance or reinsurance required pursuant to (a) above is not commercially available or is not reasonably priced, and shall include all actions taken by the fund to obtain required stop-loss insurance or reinsurance. The notification shall also describe actions taken by the fund to provide for excess losses, including, but not limited to, the establishment of contingency reserves, and funding above the level of expected losses.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.24 - Financial statement and reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A sworn annual report in a form acceptable to the Commissioner shall be prepared by each fund, filed with the Department, and made available to each fund member not later than December 31 for the end of the immediately preceding fiscal year. The report shall include:
1. An annual audited statement of the financial condition of the fund prepared by an independent certified public accountant and performed in accordance with generally accepted accounting principles, which shall include a statement of the organization of the fund, including its balance sheet and receipts and disbursements for the preceding year;
2. Reports of outstanding liabilities by line of coverage showing the number of claims, amounts paid to date and current reserves for losses, claims and unearned assessments as certified by a qualified actuary;
3. Reports of all incurred but not reported liabilities certified by a qualified actuary;
4. Any material changes in information from that previously submitted;
5. The number of covered individuals by line of coverage; and
6. Such other information, as may be requested by the Department from a particular fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.25 - Examination of funds possibly in financial condition detrimental to the public

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner may conduct an examination of any fund as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the fund may be insolvent or in a financial condition detrimental to its members or to the public. It shall be the duty of the fund members, trustees, and administrator to notify the Commissioner of any information indicating that any fund may be insolvent or in a financial condition detrimental to the fund's members or the public.
(b) The fund's members or trustees may, upon majority vote, request that the Commissioner order an examination of the fund, or any fund member, which they, in good faith, believe may be in a financial condition detrimental to other fund members or to the public.
(c) Any examination made pursuant to 18A:18B-7 and this subchapter shall be conducted in accordance with the procedures set forth in 11:15-5.6(g).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.26 - Servicing organizations; administrator

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No servicing organization or program manager of a fund, or producer appointed by a fund pursuant to 11:15-5.6(e)15, or their employees, officers or directors shall have either a direct or indirect financial interest in the administrator of that fund, or be an employee, officer or director of the administrator, unless written notice of such interest has been provided to the trustees and members.
(b) No administrator of a fund, or its employees, officers or directors shall be an employee, officer or director of, or have either a direct or indirect financial interest in, a servicing organization or program manager of that fund, or the insurance producer appointed by that fund pursuant to 11:15-5.6(e)15, unless written notice of such interest has been provided to the trustees and members.
(c) Each contract with a servicing organization or program manager shall include a clause stating, "Unless the trustees otherwise permit, the servicing organization (or program manager, as applicable) shall handle to their conclusion all claims and other obligations incurred during the contract period."
(d) The trustees shall notify the Department within 10 days of any determination to terminate or nonrenew any agreement with a servicing organization. The notification shall include a detailed statement that sets forth the manner and method by which claims handling and other obligations performed by the servicing organization will be provided or a statement that sets forth the reasons why the fund commissioners believe that the particular service is no longer necessary.
(e) The trustees may designate an administrator to carry out the policies established by the trustees and to provide day-to-day management of the fund. The minutes of the trustees' meetings shall detail the areas of authority delegated to the administrator.
(f) Any employee, officer or director of an administrator, servicing organization, program manager or insurance producer appointed pursuant to 11:15-5.6(e)15  shall disclose to the trustees any direct or indirect financial interest such employee, officer or director has in any other administrator, servicing organization, program manager or insurance producer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.27 - Conflict of interest

Current through Register Vol. 56, No. 14, July 15, 2024
All school officials and members of their immediate families shall comply with 18A:12-22 et seq., (the "School Ethics Act"), and any other applicable law governing the conduct of members, officers or employees of school boards.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.28 - Notice and hearings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall give prior written notice of any proposed suspension of authority, revocation, cease and desist order, or other enforcement action to the trustees or member as the case may be, or to any person to whom the proposed enforcement action applies specifically. The notice shall be served personally or by certified or registered mail upon all interested parties, shall set forth the grounds for the proposed enforcement action, and shall inform the interested party of their right to request a hearing on the proposed enforcement action.
(b) The interested party involved shall have 20 days from the mailing of the notice to request a hearing on the proposed enforcement action. Such a hearing shall be conducted in accordance with the Administrative Procedure Act, 52:14B-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1. Failure to mail a request for a hearing within the time prescribed shall result in the suspension, revocation, monetary penalty or cease and desist order becoming effective 30 days from issuance of the original notice. In no event shall any revocation become effective prior to the date that a hearing is scheduled.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.29 - Orders

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, as provided in 11:15-5.2 8, the Commissioner may issue an order revoking or suspending a fund's authority or requiring a person or fund to cease and desist from engaging in an act or practice found to be in violation of any provision of 18A:18B-1 et seq. or this subchapter.
(b) Upon a finding, after notice and opportunity for a hearing, as provided in 11:15-5.2 8, that a fund has violated any cease and desist order, the Commissioner may revoke his or her approval of the fund.
(c) Upon a finding, after notice and opportunity for a hearing, as provided in 11:15-5.2 8, the Commissioner may issue an order requiring the trustees to dismiss an administrator, servicing organization or program manager or terminate the contract of an administrator, servicing organization or program manager because of any fraud, material misrepresentation, incompetence or untrustworthiness, misappropriation or conversion of monies or violation of any fiduciary responsibilities by the administrator, servicing organization or program manager, or any of the employees, officers or directors thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.30 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
The rules contained in this subchapter and any of the provisions thereof shall be severable, and if any of its provisions shall be held to be unconstitutional or otherwise invalid, the decision of the court shall not affect the validity of the remaining rules and regulations or any of the provisions thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The subchapter sets forth the filing requirements and approval procedures for nonprofit corporation and Keys amendment facility joint insurance funds pursuant to 17:49A-1 et seq.
(b) This subchapter applies to all joint insurance funds formed pursuant to 17:49A-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.3 - Agreement to join joint insurance fund; duration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The board or owner, as appropriate, of any nonprofit corporation or Keys amendment facility may by resolution or otherwise in writing agree to join together with any other such corporation(s) or facility(ies) to establish a joint insurance fund as defined in this subchapter.
(b) The resolution shall provide for execution of a written agreement specifically conditioning membership on acceptance and adoption of the fund's bylaws. The agreement shall specify the extent of the member's participation in the fund with respect to the types of insurance coverage to be provided by the fund and shall include the duration of fund membership if applicable, and shall specify that the fund members have not been cancelled for nonpayment of insurance premiums for a period of at least two years prior to application. Members may renew their participation by the execution of a new agreement to join the joint insurance fund. In lieu of filing copies of the new agreement and indemnity and trust agreement referred to in 11:15-6.6(c)10  for each member's renewal of membership, the fund shall annually file a notice with the Department which sets forth the members that have renewed membership and the respective durations of such membership, as well as the members that have not rejoined.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.4 - General requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All monies, assessments, funds and other assets of a joint insurance fund shall be under the exclusive control of its insurance fund commission.
(b) Each joint insurance fund shall adopt a resolution designating a public depository or depositories for its monies. Such resolution shall also designate a person to be custodian of funds for the joint insurance fund and shall authorize the custodian to invest the temporarily free balances of any claim/trust or administrative accounts periodically as authorized by this subchapter. The custodian shall report to the fund commissioners at least quarterly on investment and interest income.
(c) The fund commissioners shall annually prepare in November of each year, the proposed budget for the fund's subsequent fiscal year. The budget shall identify the proposed items and amounts of expenditure for its operations in the aggregate and allocated by member; the anticipated amounts and sources of assessments and other income to be received during the fiscal year; and the status of the self-insurance or loss retention trust accounts maintained by the joint insurance fund. The budget shall be prepared on a basis that does not recognize investment income or discounting of claim reserves, but recognizes all anticipated or forecasted losses and administrative expenses associated with that fiscal year.
1. A copy of the fund's proposed budget or any amendments thereto shall be made available to each member of the joint insurance fund at least two weeks prior to the time scheduled for its adoption. No budget or amendment shall be adopted except in accordance with the procedures for such action set forth in the fund's bylaws as approved by the Commissioner, which procedures shall provide all members of the joint insurance fund the opportunity to present comments or objections.
2. Not later than December 31 of each year, the fund commissioners shall adopt by majority vote the budget for the fund's operations for the subsequent fiscal year.
3. A copy of each adopted budget shall be filed with the board or owner, as appropriate, of each participating member and the Commissioner within 30 days of its adoption, including a certification by an actuary that the budget is actuarially sound with respect to funding for the claim or loss retention fund accounts.
4. An adopted budget may be amended by majority vote of the membership of the joint insurance fund.
5. A copy of any amendment to a fund budget shall be filed quarterly with the board or owner of each participating member.
6. A copy of any amendment to a fund budget shall be filed with the Commissioner within 30 days of adoption of any budget amendment which either singly or cumulatively with other adopted budget amendments changes the total budget five percent from the original budget or the latest filed amended budget.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.6 - Bylaws and plan of risk management; contents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The commissioners shall prepare and, after the approval by resolution of the board or owner of each participating member, shall adopt bylaws for the joint insurance fund. The bylaws shall include, but not be limited to:
1. Procedures for the organization and administration of the joint insurance fund, the insurance fund commissioners and alternates and, if appropriate, the executive committee of the fund and alternates. The procedures may include the designation of one participating member to serve as the lead agency to be responsible for the custody and maintenance of the assets of the fund and such other duties as may be assigned by the fund commissioners;
2. Procedures for the assessment of members for their contributions to the fund and for the collection of contributions in default;
3. Procedures for the establishment, maintenance and administration of appropriate reserves in accordance with sound actuarial principles;
4. Procedures for the purchase of direct insurance or reinsurance, if any;
5. Contingency plans for paying losses in the event that the fund is exhausted, including provision for supplemental assessments as provided at 11:15-6.1 6;
6. Procedures governing loss adjustment and legal fees;
7. Procedures for the joining of the fund by non-members;
8. Procedures in compliance with 11:15-6.1 0 for the withdrawal or expulsion from the fund by a member, including any requirement that a terminated or withdrawing member provide security in a form and an amount acceptable to the Commissioner and fund commissioners as applicable, as a guarantee for the continued payment of the member's obligations pursuant to 11:15-6.1 0(c);
9. Procedures for the termination and liquidation of the joint insurance fund and the payment of its outstanding obligations; and
10. Procedures governing trust fund accounts, including transfers, withdrawals and distribution of surplus therefrom and supplemental assessments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.7 - Disapproval of bylaws and risk management program

Current through Register Vol. 56, No. 14, July 15, 2024
If the Commissioner determines that the bylaws or plan of risk management of the fund or any subsequent amendments thereto do not contain all of the information set forth in 11:15-6.6, are not submitted in the proper format set forth in 11:15-6.5, or otherwise do not meet the requirements of 17:49A-1 et seq., or this subchapter, the Commissioner shall disapprove the bylaws or plan of risk management and notify the fund in writing, which notice shall contain the specific reasons for disapproval, and the requirements to be met before approval may be granted. If not disapproved by the Commissioner within 30 working days of receipt of the bylaws and plan of risk management or any amendments or changes thereto, which contain all of the information and documentation set forth in N.J.A.C. 11:15-6.6, in the format set forth in N.J.A.C. 11:15-6.5, and which meet the requirements of 17:49A-1 et seq., and this subchapter, the bylaws and program shall be deemed approved.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.8 - Revocation of approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, the Commissioner may suspend or terminate the authority of any fund, or direct or take any action deemed necessary for good cause, to enable a fund to meets its obligations, cover its expected losses, or to liquidate, rehabilitate or otherwise modify its affairs if a fund:
1. Is found to be insolvent or has experienced a deterioration in financial condition to the extent that it causes or may cause an adverse effect upon the ability of the fund to pay expected losses;
2. Fails to timely pay any fee or assessment;
3. Fails to pay any claim within 30 days after a final judgment is rendered against the fund or the fund's obligation for such claim otherwise becomes final;
4. Fails to comply with any of the provisions of 17:49A-1 et seq. or this subchapter, or with any lawful order of the Commissioner within the time prescribed; or
5. Fails to follow its approved bylaws or risk management program.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.9 - Approval of non-members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prospective new members of the fund shall submit an application for membership to the fund's commissioners on a form acceptable to the Commissioner. The application shall include a copy of the resolution of participation and executed indemnity and trust agreement. The commissioners may approve or disapprove the application for additional members, pursuant to the bylaws of the fund.
(b) Any application approved by the fund shall within 15 days of approval by the fund be filed with the Department and shall be accompanied by a revised budget with assessment detail, if otherwise required pursuant to 11:15-6.4(e), an actuarial statement regarding the adequacy of the member's assessment to cover anticipated losses, and any amendments to the fund's bylaws and plan of risk management as may be necessary. The fund shall file only the specific changes to the bylaws or plan of risk management in effect for the current fund year. Where a fund purchases direct insurance, or where an actuary has determined a "per capita" rate for the member's assessment to cover anticipated losses which has been previously filed with the Department, actuarial certification of the adequacy of these same rates for each new member is not required. The Commissioner may nevertheless require actuarial certification of a per capita rate for the new member's assessment to cover anticipated losses if, in his or her opinion, the new member will impose an extraordinary impact on the exposure of the fund. In addition, the fund shall file the following information in the form of Exhibit D in the chapter Appendix incorporated by reference with the Department within 15 days after approval of a new member:
1. The name and address of new member;
2. The effective date of coverage;
3. The name of new member's risk manager;
4. The name of new member's fund commissioner;
5. The lines of coverage for which the new member participates;
6. The amount of assessment, if not otherwise provided, and
7. An affirmative statement from the fund that in accepting the new member, an application has been filed, the fund has adhered to its bylaws and plan of risk management, and the agreement to participate and indemnity and trust agreement have been filed with the fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.10 - Termination and/or withdrawal of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A member of the fund shall remain a member for the full term of membership, as provided in the fund's bylaws, unless earlier terminated by the fund for nonpayment of assessments, noncompliance with risk management or underwriting standards, or for other reasons subject to prior approval by the Commissioner as causes for expulsion. However, such member shall not be deemed terminated for any reason until:
1. After 30 days written notice of the intention to terminate the member has been given by the fund to the member, which notice shall state the reasons for termination and shall be given by registered mail or certified mail, return receipt requested;
2. Like notice shall have been filed with the Department, together with a certified statement that the notice provided for by (a)1 above has been given; and
3. Thirty days have elapsed after the filing required by (a)2 above has been made.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.11 - Insolvency and/or bankruptcy of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
The insolvency or bankruptcy of a member does not relieve the fund or any other member of joint and several liability for the payment of any claims incurred by the member during the period of its membership, including, but not limited to, being subject to and liable for supplemental assessments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.12 - Voluntary dissolution of a fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A fund may not voluntarily dissolve or otherwise cease to do business and distribute its assets to its members, unless and until it satisfies the following requirements:
1. A majority of the fund's members shall have voted in favor of a resolution to dissolve the fund, pursuant to a written plan adopted pursuant to the procedures set forth in the fund's bylaws, at a meeting duly called for such purposes;
2. The plan of dissolution must provide for the payment of all unpaid losses of the fund and its members, including all incurred but not reported losses, as certified by an actuary, before any assets of the fund or the trust fund accounts may be used for any other purpose;
3. The plan of dissolution shall contain a statement of the fund's current financial condition computed according to generally accepted accounting principles as attested to by an independent certified public accountant; and
4. The plan of dissolution, and such other information as may be required, shall be filed with and approved in writing by the Commissioner. The plan shall be filed with the Commissioner not later than 90 days prior to the proposed effective date of dissolution.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.13 - Establishment of trust fund accounts; transfers or withdrawals prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to the terms of the indemnity and trust agreement, each fund shall establish a separate trust fund account in accordance with 11:15-6.6(b)10  from which monies shall be disbursed solely for the payment of claims, allocated claim expenses and excess insurance or reinsurance premiums for each type of liability or risk retained jointly on a self-insured basis. Such accounts shall be designated as claims or loss retention fund accounts.
1. Other than for the purposes specified in (a) above, or as otherwise authorized by this subchapter, no withdrawal may be effected from a claim or loss retention fund without the prior written approval of the Commissioner, except for intertrust fund transfers. Intertrust fund transfers, within a fund's fiscal year, may be conducted by the fund at any time, by providing 30 days prior written notification to the Commissioner. If the Commissioner does not disapprove of the transfer, in writing, within 30 days after receiving such written notification, the request for intertrust fund transfer(s) shall be deemed approved. Any intertrust fund transfer request shall be supported by appropriate assessment and claim and expense documentation, and be accompanied by a certification signed by an actuary that the amount remaining in the trust fund account after the intertrust fund transfer will be at a level which is reasonable in relation to that account's unpaid losses, along with all documentation in support of such certification. Intertrust fund transfers may be conducted only where each member participates in each and every claim or loss retention fund account during that fund year. The Commissioner shall waive the full participation requirement provided the fund demonstrates to the Department that it maintains records of each member's pro rata share of each claim or loss retention fund account for that year, and that the transfer shall be made so that any potential dividend shall not be reduced for a member that did not participate in the account receiving the transfer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.14 - Administrative account

Current through Register Vol. 56, No. 14, July 15, 2024
Each fund shall establish an administrative account for each fund year which shall be utilized for payment of the fund's general operating expenses, including, but not limited to, loss prevention activities, data processing services and general legal expenses. A fund shall not be required to establish a separate administrative account by fund year, provided the fund provides a plan in its bylaws which provides for the recording and accounting of all transactions by fund year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.15 - Assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each participating member of a joint insurance fund shall pay to the fund its assessments as required by the joint insurance fund. During the first year of operation of a joint insurance fund these contributions shall be paid in two equal installments, the first installment payable no later than January 15 and the second installment payable no later than May 15 or in any other manner that the Commissioner in his discretion may direct. Subsequent years' assessments may be paid in such installments as shall be provided in the fund's bylaws, provided, however, that the full assessment shall be paid by each member no later than August 1 or in such other manner as provided in the fund's bylaws as approved by the Commissioner.
(b) Each member's annual assessment shall consist of an amount allocated for the administrative account, contingency trust fund account where appropriate, a specific assessment to establish and/or replenish the claim or loss retention trust fund account for each type of coverage provided by the fund and in which such member participates, plus an assessment to establish a surplus in each claim or loss retention trust fund account established in an amount equal to 20 times the maximum per occurrence loss limitation for the applicable line of coverage.
1. Notwithstanding (b) above, the surplus requirement shall not be required to be greater than an amount equal to the difference between the attachment point for aggregate excess insurance and the fund's budgeted losses for the immediately preceding fund year for the applicable line of coverage.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.16 - Supplemental assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each fund shall levy upon its members an additional assessment whenever needed or so ordered by the Commissioner, to supplement the fund's claim or loss retention or administrative accounts to assure maintenance of required surplus pursuant to 11:15-6.1 5(b) and payment of the fund's obligations, including payment of benefits under the workers' compensation law.
1. The fund shall assess each participating member an additional proportionate amount, as provided in the fund's bylaws and plan of risk management or as directed by the Commissioner, to replenish claims or loss retention or administrative accounts.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.17 - Failure or refusal to provide required assessments

Current through Register Vol. 56, No. 14, July 15, 2024
Should any member of a fund fail or refuse to pay as directed its assessment(s) to the fund or to pay as directed any supplemental assessment(s), or should the fund commissioners fail to assess funds required to meet the obligations of the fund, the chairman of the fund commission, if any, or in the event of his or her failure to do so, the custodian of the fund's assets, shall notify the Commissioner in writing. Upon such notification, the Commissioner shall order the fund or member to take such remedial action as he or she deems necessary.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.18 - Certification of funds

Current through Register Vol. 56, No. 14, July 15, 2024
Prior to any commitment or agreement requiring the expenditure of funds by the joint insurance fund, the custodian of the fund's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.19 - Investments; application of investment income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The free balance of any account maintained by a joint insurance fund, whether for claim or loss retention, administrative, or contingency, shall be invested to obtain the maximum interest return practicable. All investments shall be made in accordance with the fund's cash management plan. A fund shall invest its funds only in such investments as are authorized by the laws of this State for funds formed by local units of government or school boards pursuant to N.J.A.C. 11:15-2 or 4, respectively.
(b) The investment and interest income earned by the investment of the assets of each claim or loss retention fund account shall be allocated to each such account by fund year.
(c) The investment and interest income earned by investment of the assets of the administrative account shall be credited to that account.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.20 - Refunds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any monies for a fund year in excess of the amount necessary to fund all obligations for that fiscal year as certified by an actuary may be utilized to satisfy the surplus requirements set forth in 11:15-6.1 5(b) for the subsequent fiscal year immediately after the end of the current fiscal year, and otherwise may be declared to be refundable by the fund not less than 24 months after the end of the fiscal year.
(b) The fund may seek approval from the Commissioner to make initial refund payments from a claims or loss retention fund account remaining from any year which has been completed at least 24 months, or immediately after the end of a fund year if utilized solely to satisfy surplus requirements for a subsequent fund year, by submitting a written request to the Department with appropriate documentation including, but not limited to, assessment, claims and expense detail; actuarial certification that the loss and loss expense reserves are adequate for the fund to have an overall surplus for that fiscal year; and such other information that the Commissioner may require. The initial and any subsequent refund for any year from a claim or loss retention trust account may be in any amount subject to the limitation that after the refund, the remaining net current surplus in the account from which the refund is made must equal or exceed the surplus retention requirement to be calculated as follows:
1. Fund year paid losses shall be multiplied by the appropriate paid loss factor for the line of coverage and duration of maturity set forth in Exhibit H in the chapter Appendix incorporated herein by reference;
2. Fund year unpaid claim reserves, excluding reserves for incurred but not reported claims, shall be multiplied by the appropriate unpaid claim factor for the line of coverage and duration of maturity set forth in Appendix Exhibit H. Unpaid claim reserves, excluding reserves for incurred but not reported claims, shall be established at full value and not discounted, and shall be so certified by an actuary.
3. The greater of the results from the calculation set forth in (b)1 and 2 above shall then be reduced by the account of outstanding losses reported, including incurred but not reported claims. The result of this calculation shall be the surplus retention requirement for that fund year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.21 - Disbursements and/or payment of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All disbursements, payment of claims settlements or other expenditure of funds of the joint insurance fund whether for administrative expenses or for claims purposes shall be approved by a majority of the fund commissioners or executive committee, as applicable, unless approved pursuant to (b) below.
(b) To allow the expeditious resolution of certain claims, the fund commissioners may designate the fund's administrator or servicing organization as a "certifying and approving officer." The certifying and approving officer may be authorized by the fund commissioners to approve for payment of any or specified types of claims in an amount not to exceed an amount approved by the Commissioner in the plan of risk management. The authority of the certifying and approving officer may be conditioned or restricted by the fund commissioners to require prior consultation, limitation as to the types or total amount of claims or payments which may be approved, or such other procedures or restrictions as the fund commissioners may deem appropriate. The authority of the certifying and approving officer may be revoked or modified at any time by the fund commissioners.
1. Upon approval, the certifying and approving officer shall certify the amount and particulars of such approved claims to the official having custody of the fund's assets, directing that a check for payment be prepared.
2. The certifying and approving officer shall prepare a report of all claims approved by him or her since the last such report, detailing the nature and amount of the claim, the payee, the reasons supporting payment and any other pertinent information. This report shall be submitted to the fund commissioners at their next scheduled meeting. The fund commissioners shall review and approve the actions of the certifying and approving officer. In the event a claim approved and paid by the certifying and approving officer is not approved by the fund commissioners, they shall direct appropriate action to be taken.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.22 - Excess insurance and/or reinsurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Consistent with 11:15-6.6(a)6, each fund providing primary or underlying coverage on a self-insured or commercially insured basis shall secure excess insurance or reinsurance in a form, in an amount and by an insurer, or other entity authorized to provide such coverage in this State pursuant to law, acceptable to the Commissioner, if commercially available and not unreasonably priced, as determined by the fund commissioners for each fund year, and as approved by the Department.
1. Any approval by the Department pursuant to (a) above shall be for a period not to exceed either the longer of 12 months from the date of approval or the end of the next succeeding fund year. Any fund seeking to extend the period of the approval shall notify the Department not later than 45 days prior to the expiration of the term of the approval. The notification shall specify the basis upon which the fund commissioners have determined that excess insurance or reinsurance required pursuant to (a) above is not commercially available or is not reasonably priced, and shall include all actions taken by the fund to obtain required excess insurance or reinsurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.23 - Financial statement and reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An annual certified report in a form acceptable to the Commissioner shall be prepared by each fund, filed with the Department, and made available to each fund member on or before April 1 of each year. The report shall include:
1. An annual audited statement of the financial condition of the fund prepared by an independent certified public accountant and performed in accordance with generally accepted accounting principles, which shall include a statement of the organization of the fund indicating the persons who perform each function for the fund and the relationship and interdependency of each function, and including its balance sheet and receipts and disbursements for the preceding year;
2. Reports of outstanding liabilities by line of coverage showing the number of claims, amounts paid to date and current reserves for unpaid losses, claims and unearned assessments as certified by an actuary;
3. A certification by the chairman or administrator that periodic reports were made to fund members in the form and manner required by 11:15-6.4(h);
4. Any material changes in information from that previously submitted; and
5. Such other information as may be requested by the Department from a particular fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 6 - JOINT INSURANCE FUNDS FOR NONPROFIT CORPORATIONS AND KEYS AMENDMENT FACILITIES › Section 11:15-6.24 - Examination of funds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to any examination conducted pursuant to 11:15-6.6(g), the Commissioner may conduct an examination of any fund as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the fund may be insolvent or in a financial condition detrimental to its members or the public. It shall be the duty of the fund members, commissioners, executive committee, administrator and chairman to notify the Commissioner of any information indicating that any fund may be in a financial condition detrimental to the fund's members or the public.
(b) The fund's members, commissioners, or executive committee, if any, may, upon majority vote, request that the Commissioner order an examination of the fund, or any fund member, which they, in good faith, believe may be in a financial condition detrimental to other fund members or to the public.
(c) Any examination made pursuant to 17:49A-14 and this subchapter shall be conducted in accordance with the procedures set forth in 11:15-6.6(g).