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New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 10 - DENTAL SERVICES › Subchapter 2 - EMPLOYEE'S DENTAL BENEFIT PLANS; ALTERNATE COVERAGE › Section 11:10-2.5 - General rules

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each health insurer, dental service corporation, or dental plan organization shall, at the time a dental plan contract is offered or at the time of renewal, obtain written verification from each employer or other organization of compliance with P.L. 1983, c. 142 through 145, and this subchapter.
(b) Each employer or other organization, at the time of offering or renewal of a dental plan contract shall furnish to the health insurer, dental service corporation, or dental plan organization written verification of compliance with P.L. 1983, c. 142 through 145 and this subchapter.
(c) Each employer or other organization at the time of offering or renewal of a dental plan contract shall provide in the written notice required by 11:10-2.4(b) and (c) an outline of the differences in coverages and cost to the employee or members and their eligible dependents between a dental plan contract and the alternative coverage.
(d) The alternative coverage may be provided through an insurance contract, on a self-funded basis, or by any means which meets the approval of the Commissioner.
(e) Any alternate coverage offered through an insurance contract that is intended to be sold as a pediatric dental plan to satisfy the Essential Health Benefits requirement of 45 CFR 156.110(a)(10) must provide pediatric dental coverage as set forth in N.J.A.C. 11:10-1.6(k).
(f) Each employer or other organization shall contribute to the alternative coverage an amount equal to the premium or cost which it pays or contributes to the dental plan contract. Such contribution shall be adjusted when the premium or cost which it pays or contributes to the dental plan changes.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 10 - DENTAL SERVICES › Subchapter 2 - EMPLOYEE'S DENTAL BENEFIT PLANS; ALTERNATE COVERAGE › Section 11:10-2.6 - Separability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter, or its application to any person or circumstances, is held invalid, the remainder of this subchapter and its application to other persons or circumstances shall not be affected.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 12 - LEGAL INSURANCE › Subchapter 1 - INSURERS AUTHORIZED TO TRANSACT THE BUSINESS OF LEGAL INSURANCE › Section 11:12-1.2 - Authorization of insurers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An insurer defined in 17:46C-3.b may transact the business of legal insurance in New Jersey after satisfying the following conditions:
1. Notify the Commissioner of the intent to write legal insurance, submit satisfactory evidence of authorization to transact the business of legal insurance, and, for insurers not already entitled to transact the business of insurance under Subtitle 3 of Title 17 of the Revised Statutes or Subtitle 3 of Title 17B of the Revised Statutes, pay the required fee of $ 250.00. Such evidence shall include proof of the necessary corporate power to transact the business of legal insurance.
2. Submit to and have approved by the Commissioner a copy of the policy and certificate forms to be used.
3. Submit to and have approved by the Commissioner the rating system upon which the legal insurance rates will be based. The Commissioner has determined not to allow a file and use rating procedure at this time.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 12 - LEGAL INSURANCE › Subchapter 1 - INSURERS AUTHORIZED TO TRANSACT THE BUSINESS OF LEGAL INSURANCE › Section 11:12-1.3 - Experience reports

Current through Register Vol. 56, No. 14, July 15, 2024
An insurer transacting legal insurance in New Jersey shall submit experience reports on or before the first day of March which will be based on activities up through the prior December 31 on a form to be prescribed by the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 12 - LEGAL INSURANCE › Subchapter 1 - INSURERS AUTHORIZED TO TRANSACT THE BUSINESS OF LEGAL INSURANCE › Section 11:12-1.4 - Annual reports

Current through Register Vol. 56, No. 14, July 15, 2024
An insurer who obtains a certificate of authority under 17:46C-4 shall submit an annual report on or before the first day of March on a form to be prescribed by the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 1 - GENERAL PROVISIONS › Section 11:13-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
The Commercial Insurance Deregulation Act of 1982 (N.J.S.A. 17:29AA-1 et seq.) establishes a separate rating law for commercial lines insurance and exempts such lines from the provisions of N.J.S.A. 17:29AA-1 et seq. except as provided by the Act. This chapter provides rules for the implementation of the Act.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 1 - GENERAL PROVISIONS › Section 11:13-1.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter applies to all policies or contracts of insurance issued by a licensed insurer pursuant to Title 17 of the Revised Statutes except:
1. Ocean marine, title, mortgage guaranty, workers' compensation and employers' liability, and policy or contract of reinsurance, other than joint reinsurance, as provided for in section 22 of the Commercial Insurance Deregulation Act of 1982, insurance written through the New Jersey Medical Malpractice Reinsurance Association, insurance written through the New Jersey Insurance Underwriting Association, and the insurance issued by hospital service or medical service corporations;
2. Insurance issued for personal, family or household purposes;
i. Examples of policies of insurance issued for personal, family or household purposes are:
(1) Policies used solely to provide homeowners insurance, dwelling fire insurance on one to four family units, or individual fire insurance on dwelling contents;
(2) Policies principally used to provide primary insurance on private passenger automobiles that are individually owned and used for personal or family needs;
(3) Policies of personal inland marine, personal theft, residence glass, personal liability insurance and personal excess; and
(4) Policies of self-storage personal property insurance as defined at 11:17-1.2.
ii. Insurance issued for personal, family or household purposes does not include insurance used to cover business, professional or other commercial risks, such as farmowners, businessowners and commercial multi-peril policies.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 1 - GENERAL PROVISIONS › Section 11:13-1.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this chapter, have the following meanings unless the context clearly indicates otherwise.
"Advisory organizations" means any group, association or other organization of insurers, whether located within or outside this State, that assists insurers or rating organizations in ratemaking, by the collection and furnishing of loss or expense statistics.
"Commissioner" means the Commissioner of Banking and Insurance.
"Department" means Department of Banking and Insurance.
"Farmowners insurance" means a policy of insurance issued to the owner(s) of property used for agricultural purposes, which may include property coverages on dwellings, farm buildings and personal property including household property, farm equipment, livestock, farm produce and supplies; and farmers comprehensive personal liability coverages against liabilities as the owner of the farm property and operator of the farming enterprise. As defined herein, farmowners insurance is reported on the statutory Annual Statement as "Farmowners Multi Peril".
"Insurer" means any person, corporation, company, association, joint underwriting association, partnership, or any other legal entity licensed under the laws of this State to transact the business of insurance in this State.
"Policy" means any contract of insurance subject to this chapter and includes, but is not limited to, all policies, contracts, certificates and endorsements.
"Rating Organization" means every person or persons, corporation, partnership, company, society or association engaged in the business of rate-making for two or more insurers.
"Special Risks" means:
1. Commercial lines insurance risks as specified on a list promulgated by the Commissioner, which are of an unusual nature or high loss hazard or are difficult to place or rate or which are excess or umbrella or which are eligible for export;
2. Inland marine insurance, other than personal lines (The 1976 Revision of the Nation-wide Marine Definition, adopted by the National Association of Insurance Commissioners, has been adopted by the State of New Jersey. This instrument describes, although not exclusively, the kinds of risks which may be classified or identified as inland marine insurance.);
3. Fidelity, surety or forgery bonds; or
4. Commercial lines insurance risks which produce minimum annual premium in excess of $ 10,000 as specified in N.J.A.C. 11:13-4.
"Supplementary rate information" includes any manual or plan of rates, statistical plan, classification, rating schedule, rating rule and any other rule used by an insurer in making rates.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 1 - GENERAL PROVISIONS › Section 11:13-1.4 - Rate and policy form requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to N.J.S.A. 17:29AA-10, rates shall not be made or used which are excessive, inadequate or unfairly discriminatory.
(b) Pursuant to N.J.S.A. 17:29AA-11 policy forms shall not be unfair, inequitable, misleading or contrary to law, nor shall they produce rates, which are excessive, inadequate or unfairly discriminatory.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 1 - GENERAL PROVISIONS › Section 11:13-1.5 - Separability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this chapter, or its application to any person or circumstances is held to be invalid, the remainder of this chapter and its application to the other persons or circumstances shall not be affected.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 2 - COMMERCIAL LINES FILINGS › Section 11:13-2.1 - Filing of rates, supplementary rate information, and policies

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth procedures and requirements for the filing of commercial lines rates, supplementary rate information and policies. The requirements of this subchapter shall not be applicable to:
1. Policy forms exempted by order of the Commissioner; or
2. Rates, supplementary rate information or policy forms used in connection with any special risk provided, however, that policy forms which are used in connection with commercial lines risks producing a minimum annual premium in excess of $ 10,000 as described under 11:13-4.1(a)4  and which are not otherwise described as special risks shall be subject to the requirements and filing procedures found in this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 2 - COMMERCIAL LINES FILINGS › Section 11:13-2.2 - Filing of changes

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Filings containing changes in rates, supplementary rate information, including any manual rules or plans, or in policy forms or endorsement required to be filed with the Department shall be presented in the following fashion:
1. A copy of the page or pages containing the passage for which a change is proposed shall be filed in such form that the text is self-contained without need to refer to material not included in the filing. Matter to be changed or omitted by the filing shall be identified, preferably by marking the passages to be changed with a marking pencil; where matter is to be added, a mark ( ) shall so indicate.
2. A memorandum shall be filed reciting the rule or section of form to be changed, properly referenced as to the manual or form, with newly added matter underlined and matter to be eliminated in brackets [].
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 2 - COMMERCIAL LINES FILINGS › Section 11:13-2.3 - Adoption or rates, supplementary rate information or policies of other filers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If a filer adopts rates or supplementary rate information used by other filers or proposes to adopt policy forms or endorsements previously approved (or deemed approved) for other filers in New Jersey, the filing shall clearly identify such reference including the name of the filer and, if applicable, the date such filings were approved in this State, including any amendments thereof. The Department staff will give reasonable assistance to a filer in obtaining such information to the extent that it is a public record:
1. If the proponent only wishes to adopt the filing with a different effective date, the filing shall clearly identify the rating organization's or advisory organization's file number but shall not include a copy of the material referred to.
i. If the proponent wishes to adopt such filing material with some exceptions, he shall clearly identify such reference and shall submit copies of only those pages containing such exceptions.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 2 - COMMERCIAL LINES FILINGS › Section 11:13-2.4 - New filings

Current through Register Vol. 56, No. 14, July 15, 2024
Policy forms and supplementary rate information such as manual rules or rating plans are rarely entirely new. Most such filings are built upon something previously or currently in use. Any required action with respect to such filings will be expedited if they are identified as to their foundation. Filings shall not be identified as new filings if they properly fall under the categories discussed under 11:13-2.2 and 2.3.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 4 - SPECIAL RISKS › Section 11:13-4.1 - Special risks

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth procedures and requirements which are applicable to various categories of commercial lines risks herein designated as special risks pursuant to section 3.k of Commercial Insurance Deregulation Act of 1982. Such special risks are:
1. Commercial lines insurance risks as specified on a list promulgated by the Commissioner which are of an unusual nature or high loss hazard or are difficult to place or rate or which are excess or umbrella, or which are eligible for export;
2. Inland marine insurance, other than personal inland marine;
3. Fidelity, surety or forgery bonds; or
4. Commercial lines insurance risks which produce minimum annual premium in excess of $ 10,000. Only premiums generated by coverages subject to the Commercial Insurance Deregulation Act of 1982 shall be used in determining whether a risk generates a premium sufficient to qualify under this paragraph. Risks producing a minimum annual premium in excess of $ 10,000 shall be:
i. A single risk which generates annual premium in excess of $ 10,000 written under a single policy.
ii. A single risk which generates annual premium in excess of $ 10,000 written under more than one policy if all are written by the same insurer or group.
iii. A risk written under a single policy covering more than one risk which policy generates an annual premium in excess of $ 10,000.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 4 - SPECIAL RISKS › Section 11:13-4.2 - Reporting requirements

Current through Register Vol. 56, No. 14, July 15, 2024
The Commissioner may require the filing of such additional reports, including expense statistics with respect to special risks written by insurers, as he deems necessary to implement the provisions of the Commercial Insurance Deregulation Act of 1982 and this chapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 4 - SPECIAL RISKS › Section 11:13-4.3 - Examination

Current through Register Vol. 56, No. 14, July 15, 2024
The underwriting files, premium, loss and expense statistics, financial and other records with respect to special risks written by an insurer shall be maintained in such detail as may be required by the Commissioner and shall be subject to examination by the Commissioner or his designee in the State as often as deemed necessary by the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 5 - PROCEDURE FOR THE REGULATION OF CONSENT TO HIGHER RATE FILINGS › Section 11:13-5.1 - Higher rate filings

Current through Register Vol. 56, No. 14, July 15, 2024
(a)N.J.A.C. 11:4-7 including all subsequent amendments and supplements is hereby adopted as a rule with the modification indicated in (b) below.
1. This document is available for review at or may be purchased from the New Jersey Department of Banking and Insurance, 20 West State Street, PO Box 325, Trenton, New Jersey 08625.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 6 - COMMERCIAL INSURANCE RATING PLANS › Section 11:13-6.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter establishes standards for commercial insurance rating plans to modify rates in the development of premiums for specific risks.
(b) These standards are intended to:
1. Recognize expected loss differentials based on factors applied using sound underwriting principles;
2. Promote competition among insurers in the rating of individual commercial risks;
3. Promote fair and equitable treatment of insureds; and
4. Encourage loss control and safety measures.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 6 - COMMERCIAL INSURANCE RATING PLANS › Section 11:13-6.2 - 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.
"Base rate" means the unit charge by which the measure of exposure or the amount of insurance specified in a policy of insurance or covered thereunder is multiplied to determine the premium, which rate is filed with the Commissioner pursuant to N.J.S.A. 17:29AA-5.
"Commercial insurance rating plan" includes any plan of rates and rules for the adjustment of premiums from base rates for commercial lines insurance coverages.
"Commercial lines insurance" includes all insurance policies so defined in N.J.S.A. 17:29AA-3a.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Filer" means a rating organization or advisory organization or any insurer making its own rates and proposing to establish a new rate, a rate change, or a rating rule.
"Policy" means any contract of commercial lines insurance including, but not limited to, all policies, contracts, certificates and endorsements.
"Supplementary rate information" includes any manual or plan of rates, statistical plan, classification, rating schedule, rating rule and any other rule used by an insurer in making rates.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 6 - COMMERCIAL INSURANCE RATING PLANS › Section 11:13-6.3 - Commercial insurance rating plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Filers may submit commercial insurance rating plans that provide for modification of rates in the development of premiums for specific risks.
(b) A commercial insurance rating plan shall be filed with the Commissioner in accordance with N.J.S.A. 17:29AA-5 and this subchapter.
(c) No insurer shall charge or collect from any insured a premium for any commercial lines insurance policy that deviates from the base rates filed with the Commissioner, except in accordance with a commercial insurance rating plan filed with the Commissioner in accordance with this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 6 - COMMERCIAL INSURANCE RATING PLANS › Section 11:13-6.4 - Elements of plan

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A commercial insurance rating plan shall consist of rating rules that set forth the following:
1. The criteria for an insured's eligibility for premium modification as described in the plan;
2. A list or lists of underwriting factors and such descriptive statements or explanations as may be necessary to understand the application or use of each factor;
3. The maximum debit for each factor;
4. The maximum credit for each factor; and
5. The total maximum debits and credits for all factors combined.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 6 - COMMERCIAL INSURANCE RATING PLANS › Section 11:13-6.5 - Standards for commercial insurance rating plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Underwriting factors described in the plan shall be reasonably related to an increase or decrease in the risk expected.
(b) Maximum debits for each underwriting factor in the plan shall equal maximum credits for each underwriting factor in the plan on a percentage basis except when equal maximum credits and debits are clearly not appropriate and the filer of the plan provides a written explanation.
(c) An individual risk premium modification plan shall provide for a maximum 25 percent debit or credit from base rates for any single policy. This limitation shall not apply to experience and retrospective rating plans or expense modifications.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 6 - COMMERCIAL INSURANCE RATING PLANS › Section 11:13-6.6 - Application or use of commercial insurance rating plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Commercial insurance rating plans shall not be used in a manner that results in excessive, inadequate or unfairly discriminatory rates.
(b) Commercial insurance rating plans shall be applied uniformly to all insureds who qualify for debits or credits in accordance with the plan as filed.
(c) No individual policy premium shall be modified until the debits and credits applicable to both risk and expense modification in accordance with the commercial insurance rating plan are determined by an inspection of the property.
(d) Insurers shall develop and retain information in their underwriting file about the application of a commercial insurance rating plan to any modification of an individual policy premium. This shall include any information used to determine the eligibility for debit or credit in accordance with the filed plan, such as inspection reports, photographs, results of engineering or professional evaluations, claim history, etc.
(e) Insurers shall make this information available for examination by the Department, or supply it to the Department within 10 days of receipt of a written request.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 7 - COMMERCIAL LINES INSURANCE: POLICY FORM STANDARDS › Section 11:13-7.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) These rules interpret provisions of the Commercial Insurance Deregulation Act, N.J.S.A. 17:29AA-1 et seq. and set standards for the acceptance or disapproval of policy forms submitted pursuant to N.J.S.A. 17:29AA-6. These standards are established pursuant to N.J.S.A. 17:29AA-11, which prohibits forms which are unfair, inequitable, misleading or contrary to law, or which produce rates that are excessive, inadequate or unfairly discriminatory.
(b) These rules do not apply to policy forms not required to be submitted by N.J.S.A. 17:29AA-6, which with some exceptions does not require the filing of policy forms insuring "special risks" as defined in N.J.S.A. 17:29AA-3k. These rules do not apply to policy forms issued by eligible surplus lines insurers in accordance with the Surplus Lines Law, N.J.S.A. 17:22-6.4 0 et seq. Nothing in these rules shall, however, authorize the acceptance or use, or prohibit the disapproval, of a policy form that is otherwise prohibited by another law or rule.
(c) These rules apply to all insurers which file policy forms pursuant to N.J.S.A. 17:29AA-6.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 7 - COMMERCIAL LINES INSURANCE: POLICY FORM STANDARDS › Section 11:13-7.2 - 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.
"Commercial lines insurance" includes all property-casualty insurance policies except those excluded by N.J.S.A. 17:29AA-3a and N.J.A.C. 11:18-1.1.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Cost of legal defense" or "defense costs" means allocated attorney and all other litigation expenses that can be separately identified as arising from the defense of a specific claim.
"Day" means calendar day.
"Insurer" means any person, corporation, association, joint underwriting association subject to N.J.S.A. 17:29AA-22, partnership or company licensed under the laws of this State to transact the business of insurance and rating organizations that file policy forms on behalf of their members and subscribers.
"Liability insurance policy" means any insurance policy that provides coverage for legal liability, even if it contains other types of coverage.
"Policy" or "insurance policy" includes all endorsements.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 7 - COMMERCIAL LINES INSURANCE: POLICY FORM STANDARDS › Section 11:13-7.3 - Defense costs within policy limits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No commercial insurance policy shall be issued or renewed on a form required to be filed pursuant to N.J.S.A. 17:29AA-1 et seq. which contains a provision that includes defense costs within policy limits, except as provided in this section.
1. Regardless of whether the policy form provides defense costs within or outside of policy limits, no defense costs shall be charged against any deductible amount.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 7 - COMMERCIAL LINES INSURANCE: POLICY FORM STANDARDS › Section 11:13-7.4 - Exclusions from coverage for lead liability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Department shall approve policy forms filings that include policy provisions or rating rules as follows:
1. That the lead liability exclusion applies only if the covered premises were constructed prior to 1978; and
2. That the insurer be required to offer liability coverage for lead paint or lead contamination if the premises covered by such policy has been certified as being free of existing lead hazards pursuant to standards to be established by the Department of Community Affairs.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 8 - COMMERCIAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:13-8.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter establishes data requirements and procedures for member/subscriber insurers in rating organizations or advisory organizations to adopt or modify a rating organization's or advisory organization's prospective loss cost filing for commercial lines insurance made pursuant to N.J.S.A. 17:29AA-1 et seq.
(b) This subchapter applies to all rating organizations or advisory organizations which filed prospective loss costs and all insurer filings which adopt or modify a rating organization's or advisory organization's prospective loss cost filing for commercial lines insurance made pursuant to N.J.S.A. 17:29AA-1 et seq.
(c) All filings made pursuant to this subchapter shall be made in accordance with N.J.A.C. 11:1-32.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 8 - COMMERCIAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:13-8.2 - 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.
"Expenses" means that portion of a rate attributable to commissions and brokerage, other acquisition expenses, general expenses, taxes, licenses, and fees.
"Loss costs multiplier" means the adjustment reflecting expenses, profit loading and any modifications that the insurer uses on the loss cost to produce final rates.
"Minimum premium" means the smallest amount of premium for which an insurer will issue coverage under a given policy.
"Prospective loss costs" means that portion of a rate that does not include provisions for expenses (other than loss adjustment expenses) or profit, and are based on historical aggregate losses and loss adjustment expenses adjusted through development to their ultimate value and projected through trending to a future point in time.
"Rate" means the unit charge by which the measure of exposure or the amount of insurance specified in a policy of insurance or covered thereunder is multiplied to determine the premium.
"Rating organization" means every person or persons, corporation, partnership, company, society, or association engaged in the business of ratemaking for two or more insurers.
"Supplementary rate information" means any manual or plan of rates, statistical plan, classification, rating schedule, rating rule, and any other rule used by an insurer in making rates.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 8 - COMMERCIAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:13-8.3 - Prospective loss cost filing requirements for rating organizations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A rating organization or advisory organization that desires to file prospective loss costs with the Commissioner shall develop a filing containing advisory prospective loss costs and supporting actuarial and statistical data.
(b) Rating organizations or advisory organizations that file advisory prospective loss cost filings with the Commissioner shall:
1. Submit a filing that contains the advisory prospective loss costs and the underlying loss data and other supporting actuarial information for any calculations or assumptions underlying those loss costs; and
2. No longer develop or file minimum premiums with the filing of prospective loss costs.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 8 - COMMERCIAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:13-8.4 - Prospective loss costs filing requirements for insurers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order for an insurer to incorporate a rating organization's or advisory organization's filed prospective loss costs to establish its own rates, an insurer shall:
1. Be a member/subscriber insurer in the rating organization or advisory organization; and
2. File its loss costs multiplier using the Reference Filing Adoption Form (as set forth in Appendix A to this subchapter and incorporated herein by reference). An insurer's final rates shall be a combination of the prospective loss costs and the loss costs multiplier set forth in its filed Reference Filing Adoption Form.
i. An insurer may file modifications to the rating organization's or advisory organization's prospective loss costs filing based on its own anticipated experience by using the Reference Filing Adoption Form. Supporting documentation shall be filed for any modification (upwards or downwards) to the rating organization's or advisory organization's prospective loss costs filings.
ii. An insurer's filed loss costs multiplier shall remain in effect until the insurer withdraws the multiplier or files a revised Reference Filing Adoption Form.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 13 - COMMERCIAL LINES INSURANCE › Subchapter 8 - COMMERCIAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:13-8.5 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Rating organizations or advisory organizations and insurers which fail to comply with the filing submission requirements of this subchapter shall be subject to penalties pursuant to N.J.S.A. 17:29AA-26.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
P.L. 1983, c.376, approved November 10, 1983, authorizes 10 or more employers licensed by the state as hospitals under the Health Care Facilities Planning Act, 26:2H-1 et seq., to apply to the Commissioner of Insurance, pursuant to rules and regulations established by him, for his permission to enter into agreements to pool their liabilities under the New Jersey Workers' Compensation Law for the purpose of qualifying as self-insurers. The general purpose of this chapter is to promulgate such rules and regulations as are deemed by the Commissioner to be necessary to implement, supplement, and effectuate the minimum conditions and provisions of P.L. 1983, c.376.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.3 - Qualifications for initial approval and continued authority to act as a group

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A proposed group shall file its application with the Commissioner for his or her approval on a form prescribed by him or her and accompanied by a nonrefundable processing fee in the amount of $ 1,000. The application shall include the group's name, location of its principal office, date of organization, name and address of each of its trustees and its administrator or general manager, and service organizations, the name and address of each member hospital, and such other information as the Commissioner may reasonably require, together with the following:
1. Proof of compliance with the provisions of subsection (b) below;
2. A copy of the articles of association, if any;
3. A copy of agreements with the administrator and with any service organizations maintained by the group for the prevention of injuries, underwriting, and claims administration services;
4. A copy of the group's operating rules, including, but not limited to, by-laws, if any;
5. A copy of the indemnity and trust agreement between the group and each member of the group;
6. The address in New Jersey where the books and records of the group will be maintained at all times and the designation and appointment of a person in New Jersey upon whom service of process for the group might be made;
7. A pro forma financial statement, on a form acceptable to the Commissioner, providing him satisfactory proof of its financial ability to pay such compensation for the members of the group;
8. A statement from an actuary that the proposed group plan of operation is actuarially sound;
9. A listing of the estimated annual contributions to be paid by each member of the group;
10. Proof of payment to the group by each member of not less than 25% of that member's first year estimated annual contributions.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.4 - Issuance of certificate of approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall issue a certificate of approval to the group upon finding that the group:
1. Guarantees benefit levels equal to those required by the Workers' Compensation Law;
2. Demonstrates sufficient aggregate financial strength and liquidity to assure that all obligations under the Workers' Compensation Law will be promptly met;
3. Proposes a plan for the prompt payment of such benefits; and
4. Has satisfactorily met all requirements of the Act and these regulations.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.5 - Financial statement and other reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Annually (or more frequently if the Commissioner deems it necessary), each group shall submit to the Commissioner, on or before the last day of the sixth month following the end of the group's fiscal year, a sworn statement of financial condition audited by an independent certified public accountant in accordance with generally accepted accounting principles. The financial statement shall be on a form prescribed by the Commissioner and shall include, but not be limited to, actuarially appropriate reserves for:
1. Known claims and expenses associated therewith;
2. Claims incurred but not reported and expenses associated therewith;
3. Unearned contributions; and
4. Bad debts, which reserves shall be shown as liabilities.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.6 - Examinations

Current through Register Vol. 56, No. 14, July 15, 2024
The Commissioner shall examine the affairs, method of conducting business, transactions, account, records, and assets of each group as often as the Commissioner deems advisable, but not less often than once every three years. The expense of such examinations shall be assessed against the group and paid by it in the same manner that insurers are assessed for examinations.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.7 - Trustees: qualifications, powers, duties, and prohibitions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each group shall be operated by not fewer than five trustees whom the members of a group shall elect for stated terms of office. At least two-thirds of the trustees shall be employees, officers, directors, or trustees of members of the group. Except in the case of bona fide hospital associations, or organizations affiliated therewith, as determined by the Commissioner, the group's administrator, service company, or any owner, officer, or employee of, or any other person affiliated with, such administrator or service company shall not serve as trustees of the group. In the case of bona fide hospital associations, the preceding sentence shall apply only to any compensated employee of such association, or organization affiliated therewith, who is not also an officer, director, or trustee of a hospital. All trustees shall be residents of this State or officers of corporations authorized to do business in this State. The trustees of each group shall ensure that all claims are paid promptly and take all necessary precautions to safeguard the assets of the group, including all of the following:
1. The trustees shall:
i. Maintain responsibility for all monies collected or disbursed from the group and allocate all monies to a claims fund account and an administrative fund account. At least 70% of the net contributions shall be allocated on the books of the group for the sole purpose of paying claims, allocated claims expenses, reinsurance or excess insurance, and special fund contributions. This shall be called the claims fund account. The remaining net contributions shall be allocated on the books of the group for the payment of taxes, general regulatory fees and assessments, and administrative costs. This shall be called the administrative fund account. The Commissioner may approve an administrative fund account of more than 30% and a claims fund account of less than 70% only if the group shows to the Commissioner's satisfaction that:
(1) More than 30% is needed for an effective safety and loss control program; or
(2) The group's aggregate excess insurance attaches at less than 70%. The Commissioner may require that the accounts be segregated.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.8 - Group membership; termination; liability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employer joining a group after the group has been issued a certificate of approval shall:
1. Submit an application for membership to the trustees or the administrator; and
2. Enter into the indemnity and trust agreement. Membership shall take effect no earlier than each member's date of approval. The application for membership and its approval shall be maintained as permanent records of the group and copies shall be filed with the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.9 - Voluntary dissolution of group

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A group 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 group's members must have voted in favor of a resolution to dissolve the group pursuant to a written plan of dissolution at a meeting duly called for such purposes;
2. The plan of dissolution must provide for the payment of all incurred expenses and losses of the group and its members, including all incurred but not reported losses and associated expenses, before any assets of the group may be used for any other purposes;
3. Such plan of dissolution shall contain a statement of the group's current financial condition computed according to generally accepted accounting principles as attested to by an independent certified public accountant;
4. The plan of dissolution, and such other information as may be required by the Commissioner, shall be filed with and approved by the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.10 - Service organizations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Except with the approval of the Commissioner, no service organization or its employees, officers, or directors shall be an employee, officer, or director of, or have either a direct or indirect financial interest in, an administrator, and no administrator 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 service company.
(b) The service contract shall include a clause that, "unless the Commissioner otherwise permits, the service organization shall handle to their conclusion all claims and other obligations incurred during the contract period."
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.11 - Misrepresentation or unfair acts or practices prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
No person shall make a material misrepresentation or omission of a material fact in connection with the solicitation of a membership in a group or engage, with respect to membership in or the business and affairs of a group, in any activities of the type prohibited by 17:29B-4 and the regulations of the Department of Insurance promulgated thereunder when engaged in by persons engaged in the business of insurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.12 - Investments

Current through Register Vol. 56, No. 14, July 15, 2024
Funds not needed for current obligations may be invested by the trustees in accordance with 17:24-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.13 - Rates and reporting of rates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the first five years of its existence, except as otherwise approved by the Commissioner, each group shall maintain information in accord with the uniform classification system, uniform experience rating plan, and manual rules filed with the Commissioner.
(b) Contributions to the group shall be determined by applying its rates and rules to each member.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.14 - 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 fund year may be declared to be refundable by the trustees not less than 12 months after the end of the fund year.
(b) Each applicant for membership in the group shall be given a written description of the refund plan at the time of application for membership. Each member shall be given a written description of any changes in the refund plan prior to its being put into effect. A refund for any fund year shall be paid only in proportion to participation in the group for the fund year. Payment of a refund based on a previous fund year shall not be contingent on continued membership in the group after that fund year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 1 - HOSPITAL WORKERS' COMPENSATION GROUP SELF-INSURANCE › Section 11:15-1.15 - Contribution payment; reserves

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The group shall establish to the satisfaction of the Commissioner a contribution payment plan.
(b) The group shall establish and maintain actuarially appropriate loss reserves, which shall include reserves for: (1) known claims and expenses associated therewith; and (2) claims incurred but not reported and expenses associated therewith.
(c) The group shall establish and maintain bad debt reserves based on the historical experience of the group.