reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 11 - RELIEF FROM OBLIGATIONS IMPOSED BY THE INDIVIDUAL HEALTH INSURANCE REFORM ACT › Section 11:20-11.11 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with this subchapter, including all notice requirements set forth herein, may result in the denial of relief requested and imposition of penalties as authorized by law, including any actions that may be taken by the Board pursuant to 17B:27A-2 et seq. and the IHC Program Plan of Operation, including, but not limited to, imposition of an interest penalty for assessments due from the member and a recommendation by the Board to remove the member's authority to issue any health benefits plans in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 12 - PURCHASE OF A STANDARD HEALTH BENEFITS PLAN BY A PERSON COVERED UNDER AN INDIVIDUAL PLAN OR COVERED UNDER A GROUP PLAN › Section 11:20-12.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter sets forth the standards for purchasing a standard health benefits plan or a standard health benefits plan with rider by a person who is covered under an individual plan or a group health benefits plan.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 12 - PURCHASE OF A STANDARD HEALTH BENEFITS PLAN BY A PERSON COVERED UNDER AN INDIVIDUAL PLAN OR COVERED UNDER A GROUP PLAN › Section 11:20-12.2 - Reserved

Current through Register Vol. 56, No. 14, July 15, 2024
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 12 - PURCHASE OF A STANDARD HEALTH BENEFITS PLAN BY A PERSON COVERED UNDER AN INDIVIDUAL PLAN OR COVERED UNDER A GROUP PLAN › Section 11:20-12.3 - Reserved

Current through Register Vol. 56, No. 14, July 15, 2024
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 12 - PURCHASE OF A STANDARD HEALTH BENEFITS PLAN BY A PERSON COVERED UNDER AN INDIVIDUAL PLAN OR COVERED UNDER A GROUP PLAN › Section 11:20-12.4 - Replacement during annual open enrollment period

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Except as stated in N.J.A.C. 11:20-12.5 with respect to the special enrollment period, a person who is covered under a standard health benefits plan, standard health benefits plan with rider, or group health benefits plan may only elect during the annual open enrollment period to replace the plan or coverage with a standard health benefits plan or a standard health benefits plan with rider. The application must be submitted during the annual open enrollment period.
(b) The effective date of the replacement plan will be January 1 of the year following the annual open enrollment period if the application is submitted during the annual open enrollment period.
(c) The existing standard health benefits plan, standard health benefits plan with a rider, or group health benefits plan coverage must be terminated with the effective date of termination being no later than the effective date of the replacement plan. The carrier that issued the existing plan will terminate the existing plan or coverage as of the midnight on the day before the effective date of the replacement plan if the existing carrier is notified of the replacement within 30 days after the effective date of the replacement plan. The new carrier issuing the replacement plan may require evidence of the termination of the existing plan. If the effective date of the termination of the existing plan or coverage is not before the effective date of the replacement plan, the replacement plan shall be of no force and effect and premium paid shall be refunded.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 12 - PURCHASE OF A STANDARD HEALTH BENEFITS PLAN BY A PERSON COVERED UNDER AN INDIVIDUAL PLAN OR COVERED UNDER A GROUP PLAN › Section 11:20-12.4A - Reserved

Current through Register Vol. 56, No. 14, July 15, 2024
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 12 - PURCHASE OF A STANDARD HEALTH BENEFITS PLAN BY A PERSON COVERED UNDER AN INDIVIDUAL PLAN OR COVERED UNDER A GROUP PLAN › Section 11:20-12.5 - Replacement during special enrollment period

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A person covered under a standard health benefits plan or a standard individual health benefits plan with a rider or group health benefits plan may enroll for coverage under a different standard health benefits plan or standard individual health benefits plan with a rider during a 60-day special enrollment period that follows a triggering event. With respect to a loss of coverage the special enrollment period also includes the 60 days prior to the loss of coverage.
(b) The effective date of the new standard health benefits plan or standard health benefits plan with a rider will be no later than the first of the month following the date the carrier receives the application. In addition to the first of the month effective date, carriers may permit the effective date to be the 15th of the month following the date the carrier receives the application. However, the effective date of coverage issued following a triggering event of birth, adoption, including placement for adoption, or placement in foster care shall be the date of birth, adoption, or placement for adoption or the date of placement in foster care unless the applicant requests a later effective date. The effective date of coverage issued pursuant to a court order shall be the date stated in the court order unless the applicant requests a later effective date.
(c) Carriers may require that an applicant submit proof of the triggering event.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 17 - ENROLLMENT STATUS REPORT › Section 11:20-17.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter provides for the quarterly submission of enrollment status reports by all members of the IHC Program, and sets forth the procedures for filing those reports.
(b) This subchapter applies to all members of the IHC Program that issue or renew standard health benefits plans to individuals.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 17 - ENROLLMENT STATUS REPORT › Section 11:20-17.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Words and terms defined at 17B:27A-2 and N.J.A.C. 11:20-1, when used in this subchapter, shall have the meanings as defined therein, unless more specifically defined in (b) below or unless the context clearly indicates otherwise.
(b) The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Enrollment status report" means a complete and accurate document that is prepared and filed in accordance with the requirements of this subchapter and sets forth the information listed in 11:20-17.4.
"Insured" or "insured individual" means any individual covered under an individual health benefits plan.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 17 - ENROLLMENT STATUS REPORT › Section 11:20-17.3 - Filing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every member of the IHC Program issuing or renewing standard health benefits plans shall complete and file with the Board the enrollment status reports required by this subchapter.
(b) Members shall file enrollment status reports on a quarterly basis reflecting the information set forth in 11:20-17.4 which shall reflect data as of March 31, June 30, September 30, and December 31 of each year.
(c) Members shall submit completed enrollment status reports by e-mail to the Executive Director at the address listed in 11:20-2.1(h)  no later than 60 days following the end of the quarter.
(d) Affiliated carriers shall submit the enrollment status reports only on a combined basis. Each affiliated carrier shall be identified on the report.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 17 - ENROLLMENT STATUS REPORT › Section 11:20-17.4 - Contents of the enrollment status report

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Members shall report the following information on a quarterly basis on the enrollment status report form separately for each of the standard health benefits plans, broken out into PPO or POS or EPO for Plans A/50, B, C, and D, the HMO plans reported by copay or coinsurance, as well as catastrophic plans. Carriers shall separately report enrollment through the Marketplace and enrollment directly by the carrier.
1. Contracts inforce shall be calculated and reported by adding the number of contracts in force at the beginning of the period to the number of contracts issued during the period, and subtracting the number of contracts lapsed during the period. The enrollment at the start of a quarter shall equal the enrollment at the end of the prior quarter.
2. Persons insured shall be calculated and reported by adding the number of persons insured at the beginning of the period and the number of new insureds during the period, and subtracting the number of insureds lapsed during the period.
3. Inforce Contracts shall be reported separately by rating tier, that is: single person; or multiple person. The sum of the contracts by rating tier shall equal the number of contracts inforce.
4. Inforce contracts shall be reported separately by the primary care provider (PCP) cost sharing, that is, deductible or copayment options applicable to PCP services. Contracts that apply both the deductible and copayment to PCP services shall be reported using the PCP deductible. The sum of the contracts by PCP cost sharing shall equal the number of contracts inforce.
5. The number of contracts sold as a high deductible health plan (HDHP) which are included in (a)4 above shall be reported separately.
6. Inforce plans shall be reported according to actuarial values of the inforce plans.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to establish the requirements and procedures by which carriers issuing plans pursuant to the IHC Act may cease doing business in the individual plan market in this State. Additionally, this subchapter establishes the requirements and procedures by which carriers may cease issuing and renewing: all individual plans; a specific plan, by issuing the same plan through a different delivery mechanism; a specific plan option, by offering an alternative approved plan option; or a specific deductible/copayment option that is optional pursuant to 11:20-3.1.
(b) This subchapter applies to all carriers, whether or not affiliated with other carriers doing business in the individual plan market in New Jersey, that seek to cease offering or renewing individual plans issued pursuant to the IHC Act, and carriers that seek to cease issuing a specific standard plan, plan option, or deductible/copayment option as permitted herein.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
Words and terms, when used in this subchapter, shall have the meanings set forth in the Act or at 11:20-1.2, unless defined below or unless the context clearly indicates otherwise:
"Cease doing business" for purposes of this subchapter means market withdrawal.
"Individual plan" means a plan developed by the Individual Health Coverage Program Board offered pursuant to N.J.S.A. 17B:27A-4b and the basic and essential health care services plan developed by the Legislature and offered pursuant to P.L. 2001, c. 368, including any rider offered with such a plan.
"Market withdrawal" means a carrier's, or one or more affiliated carriers', cessation of the issuance of all individual plans and nonrenewal of all in force individual plans and pre-reform plans upon their respective anniversary dates without the carrier's offering a replacement with an individual plan.
"Plan option withdrawal" means a carrier's cessation of the issuance of an individual plan option, and the nonrenewal of all in force individual plans issued with that option upon their respective anniversary dates.
"Plan withdrawal" means a carrier's cessation of the issuance of one of the individual plans, and the nonrenewal of all in force individual plans of that type upon their respective anniversary dates.
"Pre-reform plan" means an individual health benefits plan issued in New Jersey prior to August 1, 1993.
"State" means the State of New Jersey.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.3 - Carrier cancellation of individual plans

Current through Register Vol. 56, No. 14, July 15, 2024
No carrier with in force individual plans shall cancel an individual plan, except in accordance with 17B:27A-6, or nonrenew an individual plan upon the plan's anniversary date, except in accordance with 11:20-18.5, 18.6, or 18.7.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.4 - Cessation of offer and issuance of individual plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No carrier with in force individual plans shall cease to offer and issue all of its individual plans to an eligible person unless the Commissioner has determined pursuant to N.J.S.A. 17B:27A-8b and N.J.A.C. 11:20-11 that the carrier does not have the financial resources necessary to underwrite additional coverage, and it has provided written notice to:
1. The IHC Board at least 30 days before it intends to cease offering and issuing individual plans. Upon receipt of such notice, the Board shall no longer distribute the carrier's filed rates in conjunction with the Individual Health Coverage Program Buyer's Guide; and
2. Its individual plan policyholders, in conjunction with each notice of an adjustment of rates provided to such policyholders following the date the carrier ceases to offer and issue such plans. The notice to policyholders shall state that:
i. The carrier intends to cease offering and issuing individual plans in New Jersey;
ii. The carrier will continue to renew the policyholder's health benefits plan at the policyholder's option; and
iii. The policyholder may obtain information about individual health benefits plans offered by other carriers by calling 1-800-838-0935 for a free Individual Health Coverage Program Buyer's Guide or may obtain information on the Department of Banking and Insurance website at:
http://www.nj.gov/dobi/reform.htm
.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.6 - General provisions for withdrawal of plan, plan option, or deductible/copayment option

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No carrier shall cease to issue or nonrenew an individual plan, plan option, or deductible/copayment option required or permitted to be offered by 11:20-3.1 until the carrier submits a notice of intent to withdraw a plan, plan option, or deductible/copayment option to the Department and the Commissioner approves such withdrawal in accordance with the provisions of this subchapter.
(b) A carrier may cease to issue and nonrenew an individual plan pursuant to this section only if:
1. The deductible/copayment option is not required to be offered pursuant to 11:20-3.1(b); or
2. In the case of a deductible/copayment option required to be offered pursuant to 11:20-3.1, the carrier meets its obligations to offer at least three standard individual plans and required deductible/copayment options either by offering the plans as indemnity plans or by making the plan or plans available through or in conjunction with a selective contracting arrangement to all New Jersey residents.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.7 - Restrictions on writings

Current through Register Vol. 56, No. 14, July 15, 2024
A carrier that ceases to do business pursuant to 11:20-18.5 shall be prohibited from writing new individual plans and new small employer plans in New Jersey for a period of five years beginning on the termination date of the last standard individual health benefits plan not renewed.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.8 - Election to offer at least three plans, effect on in force-plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A carrier issuing all of the standard individual plans in the IHC market on and before January 4, 2009 that elects to offer at least three but not all of the standard individual plans after January 4, 2009, as permitted by N.J.S.A. 17B:27A-4b, that has in-force business in the plan or plans that it elects to no longer offer may:
1. Withdraw the plan or plans it elects to no longer offer pursuant to 11:20-18.6;
2. Convert the in-force business in the plan or plans it no longer offers pursuant to N.J.A.C. 11:20-24.7; or
3. Make a one-time election to continue to renew the in-force business in the plan or plans it chooses to no longer offer; provided:
i. The carrier notifies the Department in writing on or before March 1, 2009 of the plan or plans for which it will renew in-force business but which it will no longer offer; and
ii. The carrier does not withdraw such plan or plans pursuant to 11:20-18.6 until such time as the rate cap for in-force individual business established at N.J.S.A. 17B:27A-3a expires.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION › Section 11:20-18.9 - Other policy or contractholder rights unaffected

Current through Register Vol. 56, No. 14, July 15, 2024
Nothing in this subchapter shall be construed to contravene any rights of policy or contractholders concerning other obligations set forth in a policy or contract issued by a carrier.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 19 - PETITIONS FOR RULEMAKING › Section 11:20-19.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter shall apply to all petitions to the Board by interested persons to adopt a new rule, or amend or repeal any existing rule by the Board, pursuant to 52:14B-4(f).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 19 - PETITIONS FOR RULEMAKING › Section 11:20-19.2 - Procedure for petitioner

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any person who wishes to petition the Board to adopt a new rule or amend or repeal any existing rule shall submit to the Board, in writing, the following information:
1. Name, address, phone, fax, and email address of the petitioner;
2. The substance or nature of the rulemaking which is requested, which may include suggested text of the proposed new rule, amended rule or repealed rule;
3. The reasons for the request and the petitioner's interest in the request;
4. References to the statutory authority of the Board to take the requested action; and
5. A caption at the top of the document identifying it as a petition for rulemaking pursuant to 52:14B-4(f)  and this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 19 - PETITIONS FOR RULEMAKING › Section 11:20-19.3 - Procedure of the Board

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon receipt of a petition in compliance with 11:20-19.2, the Board shall file, within 15 days, a notice of petition with the Office of Administrative Law for publication in the New Jersey Register. The notice shall include:
1. The name of the petitioner;
2. The substance or nature of the rulemaking action which is requested;
3. The problem or purpose which is the subject of the request; and
4. The date the petition was received.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 20 - APPEALS FROM ACTIONS OF THE BOARD › Section 11:20-20.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
This subchapter shall apply to all appeals from Board determinations and requests for hearing as expressly provided pursuant to this chapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 20 - APPEALS FROM ACTIONS OF THE BOARD › Section 11:20-20.2 - Appeals procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A member may request a hearing on a final determination by the Board within 20 days from the date of receipt of such final determination as expressly permitted by this chapter as follows:
1. A request for a hearing shall be in writing and shall include:
i. The name, address, daytime telephone number, and fax number of a contact person familiar with the matter;
ii. A copy of the Board's determination;
iii. A statement requesting a hearing; and
iv. A concise statement listing the disputed adjudicative facts warranting a hearing and describing the basis for the member's contention that the Board's findings of fact are erroneous.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 23 - RULEMAKING; INTERESTED PARTIES; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:20-23.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of 11:20-23.2 through 23.5 is to establish the procedures that the Board uses in rulemaking made pursuant to the New Jersey Administrative Procedure Act, 52:14B-1 et seq. The purpose of 11:20-23.6 is to establish procedures for public notice regarding Board meetings. The purpose of 11:20-23.7 is to establish the procedures that the Board uses in placing parties and entities on the Board's in interested parties mailing list.
(b)
									11:20-23.2 through 23.5 shall apply only to rulemaking of the Board made pursuant to New Jersey Administrative Procedure Act, 52:14B-1 et seq., and shall not apply to rules made pursuant to 17B:27A-16.1, a special rulemaking procedure set forth in the IHC Act. 11:20-23.7 shall apply to any person that wishes to be placed on the Board's interested parties mailing list.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 23 - RULEMAKING; INTERESTED PARTIES; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:20-23.2 - Public notice regarding proposed rulemaking

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Board shall provide the following types of public notice for rule proposals pursuant to the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30:
1. The rule proposal shall be filed with the Office of Administrative Law for publication in the New Jersey Register;
2. The notice of the rule proposal, as filed with the Office of Administrative Law, or a statement of the substance of the proposed rulemaking, shall be posted and made available electronically on the Department of Banking and Insurance web site at:
www.dobi.nj.gov
and in the Department of Banking and Insurance's Library, which is located on the 1st Floor 20 West State Street, Trenton, NJ 08625.
3. The news media maintaining a press office in the State House Complex shall be provided notice of the rule proposal, as posted and made available electronically on the New Jersey Department of Banking and Insurance web site; and
4. Notice of the rule proposal, as filed with the Office of Administrative Law, or a statement of the substance of the proposed rulemaking, shall be made available to the Board's list of interested parties by e-mail or hard copy.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 23 - RULEMAKING; INTERESTED PARTIES; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:20-23.3 - Extension of the public comment period

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Board, pursuant to the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, may extend the time for submission of public comments on a proposed rulemaking, at its discretion, without the need for a specific request or the demonstration of sufficient public interest.
(b) The Board, in accordance with the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, shall extend the time for submission of public comments for an additional 30-day period, if, within 30 days of the publication of a notice of proposal, sufficient public interest is demonstrated in an extension of time to submit comments.
(c) The Board shall determine that a sufficient public interest for the purpose of extending the public comment period has been demonstrated if any of the following has occurred:
1. Comments received indicate a previously unrecognized impact on a regulated entity or persons; or
2. Comments received raise unanticipated issues related to the notice of proposal.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 23 - RULEMAKING; INTERESTED PARTIES; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:20-23.4 - Conducting a public hearing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Board, in accordance with the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, may conduct a public hearing on a proposed rulemaking, at its discretion, without the need for a specific request or the demonstration of sufficient public interest.
(b) The Board, in accordance with the New Jersey Administrative Procedure Act, 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, shall conduct a public hearing if sufficient public interest has been demonstrated.
(c) A person interested in having a public hearing held on a notice of proposal shall submit an application within 30 days following the publication of the notice of proposal in the New Jersey Register to the Executive Director at the address listed in 11:21-2.1(h), containing the following information:
1. The person's name, address, telephone number, agency or association (if applicable);
2. The citation and title of the proposed rule and the date the notice of proposal was published in the New Jersey Register; and
3. The reasons a public hearing regarding the notice of proposal is considered necessary pursuant to (e) below.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 23 - RULEMAKING; INTERESTED PARTIES; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:20-23.5 - Public notice of new rules, amendments, repeals, or adoptions

Current through Register Vol. 56, No. 14, July 15, 2024
The Board shall provide notice of new rules, amendments, repeals, or adoptions by posting these rules on its website at
www.dobi.nj.gov
and to the news media maintaining a press office in the State House complex.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 23 - RULEMAKING; INTERESTED PARTIES; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:20-23.6 - Public notice regarding board meetings

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Board shall adopt an annual schedule of regular meetings to be held during the following calendar year.
(b) The Board may schedule meetings in addition to those set forth in the annual schedule.
(c) The Board shall provide public notice for all meetings by:
1. Posting a notice at the office of the Secretary of State;
2. Posting a notice at the office of the Board at the address set forth at 11:20-2.1(h);
3. Posting a notice on the Department of Banking and Insurance website at: www.dobi.ni.gov [File Link Not Available]; and
4. Providing the notice to two newspapers of general circulation designated by the Board and to the State House Press Corps.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 23 - RULEMAKING; INTERESTED PARTIES; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST › Section 11:20-23.7 - Board mailing list of interested parties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the purpose of disseminating information about the IHC Program, including, but not limited to, information about meeting dates and rulemaking made pursuant to either the New Jersey Administrative Procedure Act, 52:14B-1 et seq. or 17B:27A-16.1, the Board shall maintain a mailing list of member carriers and other interested parties.
1. The mailing list of members shall be based upon the members addresses filed with its most recently filed Exhibit K Assessment Report.
i. Upon any change in name or mailing address, a member carrier shall notify the Board in writing no later than 10 days from the date the new name or address becomes effective.
ii. Unless the Board is notified otherwise as provided in (a)1i above, the name and mailing address of a member shall be deemed correct and communications mailed to the name and address on file shall be deemed received by the member.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 24 - PROGRAM COMPLIANCE › Section 11:20-24.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the standards all carriers must meet in offering and issuing standard health benefits plans and standard health benefits plans with riders to eligible persons off the Marketplace in New Jersey.
(b) This subchapter sets forth requirements with which carriers must comply in administering standard health benefits plans and standard health benefits plans with riders in New Jersey.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 24 - PROGRAM COMPLIANCE › Section 11:20-24.2 - Eligibility, issuance, and continued coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The policyholder of a standard health benefits plan or a standard health benefits plans with rider shall be a resident, as defined at 11:20-1.2. A carrier may require reasonable proof of residency. A dependent of the policyholder may be a nonresident of New Jersey, but is not eligible to be covered under the policy if he or she resides outside of the United States.
(b) An eligible person may apply for coverage under a standard health benefits plan or standard health benefits plan with rider during:
1. An annual open enrollment period; or
2. A special enrollment period.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 24 - PROGRAM COMPLIANCE › Section 11:20-24.2A - Triggering events that result in special enrollment periods

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A special enrollment period begins on the date of the triggering event and continues for 60 days. With respect to a loss of coverage the special enrollment period also includes the 60 days prior to the loss of coverage. During this period, an eligible person may apply for coverage for himself or herself and his or her eligible dependents.
(b) A loss of coverage resulting from nonpayment of premium, fraud, or misrepresentation of material fact shall not be a triggering event.
(c) The carrier may require proof of the triggering event.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 24 - PROGRAM COMPLIANCE › Section 11:20-24.3 - Payment of premium

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A carrier may offer a credit card or debit card payment option or an automatic checking withdrawal option to individuals for the monthly or quarterly payment of premiums. In the event that a carrier elects to offer an automatic checking withdrawal option, the carrier shall offer the same option to all individuals.
(b) A carrier may offer a discount to individuals that pay premium on a quarterly basis.
(c) A carrier shall accept payment in the form of a check, a money order, a cashier's check, or cash.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Subchapter 24 - PROGRAM COMPLIANCE › Section 11:20-24.4 - Effective date of coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A carrier, prior to issuing an individual health benefits plan, may require the following:
1. A completed individual application form;
2. Proof of the applicant's residency;
3. If a person is applying during a special enrollment period, evidence of the triggering event;
4. If a person is applying for a catastrophic plan and is not under age 30, a copy of the notice with an exemption certification number (ECN) from the Marketplace indicating that the person qualifies for an exemption; and
5. Premium payment not to exceed one month's premium, which shall be refunded to the individual if the health benefits plan is not issued by the carrier.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Appendix - APPENDIX › Exhibit A

Current through Register Vol. 56, No. 14, July 15, 2024
Click here to view Exhibit A
The amended version of this exhibit 56 N.J.R. 140(a), effective 1/1/2024 is not yet available.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Appendix - APPENDIX › Exhibit B

Current through Register Vol. 56, No. 14, July 15, 2024
Click here to view Exhibit B
The amended version of this exhibit 56 N.J.R. 140(a), effective 1/1/2024 is not yet available.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Appendix - APPENDIX › Exhibit D

Current through Register Vol. 56, No. 14, July 15, 2024
[Carrier]
AMENDMENT
[Policyholder]
[Effective date]
[
]
This Amendment is part of the [Policy]. Except as stated above, nothing in this Amendment changes or affects any of the terms of the [Policy].
[Carrier shall insert its standard amendment closure and signature blocks.]
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Appendix - APPENDIX › Exhibit E

Current through Register Vol. 56, No. 14, July 15, 2024
CERTIFICATION OF COMPLIANCE WITH INDIVIDUAL HEALTH COVERAGE PLANS
In accordance with 11:20-3A.2, submit this form, upon entry into the market and by March 1 of every year, to the Department at Department of Banking and Insurance, Life & Health, IHC Certification of Compliance, 20 West State Street, P.O. Box 325, Trenton, New Jersey 08625. Carriers must complete the certification as set forth in this Exhibit; the words in the certification may not be altered.
1.
INFORMATION ABOUT THE CARRIER AND RESPONDENT
Carrier Name:_______________________________________ NAIC#:__________
Respondent Information:
Name:______________________________________________ Title:__________
Address:__________________________________________________________
-------------------------------------------------------------------
Telephone:________ FAX:_______________ Email address:______________
2.
COMPLIANCE
Check the appropriate response(s).
______(a) Plans A/50, B, C, and D comply fully with the IHC Board's individual health benefits plans forms and Explanation of Brackets set forth at Exhibits A and C of the Appendix to N.J.A.C. 11:20.
______(b) The HMO Plan complies fully with the IHC Board's individual health benefits plans form and Explanation of Brackets set forth at Exhibits B and C of the Appendix to N.J.A.C. 11:20.
3.
PLAN OPTIONS AND VARIABLES
Complete each relevant section. Attach additional pages as necessary.
(a)
Plans A/50 through D
On the attached worksheet for Plans A/50 through D, provide information regarding all of the plans carrier makes available using Plans A/50 through D. Add or delete rows under each plan designation, and provide all applicable information regarding each offering of each plan. Refer to 11:20-3.1 for information regarding permissible options.
Delivery System:
Identify whether each plan is sold as Traditional Indemnity (Designate as Indem) or Preferred Provider Organization (Designate as PPO).
Copayment:
For all plans that use a copayment, specify the applicable copayments for Physician Visits, Maternity, Specialist and Outpatient Surgery.
Deductible:
List the available deductible options. Indemnity plans as well as PPO plans that use a common deductible should list that amount under the Indemnity/Common column. PPO plans that use separate deductible for network and non-network services should list such dollar amounts under the appropriate column headings
Coinsurance:
List the available policyholder coinsurance options as specific percentages. Indemnity plans as well as PPO plans that use a common coinsurance should list that amount under the Indemnity/Common column. PPO plans that use separate coinsurance for network and non-network services should list such percentages under the appropriate column headings.
1. Do contracts provide for direct payment to health care practitioners without assignment? [] Yes [] No
2. Specify how coverage for autologous bone marrow transplants is offered.
[]Plan benefit; []or Rider benefit
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Appendix - APPENDIX › Exhibit G

Current through Register Vol. 56, No. 14, July 15, 2024
[Carrier]
Plan Update Rider
This rider amends [the] standard [indemnity] [PPO][HMO deductible and coinsurance] individual health benefits plan [A/50] [B] [C] [D].
Effective Date:
1. The
Deductible Credit
provision of the
[BENEFIT] [COVERAGE] PROVISION
section is deleted and replaced with the following:
Deductible Credit:
For the first Calendar Year of this [Policy] [Contract], a [Covered Person] [Member] will receive credit for any Deductible amounts satisfied under previous coverage within the same Calendar Year that Your first Calendar Year starts under this [Policy] [Contract] provided there has been no lapse in coverage between the previous coverage and this [Policy] [Contract].
This credit will be applied only if Your previous coverage was under a plan with Us and the new [Policy] [Contract] is being issued as a result of Our decision to convert the previous plan.
2. A new provision entitled
Coinsurance Credit
is added to the
BENEFIT [COVERAGE] PROVISION
section immediately following the Deductible Credit provision.
[Coinsurance Credit:
A [Covered Person] [Member] will receive credit for any Coinsurance amounts the [Covered Person] [Member] satisfied from January 1 of the Calendar Year in which this [Policy] [Contract] is issued.
As of the Effective Date of this [Policy] [Contract], and for the balance of the first Calendar Year, the Coinsurance amounts the [Covered Person] [Member] paid during the same Calendar Year that were accumulating toward the satisfaction of the Maximum Out of Pocket under the prior coverage will be applied toward the satisfaction of the Maximum Out of Pocket under this [Policy] [Contract].
Except as stated below, once the Maximum Out of Pocket has been reached, the Covered Person has no further obligation to pay any amounts as Deductible and Coinsurance for covered services and supplies for the remainder of the Calendar Year.
Exception:
Coinsurance paid for covered Prescription Drugs does not count toward the Maximum Out of Pocket. Such coinsurance must continue to be paid even after the Maximum Out of Pocket has been reached.]
This Rider terminates as of December 31 of the Calendar Year in which it was issued.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM › Appendix - APPENDIX › Exhibit H

Current through Register Vol. 56, No. 14, July 15, 2024
In accordance with 11:20-3.1(e)  each carriers shall file this Identification of Standard Plans no later than July 1, 2009 and an amended Identification of Standard Plans within 60 days of any change in the plans being offered by the carrier.
Identification of Standard Plans
1.
INFORMATION ABOUT THE CARRIER AND RESPONDENT
Carrier Name:_________________________________________ NAIC #:________________
Respondent Information:
Name:________________________________ Title:__________________________________
Address________________________________________________________________________ _______________________________________________________________________________
Telephone:____________ FAX:____________ Email Address:_______________________
Is Carrier a Federally Qualified HMO? _______________ If yes, attach evidence.
2.
INFORMATION ABOUT THE FILING
Date of Filing: ___________________________________
If the filing is being made after a change in the plans offered to individual consumers:
Date plan change(s) made: ___________________________________
Date of withdrawal pursuant to NJAC 11:20-18, if applicable: ___________________________________
Date of conversion pursuant to NJAC 11:20-24.7, if applicable: __________________________________
3.
IDENTIFICATION OF PLANS BEING OFFERED
Place a check next to each standard plan being offered.
[ ] Plan A/50 (Must be offered unless carrier is Federally Qualified HMO)
Delivery System (Check all that apply)
[ ] Indemnity
[ ] PPO
[ ] POS
Deductible Options (Check all that apply)
[ ] $ 2,500
[ ] $ 1,000
[ ] $ 5,000
[ ] $ 10,000
[ ] amount to
(must offer)
qualify as a HDHP
Copayment Options (Check all that apply)
[ ] $ 15
[ ] $30
[ ] $ 40
[ ] $ 50
[ ] Plan B
Delivery System (Check all that apply)
[ ] Indemnity
[ ] PPO
[ ] POS
Deductible Options (Check all that apply)
[ ] $ 2,500
[ ] $ 1,000
[ ] $ 5,000
[ ] $ 10,000
[ ] amount to
(must offer)
qualify as a HDHP
Copayment Options (Check all that apply)
[ ] $ 15
[ ] $30
[ ] $ 40
[ ] $ 50
[ ] Plan C
Delivery System (Check all that apply)
[ ] Indemnity
[ ] PPO
[ ] POS
Deductible Options (Check all that apply)
[ ] $ 2,500
[ ] $ 1,000
[ ] $ 5,000
[ ] $ 10,000
[ ] amount to
(must offer)
qualify as a HDHP
Copayment Options (Check all that apply)
[ ] $ 15
[ ] $30
[ ] $ 40
[ ] $ 50
[ ] Plan D
Delivery System (Check all that apply)
[ ] Indemnity
[ ] PPO
[ ] POS
Deductible Options (Check all that apply)
[ ] $ 2,500
[ ] $ 1,000
[ ] $ 5,000
[ ] $ 10,000
[ ] amount to
(must offer)
qualify as a HDHP
Copayment Options (Check all that apply)
[ ] $ 15
[ ] $30
[ ] $ 40
[ ] $ 50
[ ] Plan HMO
Copayment Options (Check all that apply)
[ ] $15
[ ] $ 30 (must offer)
[ ] $ 40
[ ] $ 50
Deductible and Coinsurance (list the combinations below.)
_________________________________________________________
_________________________________________________________
Referral (Check all that apply)
[ ] Required
[ ] Not Required
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 11:21-1.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This chapter implements provisions of P.L. 1992, c.162 as amended (17B:27A-17 et seq.), herein referred to as the Small Employer Health Benefits Act. This chapter establishes procedures and standards for carriers to meet their obligations under 17B:27A-17 et seq., and establishes procedures and standards applicable for the fair, reasonable and equitable administration of the Small Employer Health Benefits Program pursuant to 17B:27A-17 et seq.
(b) Provisions of the New Jersey Small Employer Health Benefits Act and of this chapter shall be applicable to all carriers that are members of the Small Employer Health Benefits Program, and to such other carriers as the specific provisions of the statute and this chapter may state.
(c) Provisions of the New Jersey Small Employer Health Benefits Act and this chapter shall be applicable to all health benefits plans delivered or issued for delivery in New Jersey, renewed or continued on or after November 30, 1992, except as the specific provisions of the statute and of this chapter state otherwise.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 11:21-1.3 - Communications with the Board

Current through Register Vol. 56, No. 14, July 15, 2024
All written communications with the SEH Board shall be submitted to the SEH Board at the following address:
New Jersey Small Employer Health Benefits Program Board
20 West State Street, 11th Floor
PO Box 325
Trenton, New Jersey 08625-0325
Fax: (609) 633-2030
E-mail: ellen.derosa@dobi.nj.gov
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 11:21-1.4 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure of a carrier to comply with any provision of this chapter shall result in the imposition of penalties as authorized by law, including, but not limited to, penalties set forth at 17B:27A-41 and 17B:27A-43.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM › Subchapter 1 - GENERAL PROVISIONS › Section 11:21-1.5 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this chapter or the application thereof to any person or circumstance is found to be invalid for any reason, the remainder of the chapter and the application thereof to other persons or circumstances shall not be affected thereby.