reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 57 - MANDATED BENEFITS FOR BIOLOGICALLY-BASED MENTAL ILLNESS › Section 11:4-57.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to implement P.L. 1999, c. 106 by specifying that certain exclusions may not be applied to treatment of biologically-based mental illness, and that benefit limits in health insurance policies and health maintenance organization contracts may not be applied to deny medically necessary benefits or services for the treatment of biologically-based mental illness when those benefit limits are not applied in the same manner to treatments for other illnesses.
(b) This subchapter shall apply to all policies and contracts providing hospital or medical services or benefits that are delivered, issued, executed or renewed in this State in the individual, small group and large group markets as follows: all hospital service corporation contracts issued pursuant to 17:48-1 et seq.; all medical service corporation contracts issued pursuant to 17:48A-1 et seq.; all health service corporation contracts issued pursuant to 17:48E-1 et seq.; all health insurance policies issued pursuant to 17B:26-1 et seq., 17B:27-26 et seq., 17B:27A-2 et seq. and 17B:27A-17 et seq.; and all health maintenance organization contracts issued pursuant to 26:2J-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 57 - MANDATED BENEFITS FOR BIOLOGICALLY-BASED MENTAL ILLNESS › Section 11:4-57.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise:
"Benefit limit" means any restriction, condition, or limitation (including, but not limited to, visit limits, dollar limits and preauthorization requirements) applied to the provision of health care services or benefits in a health insurance policy or health maintenance organization contract.
"Biologically-based mental illness" (BBMI) means a mental or nervous condition that is caused by a biological disorder of the brain and results in a clinically significant or psychological syndrome or pattern that substantially limits the functioning of the person with the illness, including, but not limited to, schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, panic disorder and pervasive developmental disorder or autism.
"Carrier" means any insurer authorized to sell health insurance pursuant to Title 17B of the New Jersey Statutes; a health, hospital or medical service corporation; or a health maintenance organization.
"Commissioner" means the Commissioner of the Department of Banking and Insurance.
"Exclusion" means a provision in a policy or contract that limits the scope of coverage by specifying causes and conditions for which benefits are not provided.
"Form" means any individual or group health insurance policy, health maintenance organization contract, any rider or endorsement for use with such policy or contract, certificates and evidence of coverage forms.
"Preauthorization" means a carrier's authorization, using paper or electronic means, for specified services or supplies that is given prior to the date the services or supplies are provided.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 57 - MANDATED BENEFITS FOR BIOLOGICALLY-BASED MENTAL ILLNESS › Section 11:4-57.3 - Exclusions and benefit limits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Notwithstanding the applicability of such exclusions to persons with physical illness, carriers shall not apply any exclusion in a health insurance policy or health maintenance organization contract to deny benefits for services or supplies that are medically necessary for the treatment of covered persons with biologically-based mental illness, so long as such services or supplies are not experimental or investigational. This proscription shall include but not be limited to:
1. Exclusions for the treatment of chronic conditions;
2. Exclusions for physical, speech and occupational therapy that is non-restorative (that is, that does not restore previously possessed function, skill or ability);
3. Exclusions for services rendered after a fixed period of time has elapsed from an injury, procedure or the onset of illness;
4. Exclusions for the treatment of developmental disorders or developmental delay;
5. Exclusions for therapy on a long-term basis;
6. Exclusions for the treatment of behavioral problems; and
7. Exclusions for the treatment of learning disabilities.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 57 - MANDATED BENEFITS FOR BIOLOGICALLY-BASED MENTAL ILLNESS › Section 11:4-57.4 - Effect on previously filed forms

Current through Register Vol. 56, No. 14, July 15, 2024
Forms that have been filed by the Commissioner containing provisions not in compliance with this subchapter shall be deemed withdrawn as of July 1, 2005.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 58 - DISCRETIONARY CLAUSES › Section 11:4-58.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to prohibit the use of discretionary clauses in all life, health and long-term care insurance policies and contracts, and all annuity contracts, to assure that all benefits provided under the policy or contract are contractually guaranteed, and to avoid the conflict of interest that occurs when the carrier responsible for providing benefits has sole discretionary authority to decide what benefits are due.
(b) This subchapter shall apply to all individual and group health insurance policies and contracts; all individual and group life insurance policies and contracts; all individual and group long-term care insurance policies; and all annuity contracts delivered or issued for delivery in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 58 - DISCRETIONARY CLAUSES › Section 11:4-58.3 - Discretionary clauses prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
No individual or group health insurance policy or contract, individual or group life insurance policy or contract, individual or group long-term care insurance policy or contract, or annuity contract, delivered or issued for delivery in this State may contain a provision purporting to reserve sole discretion to the carrier to interpret the terms of the policy or contract, or to provide standards of interpretation or review that are inconsistent with the laws of this State. A carrier may include a provision stating that the carrier has the discretion to make an initial interpretation as to the terms of the policy or contract, but that such interpretation can be reversed by an internal utilization review organization, a court of law, arbitrator or administrative agency having jurisdiction.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 58 - DISCRETIONARY CLAUSES › Section 11:4-58.4 - Noncomplying forms

Current through Register Vol. 56, No. 14, July 15, 2024
As of January 1, 2008, forms previously filed, approved or acknowledged by the Commissioner that contain provisions not in compliance with this subchapter shall be deemed withdrawn and shall not be delivered, issued, executed or renewed.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59 - DISCLOSURE REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to prescribe disclosure requirements to be utilized in connection with the sale, solicitation or negotiation of annuities directly to consumers, as required by 17B:25-34 et seq.
(b) This subchapter shall apply to any annuity, both immediate and deferred, directly solicited to a consumer, except as specifically excluded pursuant to N.J.S.A. 17B:25-37a.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59 - DISCLOSURE REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
Words and terms as defined in the Act at 17B:25-35, when used in this subchapter, shall have the meanings as defined in the Act, unless the context clearly indicates otherwise or as further defined by this subchapter. The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Act" means 17B:25-34 et seq.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"NAIC" means the National Association of Insurance Commissioners.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59 - DISCLOSURE REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59.3 - Buyer's guide

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to N.J.S.A. 17B:25-37d, an insurance producer, agent, representative or member of a fraternal benefit society not required to be licensed as an insurance producer pursuant to 17:44B-32, or an insurer shall provide a consumer who applies for an annuity a copy of a buyer's guide regarding the sale of annuities.
1. Pursuant to N.J.S.A. 17B:25-37d(1), the buyer's guide shall be provided no later than five business days after receipt of the application.
2. Pursuant to N.J.S.A. 17B:25-37d(2), if the direct response solicitation occurs via the Internet, the requirement in (a)1 above shall be satisfied by:
i. Making the buyer's guide available, in printable form, to consumers on the issuing insurer's Internet website, and providing notice to the consumer of its availability; and
ii. Allowing consumers to request, through the issuing insurer's Internet website, a mailed copy of the buyer's guide, provided that the insurer provides the documents to the consumer no later than five business days after receipt of the application.
3. If the buyer's guide is not provided in accordance with (a)1 or 2 above, as applicable, the consumer shall have a period of not less than 15 days after receipt of any annuity purchased, or longer if provided by the terms of the annuity, to cancel the annuity and receive from the insurer a prompt refund of any account value of the annuity, including any contract fees or other charges, by mailing or otherwise surrendering the annuity together with a written request for cancellation. This cancellation period shall run concurrently with the cancellation period provided by 17B:25-39.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59 - DISCLOSURE REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59.4 - Disclosure statement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to N.J.S.A. 17B:25-37d, an insurance producer, agent, representative or member of a fraternal benefit society not required to be licensed as an insurance producer pursuant to 17:44B-32, or an insurer shall provide to a consumer who applies for an annuity a copy of the annuity contract disclosure statement.
(b) The annuity contract disclosure statement required for distribution, pursuant to (a) above shall, at a minimum, contain the information and be in the form set forth in N.J.S.A. 17B:25-37c and in the Appendix to this subchapter, incorporated herein by reference.
(c) Persons or entities required to utilize the disclosure statement may include such additional information as they deem appropriate, provided such additional information is not inconsistent with any law of this State or administrative rule of the Department or any information required to be disclosed as set forth in the Appendix.
(d) The disclosure statement form to be used in connection with an annuity shall be filed with the Department as part of the filing of the annuity form pursuant to N.J.A.C. 11:4-40. For contract forms previously approved, the insurer shall file a copy of a disclosure statement that complies with this section that is to be utilized with such form no later than December 3, 2011. Failure to timely file a disclosure statement that complies with this section for use with a previously approved annuity form shall result in such previously filed and approved form being deemed withdrawn.
(e) Pursuant to N.J.S.A. 17B:25-37d(1), the disclosure statement shall be provided to the consumer no later than five business days after receipt of the application.
(f) Pursuant to N.J.S.A. 17B:25-37d(2), if a direct response solicitation occurs via the Internet, the requirements of this section shall be satisfied by:
1. Making the disclosure statement available, in printable form, to consumers on the issuing insurer's Internet website, and providing notice to the consumer of its availability; and
2. Allowing consumers to request, through the issuing insurer's Internet website, a mailed copy of the disclosure statement, provided that the insurer provides the document to the consumer no later than five business days after receipt of the application.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59 - DISCLOSURE REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59.5 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with this subchapter may result in the imposition of penalties as authorized by law, including penalties as authorized pursuant to 17B:25-42.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59 - DISCLOSURE REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Appendix - APPENDIX

Current through Register Vol. 56, No. 14, July 15, 2024
ANNUITY DISCLOSURE STATEMENT
(a) The issuing insurer's name and address. The form should include the street address, not just a PO Box number. If address is not in state of domicile, both domiciliary address and administrative address should be given.
(b) The generic name of the annuity (i.e., Fixed Single Premium Deferred Annuity Disclosure, Flexible Premium Deferred Annuity Disclosure, or Single Premium Immediate Annuity Disclosure).
-- The insurer's product/marketing name, if any
-- Annuity form number for which the disclosure will be used, and
-- The same information for any rider or endorsement to the annuity;
(This information should be shown at the top of the page. A company logo may also be inserted.)
(c) A statement that the product is a deferred or immediate annuity, accompanied by a definition of an annuity or immediate annuity.
1. This statement shall briefly explain each of the major features of the annuity. (Suggested language: (i) This annuity is fixed, which means it earns a guaranteed interest rate during the entire life of the contract; (ii) This annuity is deferred, which means payouts begin at a future date. You don't pay taxes on the interest it earns until the money is paid to you; or (iii) This is an immediate annuity which means payouts must begin within 13 months of the issue date.)
2. The disclosure shall state that the account value has premiums and interest credited, and expense charges subtracted. It also shall state that the account value is used to determine annuity, death, and surrender or withdrawal payments.
3. The term flexible premiums must indicate any limits (maximum, minimum, or timing) on premiums.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59A - SUITABILITY AND INSURER SUPERVISION REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59A.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to implement 17B:25-34 et seq. and 17B:30-1 et seq. to require insurers to establish a system to supervise recommendations and to set forth standards and procedures for recommendations to consumers that result in transactions involving annuity products so that the insurance needs and financial objectives of consumers at the time of the transaction are appropriately addressed.
(b) This subchapter shall apply to any annuity, both immediate and deferred, directly solicited to a consumer, except as specifically excluded in N.J.S.A. 17B:25-38a and this subchapter. This subchapter also shall apply to any recommendation to purchase, exchange, or replace an annuity made to a consumer by an insurance producer, or an insurer where no producer is involved, that results in the purchase, exchange, or replacement recommended.
(c) Unless otherwise specifically included, this subchapter shall not apply to transactions involving:
1. Direct response solicitations where there is no recommendation based on information collected from the consumer pursuant to this subchapter;
2. Contracts used to fund:
i. An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA), 29 U.S.C. §§
												1001 et seq.;
ii. A plan described by sections 401(a), 401(k), 403(b), 408(k) or 408(p) of the Internal Revenue Code (IRC), as amended, if established or maintained by an employer;
iii. A government or church plan defined in section 414 of the IRC, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under section 457 of the IRC;
iv. A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;
v. Settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process;
vi. Formal prepaid funeral contracts; and
vii. Any transaction exempt under 17B:25-38.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59A - SUITABILITY AND INSURER SUPERVISION REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59A.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
Words and terms as defined in 17B:25-35, when used in this subchapter, shall have the meanings as defined in the Act, unless the context clearly indicates otherwise or as further defined in this subchapter. The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Act" means 17B:25-34 et seq.
"Annuity" means a product as defined at 17B:17-5 that is individually solicited, whether the product is classified as an individual or group annuity.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Continuing education credit" or "CE credit" means one continuing education credit as defined in N.J.A.C. 11:17-3.
"Continuing education provider" or "CE provider" means an individual or entity that is approved to offer continuing education courses pursuant to N.J.A.C. 11:17-3.
"Department" means the New Jersey Department of Banking and Insurance.
"FINRA" means the Financial Industry Regulatory Authority or a succeeding agency.
"Recommendation" means advice provided by an insurance producer, or an insurer where no producer is involved, to an individual consumer that results in a purchase, exchange, or replacement of an annuity in accordance with that advice.
"Replacement" means a transaction in which a new policy or contract is to be purchased, and it is known or should be known to the proposing producer, or to the proposing insurer if there is no producer, that by reason of the transaction, an existing policy or contract has been or is to be:
1. Lapsed, forfeited, surrendered, or partially surrendered, assigned to the replacing insurer or otherwise terminated;
2. Converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values;
3. Amended so as to effect either a reduction in benefits or in the term for which coverage would otherwise remain in force or for which benefits would be paid;
4. Reissued with any reduction in cash value; or
5. Used in a financed purchase.
"Suitability information" means information that is reasonably appropriate to determine the suitability of a recommendation, including the following:
1. Age;
2. Annual income;
3. Financial situation and needs, including the financial resources used for the funding of the annuity;
4. Financial experience;
5. Financial objectives;
6. Intended use of the annuity;
7. Financial time horizon;
8. Existing assets, including investment and life insurance holdings;
9. Liquidity needs;
10. Liquid net worth;
11. Risk tolerance;
12. Tax status; and
13. Any other factors set forth in N.J.S.A. 17B:25-38b not referenced or subsumed in the factors set forth in 1 through 12 above.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59A - SUITABILITY AND INSURER SUPERVISION REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59A.3 - Duties of insurers and of insurance producers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In recommending to a consumer the purchase of an annuity or the exchange of an annuity that results in another insurance transaction or series of insurance transactions, the insurance producer, or the insurer where no producer is involved, shall have reasonable grounds for believing that the recommendation is suitable for the consumer on the basis of the facts disclosed by the consumer as to his or her investments and other insurance products and as to his or her financial situation and needs, including the consumer's suitability information, and that there is a reasonable basis to believe all of the following, which are intended to supplement and not replace the requirements for disclosure set forth in N.J.A.C. 11:4-59:
1. The consumer has been reasonably informed of various features of the annuity, such as the potential surrender period and surrender charge; potential tax penalty if the consumer sells, exchanges, surrenders, or annuitizes the annuity; mortality and expense fees; investment advisory fees; potential charges for and features of riders; limitations on interest returns; insurance and investment components; and market risk;
2. The consumer would benefit from certain features of the annuity, such as tax deferred growth, annuitization, or death or living benefit;
3. The particular annuity as a whole, the underlying subaccounts to which funds are allocated at the time of purchase or exchange of the annuity, and riders and similar product enhancements, if any, are suitable (and in the case of an exchange or replacement, the transaction as a whole is suitable) for the particular consumer based on his or her suitability information; and
4. In the case of an exchange or replacement of an annuity, the exchange or replacement is suitable including taking into consideration whether:
i. The consumer will incur a surrender charge, be subject to the commencement of a new surrender period, lose existing benefits (such as death, living, or other contractual benefits), or be subject to increased fees, investment advisory fees, or charges for riders and similar product enhancements;
ii. The consumer would benefit from product enhancements and improvements; and
iii. The consumer has had another annuity exchange or replacement and, in particular, an exchange or replacement within the preceding 36 months.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59A - SUITABILITY AND INSURER SUPERVISION REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59A.4 - Insurance producer training

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An insurance producer shall not solicit the sale of an annuity product unless the insurance producer has adequate knowledge of the product to recommend the annuity and the insurance producer is in compliance with the insurer's standards for product training. An insurance producer may rely on insurer-provided product-specific training standards and materials to comply with this subsection.
(b) An insurance producer who engages in the sale of annuity products shall complete a one-time four-credit training course approved by the Department and provided by a Department-approved education provider.
(c) Insurance producers who hold a life insurance line of authority on February 4, 2013 and who desire to sell annuities shall complete the requirements of this section by August 4, 2013. Individuals who obtain a life insurance line of authority on or after February 4, 2013 may not engage in the sale of annuities until the annuity training course required under this section has been completed.
(d) The minimum length of the training required under this section shall be sufficient to qualify for at least four CE credits, but may be longer.
(e) The training required under this section shall include information on the topics set forth in the outline below:
1. The types of annuities and various classifications of annuities;
2. Identification of the parties to an annuity;
3. How fixed, variable, and indexed annuity contract provisions affect consumers;
4. The application of income taxation laws and Internal Revenue Code provisions to qualified and non-qualified annuities;
5. The primary uses of annuities; and
6. Appropriate sales practices, replacement, and disclosure requirements.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59A - SUITABILITY AND INSURER SUPERVISION REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59A.5 - Recordkeeping

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Insurers, general agents, independent agencies, and insurance producers shall maintain or be able to make available to the Commissioner records of the information collected from the consumer and other information used in making the recommendations that were the basis for insurance transactions for 10 years after the insurance transaction is completed by the insurer. An insurer may, but shall not be required, to maintain documentation on behalf of an insurance producer.
(b) Records required to be maintained by this subchapter may be maintained in paper, photographic, micro-process, magnetic, mechanical, or electronic media or by any process that accurately reproduces the actual document.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 59A - SUITABILITY AND INSURER SUPERVISION REQUIREMENTS FOR ANNUITIES DIRECTLY SOLICITED TO CONSUMERS › Section 11:4-59A.6 - Compliance mitigation; penalties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An insurer shall be responsible for compliance with this subchapter. If a violation occurs, either because of the action or inaction of the insurer or its insurance producer, the Commissioner may order:
1. An insurer to take reasonably appropriate corrective action for any consumer harmed by the insurer's, or by its insurance producer's, violation of this subchapter;
2. A general agency, independent agency, or the insurance producer to take reasonably appropriate corrective action for any consumer harmed by the insurance producer's violation of this subchapter; and
3. Appropriate penalties and sanctions pursuant to law, including penalties as authorized pursuant to 17B:25-42.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 60 - LIMITATIONS ON THE USE OF SPECIFIC TERMS OR DESIGNATIONS IN THE SALE OF LIFE INSURANCE › Section 11:4-60.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to establish limitations, consistent with 17B:25-36 and the Unfair Trade Practices Act, 17B:30-1 et seq., on the use of certifications, professional designations, or forms of advertising by insurance producers, representatives of fraternal benefit societies and insurers expressing that the person or entity has special education, training or experience in advising or servicing senior citizens or retirees in connection with the solicitation, negotiation of sale of life insurance.
(b) This subchapter shall apply to the sale, solicitation, or negotiation of life insurance by a person or entity set forth in (a) above.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 60 - LIMITATIONS ON THE USE OF SPECIFIC TERMS OR DESIGNATIONS IN THE SALE OF LIFE INSURANCE › Section 11:4-60.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Insurance producer" means a person licensed to sell, solicit, or negotiate insurance pursuant to 17:22A-26 et seq.
"Insurer" means any corporation, association, partnership, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society or other person authorized to engage in the business of insurance in this State.
"Life insurance" is as defined in 11:4-40.2.
"Negotiate" means the act of conferring directly with or offering advice directly to a consumer as the purchaser or prospective purchaser of a particular life insurance policy concerning any of the substantive benefits, terms or conditions of the life insurance policy, provided that the person engaged in that act either: sells life insurance or obtains life insurance from insurers for purchasers.
"Sell" means to exchange a life insurance policy by any means, for money or its equivalent, on behalf of an insurer.
"Solicit" means attempting to sell a life insurance policy or asking or urging a consumer to apply for a particular life insurance policy from a particular insurer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 60 - LIMITATIONS ON THE USE OF SPECIFIC TERMS OR DESIGNATIONS IN THE SALE OF LIFE INSURANCE › Section 11:4-60.3 - Limitation on use of terms or designations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Consistent with the unfair trade practices set forth in 17B:30-1 et seq., an insurance producer, or an agent, representative or member of a fraternal benefit society not required to be licensed as an insurance producer in accordance with 17:44B-32, or an insurer, if no producer or non-licensed society agent, representative or member is involved, shall not use a certification, professional designation, or form of advertising expressing or implying in an untrue, deceptive, misleading, or false manner that the producer, non-licensed society agent, representative or member, or insurer has special education, training, or experience in advising or servicing senior citizens or retirees in connection with the solicitation, negotiation, or sale of life insurance, or its value or suitability, either directly or indirectly, including through a publication or writing, or by issuing or promulgating an analysis or report relating to a life insurance policy.
(b) The provisions of (a) above shall not apply to:
1. A title or designation conferred through an academic degree, certifying the completion of a course of study from an accredited institution of higher education, so long as the title or designation is not used in an untrue, deceptive, misleading, or false manner in connection with the solicitation, negotiation, or sale of a life insurance policy; or
2. A professional job title presented by an employer or other organization that is licensed or registered by a state or Federal financial services regulatory agency, including any agency that regulates financial institutions, insurers, investment companies as defined under the Investment Company Act of 1940, Title I of Pub. L. 76-768 ( 15 U.S.C. §§
											80a-1 et seq.), investment advisers as defined under the Investment Advisers Act of 1940, Title II of Pub. L. 76-768 ( 15 U.S.C. §§
											80b-1 et seq.), and broker-dealers, and that indicates seniority or standing within the employer or other organization's operation or specifies an area of specialization recognized by that employer or other organization, so long as the professional job title is not used in an untrue, deceptive, misleading, or false manner in connection with the solicitation, negotiation, or sale of a life insurance policy.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 60 - LIMITATIONS ON THE USE OF SPECIFIC TERMS OR DESIGNATIONS IN THE SALE OF LIFE INSURANCE › Section 11:4-60.4 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with this subchapter may result in the imposition of penalties as authorized by law, including penalties authorized pursuant to 17:22A-45 and 17B:30-17.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 61 - RETAINED ASSET ACCOUNTS › Section 11:4-61.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to set forth the disclosure and filing requirements for retained asset accounts, and disclosure requirements for all settlement options related to life insurance policies issued in this State.
(b) This subchapter shall apply to all insurers authorized or admitted in this State pursuant to Title 17B of the New Jersey Statutes that require or offer as an option a retained asset account or other settlement options for the payment of death benefits on life insurance policies issued in this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 61 - RETAINED ASSET ACCOUNTS › Section 11:4-61.2 - 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.
"FDIC" means the Federal Deposit Insurance Corporation established by 12 U.S.C. §
										227.
"Insurer" means an insurer authorized or admitted pursuant to Title 17B of the New Jersey Statutes to transact life insurance in this State.
"Life insurance" is as defined in 11:4-40.2.
"Retained asset account" or "RAA" means any mechanism whereby the settlement of proceeds payable under a life insurance policy is accomplished by the insurer or entity acting on behalf of the insurer depositing the proceeds into an account with check or draft writing privileges, or through the use of a debit card or other similar instrument upon which the proceeds may be drawn, where those proceeds are retained by the insurer, pursuant to the life insurance contract or a supplementary contract not involving annuity benefits.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 61 - RETAINED ASSET ACCOUNTS › Section 11:4-61.3 - Disclosure and filing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All insurers offering RAAs in this State shall, prior to the issuance of a group policy which provides for the payment of claims through an RAA or on which the opening of an RAA is an option, and prior to the transfer of a death benefit on an individual or group policy to an RAA, provide to the prospective owner of the group policy or to the beneficiary of the death benefit a written notice disclosing in easy-to-understand language, pertinent information related to the use of an RAA which shall include, at a minimum, the following:
1. A statement that payment of the full benefit amount is accomplished by delivery of the draft book/checkbook or similar instrument;
2. A statement that one draft or check may be written to access the entire amount, including interest, of the RAA at any time;
3. Notice whether other available settlement options are preserved until the entire balance is withdrawn or the balance drops below the insurer's minimum balance requirement;
4. A statement identifying the account as either a checking or draft account and an explanation of how the account works;
5. Information about the account services provided and contact information where the beneficiary may request and obtain more details about such services;
6. A description of fees charged, if applicable;
7. Information about the frequency of statements showing the current account balance, the interest credited, drafts/checks written and any other account activity, and the method of delivery of such statements (that is, via postal mail, e-mail, etc.);
8. How the interest rate to be credited to the account will be determined;
9. A statement that the interest earned on the account may be taxable;
10. A statement that RAA funds held by insurance companies are not guaranteed by the Federal Deposit Insurance Corporation (FDIC), but are guaranteed by the State Guaranty Associations. The beneficiary should be advised to contact the National Organization of Life and Health Insurance Guaranty Associations ((www.nolhga.com [File Link Not Available])) to learn more about coverage or limitations to his or her account; and
11. A description of the insurer's policy regarding RAAs that may become inactive.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 61 - RETAINED ASSET ACCOUNTS › Section 11:4-61.4 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with the provisions of this subchapter shall result in the imposition of penalties as may be authorized by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 62 - PHARMACY BENEFITS MANAGERS › Section 11:4-62.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the requirements for contracts between a pharmacy benefits manager and a contracted pharmacy pursuant to
N.J.S.A. 17B:27F-1
et seq., and requires pharmacy benefits managers to certify that new or existing contracts, upon renewal, comply with the requirements set forth in
N.J.S.A. 17B:27F-1
et seq., and this subchapter.
(b) This subchapter shall apply to all contracts between a pharmacy benefits manager and a contracted pharmacy pursuant to
N.J.S.A. 17B:27F-1
et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 62 - PHARMACY BENEFITS MANAGERS › Section 11:4-62.3 - Pharmacy benefits manager contracts

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Upon execution or renewal of each contract, a pharmacy benefits manager shall, with respect to contracts between a pharmacy benefits manager and a contracted pharmacy:
1. Include in the contract the sources utilized to determine multiple source generic drug pricing, including, if applicable, the maximum allowable cost or any successive pricing formula, of the pharmacy benefits manager;
2. Update that pricing information every seven calendar days; and
3. Establish a reasonable process by which contracted pharmacies have a method to access relevant maximum allowable cost pricing lists and any successive pricing formulas in a timely manner. Examples of such a process include: providing online access to the maximum allowable cost pricing, the sources thereof and the date of the last update of such pricing; providing such information through e-mail to contracted pharmacies; or, by similar means.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 62 - PHARMACY BENEFITS MANAGERS › Section 11:4-62.4 - Appeals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All contracts between a pharmacy benefits manager and a contracted pharmacy shall include a process to appeal, investigate, and resolve disputes regarding multiple source generic drug pricing. The contract provision establishing the process shall include the following:
1. The right to appeal shall be limited to 14 calendar days following the initial claim;
2. The appeal shall be investigated and resolved by the pharmacy benefits manager through an internal process within 14 calendar days of receipt of the appeal by the pharmacy benefits manager; and
3. A telephone number at which a pharmacy may contact the pharmacy benefits manager and speak with an individual who is involved in the appeals process.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 62 - PHARMACY BENEFITS MANAGERS › Section 11:4-62.5 - Certification of compliance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All pharmacy benefits managers shall file a certification with the Department in the form of N.J.A.C. 11:4-62 Appendix Exhibit A, which is incorporated herein by reference, attesting that all pharmacy benefits contracts executed or renewed between the pharmacy benefits manager and all contracted pharmacies located in this State comply with the requirements set forth in
N.J.S.A. 17B:27F-1
et seq., and this subchapter. Such certification shall be filed with the Department no later than February 1, 2018, or within 30 days of commencing business as a pharmacy benefits manager, with respect to any existing and future contracts. Certifications shall be mailed to:
New Jersey Department of Banking and Insurance
Office of Life and Health
20 West State St.
PO Box 325
Trenton, NJ 08625-0325
(b) For purposes of this section, if no renewal date is specified in the contract between a pharmacy benefits manager and a contracted pharmacy, such contract shall be deemed to renew at such time that there is change in any substantive term of the contract.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 62 - PHARMACY BENEFITS MANAGERS › Section 11:4-62.6 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Failure to comply with the terms of this subchapter shall result in the imposition of penalties as authorized by law.
(b) A pharmacy benefits manager that fails to file a certificate of compliance as required by N.J.A.C. 11:4-62.5 may, after notice and opportunity for a hearing, be subject to a penalty of up to $ 1,000 for each violation.
(c) A pharmacy benefits manager that fails to comply with the requirements of
N.J.S.A. 17B:27F-1
et seq., or N.J.A.C. 11:4-62.3 and 62.4 may, after notice and opportunity for a hearing, be subject to a penalty of not less than $ 5,000 or more than $ 10,000 for each violation.
(d) Penalties shall be imposed in accordance with the procedures set forth in
N.J.A.C. 11:17D
.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 62 - PHARMACY BENEFITS MANAGERS › Appendix - APPENDIX › Exhibit A - CERTIFICATION OF COMPLIANCE

Current through Register Vol. 56, No. 14, July 15, 2024
I, (Name of Individual Acting on Behalf of the Pharmacy Benefits Manager), hereby certify that with respect to all pharmacy benefits contracts executed or renewed between (Name of Pharmacy Benefits Manager) and a contracted pharmacy located in this State, such contracts comply with the requirements set forth in
N.J.S.A. 17B:27F-1
et seq. and N.J.A.C. 11:4-62. I further certify that I am authorized to make this certification on behalf of between (Name of Pharmacy Benefits Manager). .
I certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment.
_____________________________________
Signature
_____________________________________
Print Name
_____________________________________
Title
_____________________________________
Date
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 5 - REAL ESTATE COMMISSION › Subchapter 1 - ORGANIZATIONAL RULES › Section 11:5-1.1 - Commission responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
The Real Estate Commission is responsible for the supervision and regulation of the education, examination and licensing of real estate brokers, broker-salespersons, salespersons, and referral agents; the regulation of the sale or lease of out-of-State properties to New Jersey residents through promotional activities in New Jersey; the investigation and adjudication of disciplinary actions against licensees; and the administration of the Real Estate Guaranty Fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 5 - REAL ESTATE COMMISSION › Subchapter 1 - ORGANIZATIONAL RULES › Section 11:5-1.3 - Functions of the Commission

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commission is comprised of four sections whose functions are as follows:
1. The Investigations Unit is responsible for investigating the qualifications of applicants for licensure and for investigating complaints against licensed brokers, broker-salespersons, salespersons, referral agents, or individuals who have allegedly engaged in the business of a real estate broker, salesperson, or referral agent without being licensed to do so.
2. The Education Bureau is responsible for reviewing the qualifications of real estate school and instructor applicants; reviewing the qualifications of continuing education provider, course, and instructor applicants; and for regulating their activities.
3. The Bureau of Subdivided Land Sales Control is responsible for enforcing the provisions of the New Jersey Real Estate Sales Full Disclosure Act, N.J.S.A. 45:15-16.27 et seq. Its duties include, but are not limited to, reviewing applications for the registration of new projects, conducting inspections of conditionally registered projects, and reviewing applications for the renewal of projects.
4. The Licensing Bureau issues licenses to real estate brokers and salespersons, real estate schools, and course instructors, as well as establishes standards of practice for the real estate brokerage profession.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 5 - REAL ESTATE COMMISSION › Subchapter 1 - ORGANIZATIONAL RULES › Section 11:5-1.4 - Information available to the public

Current through Register Vol. 56, No. 14, July 15, 2024
With the exception of the records designated as non-public in 11:5-1.5(g), the public may obtain information or make submissions or requests concerning any Commission functions by contacting the Real Estate Commission, Department of Banking and Insurance, PO Box 328, Trenton, New Jersey 08625-0328.