reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.5 - Application procedures and filing format

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any member organization seeking relief shall submit such request to the Department as set forth in (f) below no later than 15 days following the due date of payment of the assessment.
(b) All requests shall be accompanied by a statement averring a need for relief from the obligation, including supporting documentation as set forth in 11:4-1.6, and shall specify the statutory and regulatory basis for such relief.
(c) Each request shall be in loose leaf form inserted into standard two-ring or three-ring binders tabbed or otherwise indexed to correspond to the exhibits set forth in 11:4-1.6. The loose leaf sheets used in the request shall be eight and one-half inches wide and 11 inches long and punched for two-ring or three-ring binders, as appropriate.
(d) All member organizations requesting relief pursuant to this subchapter shall submit five copies of each request in the format set forth in (c) above.
(e) If a request fails materially to comply with the filing format and information requirements set forth in 11:4-1.6 and this section, the Department shall notify the member organization that its request for relief is deficient and is denied on such grounds within 15 days of receipt of the request. The notice shall also set forth any information or other action required to cure the deficiency(s). If the member organization intends to pursue its request, the member organization shall submit the additional information specified or otherwise submit a filing in accordance with the format requirements specified in this section within 15 days of receipt of the Department's notice of deficiency. Failure to submit within 15 days the information necessary in the proper format to cure the deficiency shall result in the member organization's request being denied.
(f) All requests for relief or other information required pursuant to this subchapter shall be filed with the Department at the following address:
HMO Assistance Fund
Request for Relief
New Jersey Department of Banking and Insurance
Office of Financial Examinations
PO Box 325
Trenton, NJ 08625-0325
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.6 - Informational filing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When requesting relief, the applicant shall provide with its request the following information in a clear, concise and complete manner:
1. A cover letter stating:
i. The name of the applicant;
ii. The form of relief and, if for less than the full amount, specific amount/percentage of relief which the applicant is requesting;
iii. A statement of facts relied upon as the basis under which relief is sought, including the specific factor(s) upon which the Commissioner may find that the payment of the assessment would endanger the ability of the applicant to fulfill its contractual obligations, or place the applicant in a hazardous financial condition; or that the failure to include assessments in the applicant's schedule of charges or rates would significantly and adversely affect the applicant as set forth at 11:4-1.9, as applicable; and
iv. The name, title, telephone number and telefax number of a contact person familiar with the filing to whom the Department may direct any additional questions;
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.7 - Confidentiality of request for relief

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All data or information contained in the request for relief filed pursuant to this subchapter shall be confidential and shall not be subject to public disclosure or copying pursuant to the "Right to Know" law, 47:1A-1 et seq., except for the following items, but only upon written, specified request and following 10 days written notice by the Department to the member/applicant:
1.
										11:4-1.6(a)1  i and ii--cover letter with name of applicant and describing relief sought;
2.
										11:4-1.6(a)1  iv--name, title, telephone number and telefax number of person familiar with the filing;
3.
										11:4-1.6(a)3  --most recent financial examination report;
4.
										11:4-1.6(a)5  i and ii--list of members of holding company system and intercompany transactions for period preceding date of filing;
5.
										11:4-1.6(a)8  --annual statement filed immediately preceding date of filing; and
6.
										11:4-1.6(a)12  --additional information required by the Commissioner to evaluate a particular filing.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.8 - Disposition of request for relief

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When the Commissioner determines pursuant to N.J.S.A. 17B:32B-9e that payment of the assessment would endanger the ability of the member organization to fulfill its contractual obligations or, based on indicia that relate to the ability to pay the assessment by the member organization, would place it in an unsafe or unsound financial condition, the Commissioner shall notify the Association of such finding and direct the Association to exempt, abate or defer the obligation of the member organization, as set forth in (b) below. If the Commissioner decides to defer, in whole or in part, a member organization's obligation to pay assessments, the member shall remain liable to the Association for the amount deferred. The Commissioner shall find that a member is or would be unable to meet its contractual obligations or be placed in an unsafe or unsound financial condition if:
1. The member has been placed in rehabilitation or liquidation pursuant to 17B:32-31 et seq. or such similar law of the member's state of domicile;
2. The member has been placed under administrative supervision pursuant to 17:51A-1 et seq. or such similar law of the member's state of domicile; or
3. The Commissioner finds based solely on indicia of N.J.A.C. 11:2-27 that relate to the ability to pay the assessment that the member is or would be placed in a hazardous financial condition.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.9 - Rates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In determining its schedule of charges or rates filed with the Commissioner pursuant to N.J.S.A. 26:2J-8b, or filed in accordance with any other law requiring such filing, no member organization shall include the amount paid or to be paid as assessments under 17B:32B-1 et seq., or any portion of that amount, unless the Commissioner specifically determines that exclusion of those assessments in determining its schedule of charges or rates will significantly and adversely affect the organization by precluding it from earning a constitutionally adequate rate of return, or as otherwise set forth in (c) below. Each member organization shall annually file a certification to the Commissioner that the member organization has not included any amounts assessed in its schedule of charges or rates, unless permitted to do so pursuant to this section.
(b) No member organization shall be permitted to include the amount paid or to be paid as assessments unless it first requested relief from payment of such assessment, and such request was denied, pursuant to this subchapter. However, a request for relief shall not be required provided the filer files a request to include assessments paid in its schedule of charges or rates that includes the information set forth at 11:4-1.6 in the format of 11:4-1.5, wherein the filer recognizes that the Department shall review the information filed to determine whether relief is warranted pursuant to 11:4-1.8
(c) The Commissioner shall find that exclusion of assessments in determining the member organization's schedule of charges or rates will significantly and adversely affect the organization if the member organization demonstrates that it is unable to earn a constitutionally adequate rate of return after paying the assessment. Alternatively, the Commissioner may consider in determining whether the exclusion of assessments will significantly and adversely affect the organization if the member organization demonstrates that:
1. Its net worth will be below that required by N.J.A.C. 8:38-11.1 after payment of the assessment; and
2. For the three-year period immediately following payment of the assessment, its net worth will be less than that required by N.J.A.C. 8:38-11.1 if the assessment is not included in the member's schedule of charges or rates.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.10 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with this subchapter may result in the denial of relief requested and imposition of penalties as authorized by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Section 11:4-2.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is:
1. To regulate the activities of insurers and producers with respect to the replacement of existing life insurance and annuities; and
2. To protect the interests of life insurance and annuity purchasers by establishing minimum standards of conduct to be observed in replacement or financed purchase transactions by:
i. Assuring that a purchaser receives information with which a decision can be made in his or her own best interest;
ii. Reducing the opportunity for misrepresentation and incomplete disclosures; and
iii. Establishing penalties for failure to comply with the requirements of this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Section 11:4-2.3 - Duties of producers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A producer who initiates an application shall submit to the insurer, with or as part of the application, a statement signed by both the applicant and the producer as to whether the applicant has existing policies or contracts. If the answer is "no," the producer's duties with respect to replacement are complete.
(b) If the applicant answers "yes" to the question regarding existing coverage referred to in (a) above, the producer shall present and offer to read to the applicant, not later than at the time of taking the application, a notice regarding replacements in the form as described in subchapter Appendix A, incorporated herein by reference, or other substantially similar form approved by the Commissioner and submitted to Consumer Protection Services. However, no approval of the Commissioner shall be required when revisions to the notice are limited to the deletion of references not applicable to the product being sold or replaced. The notice may be presented to the applicant either in writing via a hard copy or electronically.
1. If the notice is presented electronically, the insurer shall mail the applicant a copy of the signed notice within three business days after the application is submitted to the insurer.
2. The notice shall be signed by both the applicant and the producer attesting that the notice has been read aloud by the producer, or that the applicant did not wish the notice to be read aloud (in which case the producer need not have read the notice aloud) and shall remain with the applicant or be mailed to the applicant as provided in (b)1 above.
3. The notice shall list all life insurance policies or annuities proposed to be replaced, properly identified by name of insurer, the insured or annuitant, and policy or contract number if available, and shall include a statement as to whether each policy or contract will be replaced or whether a policy will be used as a source of financing for the new policy or contract. If a policy or contract number has not been issued by the existing insurer, alternative identification, such as an application or receipt number, shall be listed.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Section 11:4-2.4 - Duties of replacing insurers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Where a replacement is involved in the transaction, the replacing insurer shall:
1. Verify that the required forms are received and are in compliance with this subchapter;
2. Ascertain that the sales material and illustrations used in the replacement meet the requirements of this subchapter and are complete and accurate for the proposed policy or contract;
3. Notify any other existing insurer that may be affected by the proposed replacement within five business days of receipt of a completed application indicating replacement and/or accompanying statement indicating replacement (or when the replacement is identified if not indicated on the application), and mail to the insurer a copy of the available illustration and/or policy summary for the proposed policy or available disclosure document for the proposed contract within five business days of a request from an existing insurer;
4. Be able to produce copies of the notifications regarding replacement required in 11:4-2.3(b), indexed by producer, for at least the immediately preceding five years or until the next regular examination by the Department, whichever is later; and
5. Provide to the policy or contract owner notice of the right to return the policy or contract within 30 days of the delivery and receive an unconditional full refund of all premiums or considerations paid on it, including any policy fees or charges or, in the case of a variable or market value adjustment policy or contract, a payment of the cash surrender value provided under the policy or contract plus the fees and other charges deducted from the gross premiums or considerations or imposed under such policy or contract. Such notice may be included in Appendix A or C.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Section 11:4-2.5 - Duties of insurers that use producers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each insurer shall maintain a system of supervision and control to ensure compliance with the requirements of this subchapter. At a minimum, all such systems shall provide for the insurer to:
1. Inform its producers of the requirements of this subchapter and incorporate the requirements of this subchapter into all relevant producer training manuals prepared by the insurer;
2. Provide to each producer a written statement of the company's position with respect to the acceptability of replacements that provides guidance to the producer as to the appropriateness of these transactions;
3. Include a system to review the appropriateness of each replacement transaction that the producer does not indicate is in accord with (a)2 above;
4. Include procedures to verify that the requirements of this subchapter have been met; and
5. Include procedures to detect transactions that are replacements of existing policies or contracts by the existing insurer, but that have not been reported as such by the applicant or producer. Compliance with this subchapter may include but shall not be limited to, systematic customer surveys, interviews, confirmation letters, or programs of internal monitoring.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Section 11:4-2.6 - Duties of the existing insurer

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Where a replacement is involved in the transaction, the existing insurer shall:
1. Retain and be able to produce all replacement notifications received, indexed by replacing insurer, for at least five years after replacement or until the conclusion of the next regular examination conducted by the Department, whichever is later;
2. Notify the policy or contract owner in writing within five business days of receipt of a notice referred to in (a)1 above that the policy or contract owner has the right to receive information regarding the existing policy or contract values, including, if available, an in force illustration, or a policy summary if an in force illustration cannot be produced. The insurer shall send the information within five business days of receipt of the request from the policy or contract owner; and
3. Upon receipt of a request to borrow, surrender or withdraw any policy values, send a notice advising the policy owner of the effect that the release of policy values will have on the non-guaranteed elements, face amount or surrender value of the policy from which the values are released. The notice shall be sent separately from the check if the check is sent to anyone other than the policy owner. In the case of consecutive automatic premium loans, the insurer is only required to send the notice at the time of the first loan.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Section 11:4-2.7 - Duties of insurers with respect to direct response solicitations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In the case of an application that is initiated as a result of a direct response solicitation, the insurer shall require, with or as part of each completed application for a policy or contract, a statement asking whether the applicant, by applying for the proposed policy or contract, intends to replace, discontinue or change an existing policy or contract. If the applicant indicates a replacement, discontinuance or change is not intended, or if the applicant fails to respond to the statement, the insurer shall send the applicant, with the policy or contract, a notice regarding replacement as described in subchapter Appendix B, incorporated herein by reference, or other substantially similar form approved by the Commissioner.
(b) If the insurer has proposed the replacement, or if the applicant indicates a replacement is intended, and the insurer continues with the replacement, the insurer shall:
1. Provide to applicants or prospective applicants with the policy or contract a notice as described in subchapter Appendix C, incorporated herein by reference, or other substantially similar form approved by the Commissioner. In these instances the insurer may delete the references to the producer, including the producer's signature, without having to obtain approval of the form from the Commissioner. The insurer's obligation to obtain the applicant's signature shall be satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the notice referred to in this paragraph. The requirement to make a diligent effort shall be deemed satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed notice referred to in this section; and
2. Comply with the requirements of 11:4-2.4(a)2, if the applicant furnishes the names of the existing insurers, and the requirements of 11:4-2.4(a)3, (a)4 and (b).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Section 11:4-2.8 - Violations and penalties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any failure to comply with the requirements of this subchapter shall be considered a violation of 17B:30-6. Such violations include, but are not limited to:
1. Any deceptive or misleading information set forth in sales material;
2. Failing to ask the applicant when completing the application pertinent questions regarding the possibility of financing or replacement as required by this subchapter;
3. The intentional incorrect recording of an answer;
4. Advising an applicant to respond negatively to any question regarding replacement in order to prevent notice to the existing insurer; or
5. Advising a policy or contract owner to write directly to the company in such a way as to attempt to obscure the identity of the replacing producer or company.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Section 11:4-2.9 - Separability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provisions of this subchapter shall be held invalid, the remainder of the subchapter shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 2 - LIFE INSURANCE AND ANNUITIES REPLACEMENT › Appendix B

Current through Register Vol. 56, No. 14, July 15, 2024
EXHIBIT B
APPENDIX B
NOTICE REGARDING REPLACEMENT:
REPLACING YOUR LIFE INSURANCE POLICY OR ANNUITY
Are you thinking about buying a new life insurance policy or annuity and
discontinuing or changing an existing one? If you are, your decision could be
a good one--or a mistake. You will not know for sure unless you make a
careful comparison of your existing benefits and the proposed policy's or
contract's benefits.
Make sure you understand the facts. You should ask the company or agent that
sold you your existing policy or contract to give you information about it.
Hear both sides before you decide. This way you can be sure that you are
making a decision that is in your best interest.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 3 - COUPON POLICIES AND POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-3.1 - Payments

Current through Register Vol. 56, No. 14, July 15, 2024
Payment of guaranteed annual endowment benefits in a policy shall not be made contingent on the payment of a premium falling due at the time such benefit would otherwise be payable or credited to the insured.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 3 - COUPON POLICIES AND POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-3.2 - Gross premium shown

Current through Register Vol. 56, No. 14, July 15, 2024
The gross premium for the guaranteed annual endowments shall be shown prominently and separately in the policy as distinct from the regular insurance gross premium.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 3 - COUPON POLICIES AND POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-3.3 - Gross premium regarding additional insurance

Current through Register Vol. 56, No. 14, July 15, 2024
The gross premium for any additional insurance effective after the first policy year, other than return of premiums, shall also be shown prominently and separately in the policy.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 3 - COUPON POLICIES AND POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-3.4 - Coupons

Current through Register Vol. 56, No. 14, July 15, 2024
Annual coupons for the guaranteed annual endowments shall not be included as a part of policies containing guaranteed annual endowments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 3 - COUPON POLICIES AND POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-3.5 - Guaranteed annual endowments

Current through Register Vol. 56, No. 14, July 15, 2024
Guaranteed annual endowments shall not be included as benefits in policies entitled to participate in dividends.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 3 - COUPON POLICIES AND POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-3.6 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this regulation or the application thereof to any person or circumstance is held invalid, the remainder of the regulation and the application of such provision to other persons or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 3 - COUPON POLICIES AND POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-3.7 - Effective date

Current through Register Vol. 56, No. 14, July 15, 2024
The effective date of this regulation shall be August 1, 1963.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 4 - PASSBOOKS USED IN CONNECTION WITH COUPON POLICIES OR POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-4.1 - General provisions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Passbooks resembling those used for savings deposits in banks shall not be used in connection with policies to which this regulation applies which contain guaranteed annual endowment benefits.
(b) No reference shall be made in any material used in connection with such policies to "passbook" or "premium deposit" or other language which might give the impression to an applicant or person insured that the transaction involves premium deposits of a savings nature.
(c) The practice of using such books is determined to be an unfair method of competition and unfair or deceptive act or practice in the business of insurance in that it is a "statement misrepresenting the terms of any policy issued or to be issued or the benefits or advantages promised thereby" as defined at 17B:30-3.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 4 - PASSBOOKS USED IN CONNECTION WITH COUPON POLICIES OR POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-4.2 - Unfair practice

Current through Register Vol. 56, No. 14, July 15, 2024
The use of such books as described at 11:4-4.1(a)  is determined to be an unfair method of competition and unfair or deceptive act or practice pursuant to 17B:30-18, and such books shall not be used in connection with policies to which this regulation applies.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 4 - PASSBOOKS USED IN CONNECTION WITH COUPON POLICIES OR POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-4.3 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This practice shall be discontinued with respect to policies to which this regulation applies because it conflicts with 17B:25-5 which requires "that the policy constitute the entire contract between the parties".
(b) The reference to such language as "deposits" in such books, but not in the policy itself, is in conflict with the required provision that the policy constitute the entire contract.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 4 - PASSBOOKS USED IN CONNECTION WITH COUPON POLICIES OR POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-4.4 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this regulation or the application thereof to any person or circumstance is held invalid, the remainder of the regulation and the application of such provision to other persons or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 4 - PASSBOOKS USED IN CONNECTION WITH COUPON POLICIES OR POLICIES CONTAINING GUARANTEED ANNUAL ENDOWMENT BENEFITS › Section 11:4-4.5 - Effective date

Current through Register Vol. 56, No. 14, July 15, 2024
The effective date of this regulation shall be August 1, 1963.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter applies to all insurers authorized to write health insurance in this State. These standards apply to all individual and group health insurance coverages issued prior to January 1, 2017. Reserve standards for such coverages issued prior to January 1, 2017, including claims incurred on and after January 1, 2017, on those policies, shall follow the requirements in the NAIC Accounting Practices and Procedures Manual (APPM), Appendix A, A-010. Reserve standards for such coverages issued prior to January 1, 2017, for claims incurred prior to January 1, 2017, but which are still open claims on or after January 1, 2017, shall follow applicable requirements for such open claims in the APPM, Appendix A, A-010. For all such coverages issued on and after January 1, 2017, the standards and reserve requirements provided in the Valuation Manual shall apply. These standards do not apply to credit insurance.
(b) When an insurer determines that adequacy of its health insurance reserves requires reserves in excess of the minimum standards specified in this subchapter, such increased reserves shall be held and shall be considered the minimum reserves for that insurer.
(c) With respect to any block of contracts, or with respect to an insurer's health business as a whole, a prospective gross premium valuation is an important test of reserve adequacy as of a given valuation date. Such a gross premium valuation will take into account, for contracts in force, in a claims status, or in a continuation of benefits status on the valuation date, the present value as of the valuation date of: all expected benefits unpaid, all expected expenses unpaid, and all unearned or expected premiums, adjusted for future premium increases reasonably expected to be put into effect.
(d) Such a gross premium valuation is to be performed whenever a significant doubt exists as to reserve adequacy with respect to any major block of contracts, or with respect to the insurer's health business as a whole. In the event inadequacy is found to exist, immediate loss recognition shall be made and the reserves restored to adequacy. Adequate reserves (inclusive of claim, premium and contract reserves, if any) shall be held with respect to all contracts, regardless of whether contract reserves are required for such contracts under these standards.
(e) Whenever minimum reserves, as defined in these standards, exceed reserve requirements as determined by a prospective gross premium valuation, such minimum reserves remain the minimum requirement under these standards.
(f) The following subchapter sets forth minimum standards for three categories of health insurance reserves:
1. Claim reserves;
2. Premium reserves; and
3. Contract reserves.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.3 - Claim reserves-general requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Claim reserves are required for all incurred but unpaid claims on all health insurance policies.
(b) Appropriate claim expense reserves are required with respect to the estimated expense of settlement of all incurred but unpaid claims.
(c) All claim reserves for prior valuation years are to be tested for adequacy and reasonableness along the lines of claim runoff schedules in accordance with the statutory financial statement including consideration of any residual unpaid liability.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.4 - Claim reserves-minimum standards for claim reserves

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following applies to disability income:
1. The maximum interest rate for claim reserves is specified in 11:4-6.1 6.
2. Minimum standards with respect to morbidity are those specified in 11:4-6.1 4 and 6.15, except that, at the option of the insurer:
i. For claims with a duration from date of disablement of less than two years, reserves may be based on the insurer's experience, if such experience is considered credible, or upon other assumptions designed to place a sound value on the liabilities.
ii. For group disability income claims with a duration from date of disablement of more than two years but less than five years, reserves may, with the approval of the Commissioner, be based on the insurer's experience for which the insurer maintains underwriting and claim administration control. The request for such approval of a plan of modification to the reserve basis shall include:
(1) An analysis of the credibility of the experience;
(2) A description of how all of the insurer's experience is proposed to be used in setting reserves;
(3) A description and quantification of the margins to be included;
(4) A summary of the financial impact that the proposed plan of modification would have had on the insurer's last filed annual statement;
(5) A copy of the approval of the proposed plan of modification by the Commissioner of the state of domicile; and
(6) Any other information deemed necessary by the Commissioner.
iii. For experience to be considered credible for the purposes of this subsection, the company should be able to provide claim termination patterns over no more than six years reflecting at least 5,000 claims terminations during the third through fifth claims durations on reasonably similar applicable policy forms.
iv. For claims reserves to reflect sound values and reasonable margins, reserve tables based on credible experience should be adjusted regularly to maintain reasonable margins. Demonstrations may be required.
3. For contracts with an elimination period, the duration of disablement should be measured as dating from the time that benefits would have begun to accrue had there been no elimination period.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.5 - Claim reserves-claim reserve methods

Current through Register Vol. 56, No. 14, July 15, 2024
A generally accepted actuarial reserving method or other reasonable method, if the method is approved by the Commissioner prior to the statement date, or a combination of methods, may be used to estimate all claim liabilities. The methods used for estimating liabilities generally may be aggregate methods, or various reserve items may be separately valued. Approximations based on groupings and averages may also be employed. Adequacy of the claim reserves, however, shall be determined in the aggregate.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.6 - Premium reserves-general requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Unearned premium reserves are required for all contracts with respect to the period of coverage for which premiums, other than premiums paid in advance, have been paid beyond the date of valuation.
(b) If premiums due and unpaid are carried as an asset, such premiums shall be treated as premiums in force, subject to unearned premium reserve determination. The value of unpaid commissions, premium taxes, and the cost of collection associated with due and unpaid premiums shall be carried as an offsetting liability.
(c) The gross premiums paid in advance for a period of coverage commencing after the next premium due date which follows the date of valuation may be appropriately discounted to the valuation date and shall be held either as a separate liability or as an addition to the unearned premium reserve which would otherwise be required as a minimum.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.7 - Premium reserves-minimum standards for unearned premium reserves

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The minimum unearned premium reserve with respect to any contract is the pro rata unearned modal premium that applies to the premium period beyond the valuation date, with such premium determined on the basis of:
1. The valuation net modal premium on the contract reserve basis applying to the contract; or
2. The gross modal premium for the contract if no contract reserve applies.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.8 - Premium reserves-premium reserve methods

Current through Register Vol. 56, No. 14, July 15, 2024
The insurer may employ suitable approximations and estimates; including, but not limited to, groupings, averages and aggregate estimation in computing premium reserves. Such approximations or estimates shall be tested periodically to determine their continuing adequacy and reliability.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.9 - Contract reserves-general requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Contract reserves are required, unless otherwise specified in 11:4-6.9(b), for:
1. All individual and group contracts with which level premiums are used; or
2. All individual and group contracts with respect to which, due to the gross premium pricing structure at issue, the value of the future benefits at any time exceeds the value of any appropriate future valuation net premiums at that time. This valuation may be applied on a rating block basis if the total premiums for the block were developed to support the total risk assumed and expected expenses for the block each year, and a qualified actuary certifies the premium development. The actuary shall state in the certification that premiums for the rating block were developed such that each year's premium was intended to cover the year's costs without any prefunding. If the premium is also intended to recover costs for any prior years, the actuary shall also disclose the reasons for and magnitude of such recovery. The values specified in this paragraph shall be determined on the basis specified in 11:4-6.1 0.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.10 - Contract reserves-minimum standards for contract reserves

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following applies to the basis for contract reserves:
1. Minimum standards with respect to morbidity or other contingency are those set forth in 11:4-6.1 4 and 6.15. Valuation net premiums used under each contract shall have a structure consistent with the gross premium structure at issue of the contract as this relates to advancing age of insured, contract duration and period for which gross premiums have been calculated.
i. Contracts for which tabular morbidity standards are not specified in 11:4-6.1 4 or 6.15 shall be valued using tables established for reserve purposes by a qualified actuary and acceptable to the Commissioner. The morbidity tables shall contain a pattern of incurred claims cost that reflects the underlying morbidity and shall not be constructed for the primary purpose of minimizing reserves.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.11 - Contract reserves-alternative valuation methods and assumptions generally

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Provided the contract reserve on all contracts to which an alternative method or basis is applied is not less in the aggregate than the amount determined according to the applicable standards specified in 11:4-6.1 0, an insurer may use any reasonable assumptions as to interest rates, termination and mortality rates, and rates of morbidity or other contingency.
(b) Subject to the condition in (a) above, the insurer may employ methods other than the methods stated above in determining a sound value of its liabilities under such contracts, including, but not limited to the following:
1. The net level premium method;
2. The one-year full preliminary term method;
3. Prospective valuation on the basis of actual gross premiums with reasonable allowance for future expenses;
4. The use of approximations such as those involving age groupings, groupings of several years of issue, average amounts of indemnity, or grouping of similar contract forms;
5. The computation of the reserve for one contract benefit as a percentage of, or by other relation to, the aggregate contract reserves exclusive of the benefit or benefits so valued; or
6. The use of a composite annual claim cost for all or any combination of the benefits included in the contracts valued.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.12 - Tests for adequacy and reasonableness of contract reserves

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Annually, an appropriate review shall be made of the insurer's prospective contract liabilities on contracts valued by tabular reserves, to determine the continuing adequacy and reasonableness of the tabular reserves giving consideration to future gross premiums. The insurer shall make appropriate increments to such tabular reserves if such tests indicate that the basis of such reserves is no longer adequate, subject, however, to the minimum standards of 11:4-6.1 0.
(b) In the event a company has a contract or a group of related similar contracts, for which future gross premiums will be restricted by contract, regulations of the Department or any other regulatory entity, or for other reasons, such that the future gross premiums reduced by expenses for administration, commissions, and taxes will be insufficient to cover future claims, the company shall establish contract reserves for such shortfall in the aggregate.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.13 - Reinsurance

Current through Register Vol. 56, No. 14, July 15, 2024
Increases to, or credits against, reserves carried, arising because of reinsurance assumed or reinsurance ceded, shall be determined in a manner consistent with these minimum reserve standards and with all applicable provisions of the reinsurance contracts which affect the insurer's liabilities.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.14 - Specific standards for morbidity for valuation of specified individual contract health insurance benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Minimum morbidity standards for valuation of specified individual contract health insurance benefits are as follows:
1. For disability income benefits due to accident or sickness use:
i. When calculating contract reserves:
(1) For contracts issued on or after January 1, 1965 and prior to January 1, 2001: The 1964 Commissioners Disability Table (64 CDT), incorporated herein by reference.
(2) For contracts issued on or after January 1, 2001:
(A) The 1985 Commissioners Individual Disability Tables A (85CIDA), incorporated herein by reference; or
(B) The 1985 Commissioners Individual Disability Tables B (85CIDB), incorporated herein by reference.
(3) For contracts issued from January 1, 1999 through December 31, 2000:
(A) Optional use of either the 1964 Table or the 1985 Tables.
(B) Each insurer shall elect, with respect to all individual contracts issued in any one statement year, whether it will use Tables A or Tables B as the minimum standard. The insurer may, however, elect to use the other tables with respect to individual contracts issued in any subsequent statement year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.15 - Specific standards for morbidity for valuation of specified group contract health insurance benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Minimum morbidity standards for valuation of specified group contract health insurance benefits are as follows:
1. For disability income benefits due to accident or sickness use:
i. When calculating contract reserves:
(1) For contracts issued prior to January 1, 2001: The same basis, if any, as that employed by the insurer as of January 1, 2001;
(2) For contracts issued on or after January 1, 2001: The 1987 Commissioners Group Disability Income Table (87CGDT), (incorporated herein by reference).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.16 - Specific standards for interest

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For contract reserves the maximum interest rate is:
1. For contracts issued prior to January 1, 1973: 3 1/2 percent.
2. For contracts issued on or after January 1, 1973 through December 31, 2000: A rate of interest not exceeding the maximum rate of interest specified in 17B:19-8 for policies of life insurance which are issued the same year and, if relevant, for policies of life insurance containing a maximum guaranteed duration of more than 10 years but not more than 20 years.
3. For contracts issued on or after January 1, 2001: The maximum rate permitted by law in the valuation of whole life insurance issued on the same date as the health insurance contract.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.17 - Specific standards for mortality

Current through Register Vol. 56, No. 14, July 15, 2024
The mortality basis used for all policies except long-term care individual policies and group certificates and for long-term care individual policies or group certificates issued before January 1, 2001 shall be according to a table (but without use of selection factors) permitted by law for the valuation of whole life insurance issued on the same date as the health insurance contract. For long-term care insurance individual policies or group certificates issued on or after January 1, 2001 the mortality basis used shall be the 1983 Group Annuity Mortality Table, incorporated herein by reference, without projection.