reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.6 - Order of benefits determination when PIP is secondary coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When the named insured of an automobile policy has selected the PIP-as-secondary coverage option, all health benefits plans for which the insured is eligible shall provide coverage for the allowable expenses incurred by the insured due to an automobile-related injury prior to any benefits for medical expenses being paid by a PIP plan.
(b) If the insured is eligible for coverage under more than one group health benefits plan, the group health benefits plans shall coordinate benefits with one another in accordance with the rules set forth for such plans at N.J.A.C. 11:4-28.
(c) The PIP plan shall provide benefits for allowable expenses remaining uncovered after all health benefits plans for which the insured is eligible have paid benefits towards those allowable expenses.
(d) The PIP plan shall continue to be liable for expenses related to the same occurrence as the expenses are incurred, whether or not the health benefits plan(s) in force at the time of the accident terminate(s) coverage, or benefits provided under the health benefits plan(s) are exhausted subsequent to the occurrence of the accident, up to the maximum PIP benefits available to the insured under the terms of the automobile policy.
(e) Total benefits paid by an insured's health benefits and PIP plans shall not exceed the amount of total allowable expenses.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.7 - Determination of PIP medical benefits payable when PIP is secondary coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In calculating the actual benefits to be paid by the automobile insurer when the PIP-as-secondary coverage option has been selected, the automobile insurer shall first determine the amount of eligible expenses which would have been paid after application of the deductible and copayment limitations had the PIP-as-secondary coverage option not been selected.
1. In the event the remaining allowable expenses are less than the benefits calculated pursuant to (a) above, the automobile insurer shall pay actual benefits equal to the remaining allowable expenses, without reducing the remaining allowable expenses by its deductible or copayments.
2. In the event the remaining allowable expenses are greater than the benefits calculated pursuant to (a) above, the actual benefits paid by the automobile insurer shall be the benefits calculated pursuant to (a) above, without reducing the remaining allowable expenses by its deductible or copayments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.8 - Health benefits plan coverage ineligibility

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When, subsequent to the selection of the PIP-as-secondary coverage option by a named insured, it is determined that an insured did not have health coverage in effect at the time of an injury, or had health coverage in effect at the time of any injury which is such that the PIP-as-secondary coverage option selection could have been invalidated by the automobile insurer and elimination of the premium reduction amount effected in accordance with 11:3-37.5(a), but was not, then the insured shall be provided benefits for incurred medical expenses through the PIP medical expense provision.
1. Benefits payable shall be subject to a per accident deductible equalling the total of $ 750.00 plus the PIP deductible selected by the named insured of the policy.
2. Benefits payable shall be subject to a 20 percent copayment for amounts less than $ 5,000 after the deductible has been satisfied.
3. Determination of the amount of benefits payable shall be made in accordance with medical fee schedules promulgated pursuant to 39:6A-4.6 and set forth at N.J.A.C. 11:3-29, or on a reasonable basis, as determined by the automobile insurer, considering the medical fee schedules for similar services or equipment in the region where the service or equipment was provided, when an item of expense is not included on the medical fee schedules.
4. Total benefits paid for each insured eligible for benefits in any one accident shall not exceed the maximum PIP benefits provided for by the terms of the policy.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.9 - Determination of benefits when PIP is primary coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) When no election has been made by a named insured to make his or her health benefits plan(s) primary coverage provider(s), so that the PIP plan will provide primary coverage for medical expenses incurred for treatment of injuries, the PIP plan shall provide benefits to the insured without consideration of any benefits for which the insured may be eligible under any health benefits plan.
(b) Actual benefits paid by the PIP plan shall be medical expenses, subject to the policy limits and the application of any deductible and copayment provided for by the terms of the automobile policy, approved by the Commissioner pursuant to 39:6A-4 or 39:6A-3.1, and any rules promulgated thereunder.
(c) Actual benefits payable by a health benefits plan, when the PIP plan is providing primary coverage for medical expenses incurred for treatment of injuries, shall be the lesser of the remaining uncovered allowable expenses or the actual benefits that would have been payable had the health benefits plan been providing coverage primary to the PIP plan.
1. Actual benefits payable may be reduced by the deductible(s) and copayment requirements applicable by the terms of the health benefits plan, and shall not exceed the amount of actual benefits that would have been payable had the health benefits plan been providing coverage primary to the PIP plan.
2. Allowable expenses remaining uncovered, which the health benefits plan(s) shall consider when the PIP plan is providing primary coverage, include:
i. Any PIP deductible(s);
ii. Any PIP copayment amounts;
iii. Any expenses which exceed the medical expense coverage limits of the PIP plan per person per accident, as set forth by the terms of the automobile policy; and
iv. Any expenses not covered by the PIP plan when such expense was determined to be in excess of the reasonable charge for an item of expense not listed on the medical fee schedules, but for which the automobile insurer determined a reasonable charge based on the medical fee schedule for a similar item of expense in the region where the service or equipment was provided.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.10 - Explanation of benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Automobile insurers shall develop and utilize an explanation of benefits form to be provided with the payment of benefits for expenses incurred for treatment of injuries which clearly identifies and explains the following:
1. Each procedure for which a claim has been made;
2. Eligible expense related to each procedure with an indication of whether the eligible expense is based on the medical fee schedules or is the reasonable charge as determined by the automobile insurer;
3. Actual benefits paid;
4. Any deductible or copayment applied;
5. A concise explanation why any item of expense is considered an ineligible expense, when this occurs; and
6. A statement to insureds that no health care provider may demand or request any payment from any person in excess of those permitted by N.J.A.C. 11:3-29, and that no person is liable to any health care provider for any amount of money which results from the charging of fees in excess of those permitted by N.J.A.C. 11:3-29 pursuant to 39:6A-4.6.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.11 - Dispute as to primacy of coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If, subsequent to the selection of the PIP-as-secondary coverage option by the named insured, injuries are sustained by an insured eligible for health benefits plan coverage, but a dispute exists between the health benefits provider and the automobile insurer, then the health benefits provider shall provide benefit as if it were the primary coverage provider and no PIP benefits were available to the insured. In no event shall the provision of benefits be unreasonably delayed by either a health benefits provider or an automobile insurer.
(b) If the health benefits provider asserts that it is not subject to 11:3-37.3, and thus, will not act as the primary coverage provider then the automobile insurer shall assume the role of primary coverage provider, and provide its benefits in accordance with 11:3-37.8. The automobile insurer shall be entitled to recover premium reductions in accordance with 11:3-37.8(c).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.12 - Eligibility under two or more automobile policies

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If an insured is eligible for coverage of medical expenses under more than one automobile policy, the determination as to which automobile policy will assume coverage responsibility for that insured shall be as follows:
1. A named insured shall receive benefits for medical expenses under the terms of the automobile policy on which he or she, or his or her spouse, is identified as the named insured.
2. A family member who is a child of a named insured or the named insured's spouse shall receive benefits for medical expenses under the automobile policy of the named insured, subject to the following:
i. If the child is a child of more than one named insured or of more than one spouse of a named insured, the child shall receive benefits under the terms of the automobile policy of the named insured who has legal custody of that child or whose spouse has legal custody of that child.
ii. If the child is a child of more than one named insured or of more than one named insured's spouse, and legal custody of that child has either never been awarded, or has been awarded jointly, then the child shall receive benefits under the terms of the automobile policy of the named insured whose birthday occurs earliest in the calendar year.
iii. If the child is a named insured or the spouse of a named insured, (a)1 above shall apply.
3. If neither (a)1 nor (a)2 above apply to an adult or child family member, then that family member shall receive benefits for medical expenses under the terms of the automobile policy of the named insured whose birthday occurs earliest in the calendar year.
4. If an automobile policy identifies more than one person as a named insured on the automobile policy, the birthday of the named insured whose birthday occurs earliest in the calendar year shall be considered the determinant birthday on that automobile policy.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.13 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Each automobile policy or health benefits plan subject to the terms of this subchapter which fails to comply with the terms herein shall be in violation of this subchapter. Failure to comply with the terms of this subchapter may result in the assessment of any and all penalties in accordance with the laws of this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 37 - ORDER OF BENEFIT DETERMINATION BETWEEN AUTOMOBILE PERSONAL INJURY PROTECTION AND HEALTH INSURANCE › Section 11:3-37.14 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter or application thereof to any person or circumstance is held invalid, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 39 - REDUCTIONS IN PREMIUM CHARGES FOR PRIVATE PASSENGER AUTOMOBILES EQUIPPED WITH ANTI-THEFT, VEHICLE RECOVERY AND SAFETY FEATURES › Section 11:3-39.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this subchapter is to encourage consumers to invest in and use anti-theft and vehicle recovery devices and safety features in private passenger automobiles by providing that there shall be a reduction in the base rates applicable to automobile physical damage coverage, in accordance with 17:33B-44, for those private passenger automobiles equipped with anti-theft and vehicle recovery devices and safety features.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 39 - REDUCTIONS IN PREMIUM CHARGES FOR PRIVATE PASSENGER AUTOMOBILES EQUIPPED WITH ANTI-THEFT, VEHICLE RECOVERY AND SAFETY FEATURES › Section 11:3-39.2 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter shall apply to all insurers which write private passenger automobile insurance in this State.
(b) This subchapter shall apply to all policies which include provisions for physical damage coverage and which are issued or renewed on or after September 1, 1991.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 39 - REDUCTIONS IN PREMIUM CHARGES FOR PRIVATE PASSENGER AUTOMOBILES EQUIPPED WITH ANTI-THEFT, VEHICLE RECOVERY AND SAFETY FEATURES › Section 11:3-39.3 - 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.
"Alarm" means a device which emits sounds audible at 300 feet or more, such as a horn, bell or siren, but does not include those sounds that reasonably may be confused with police or emergency response vehicle sirens.
"Automobile physical damage insurance" means a policy providing one or more of the following coverages:
1. Collision;
2. Comprehensive; and
3. Fire and theft.
"Electronic lock or keyless lock device" means an electronic coding device possessing 10,000 possible combinations or more, which may be unlocked by use of a keyboard or similar data entry device or by means of a remote control device.
"Inspection" means a physical examination of an automobile by an authorized representative of the insurer, in accordance with the standards set forth at 11:3-36.6.
"Insured" means the named insured, as defined in the policy, or an applicant for automobile physical damage insurance.
"Insurer" means any person authorized to write automobile insurance in New Jersey, including any residual market mechanism, and includes all affiliated companies within a group.
"Nonpassive" means a device or system designed to remain inoperative and nonfunctional until actively engaged by the user.
"Passive" means a device or system designed to become automatically operative and functional when the automobile's ignition key is moved or stationed in the off position.
"Private passenger automobile" means a vehicle that meets the definition at 39:6A-2.
"Tubular lock" means a lock which may be opened by a specific cylindrically shaped key and which possesses at least 50,000 possible combinations.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 39 - REDUCTIONS IN PREMIUM CHARGES FOR PRIVATE PASSENGER AUTOMOBILES EQUIPPED WITH ANTI-THEFT, VEHICLE RECOVERY AND SAFETY FEATURES › Section 11:3-39.4 - Reductions in rates for anti-theft and vehicle recovery devices

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every insurer writing automobile physical damage insurance shall provide a reduction in the base rates of its comprehensive and fire and theft coverages, if different, for all private passenger automobiles equipped with one or more anti-theft or vehicle recovery devices, as described at 11:3-39.5. The reductions in the base rates shall be as follows:
1. At least five percent for devices which qualify as Category I anti-theft devices;
2. At least 10 percent for devices which qualify as Category II anti-theft devices;
3. At least 15 percent for devices which qualify as Category III anti-theft or vehicle recovery devices; and
4. At least 20 percent for devices which qualify as Category IV anti-theft or vehicle recovery devices.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 39 - REDUCTIONS IN PREMIUM CHARGES FOR PRIVATE PASSENGER AUTOMOBILES EQUIPPED WITH ANTI-THEFT, VEHICLE RECOVERY AND SAFETY FEATURES › Section 11:3-39.5 - Categories of anti-theft and vehicle recovery devices

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A device qualifies as a Category I anti-theft device if it meets the requirements of one of the devices listed below.
1. An ignition or starter cut-off switch device is qualified if a warning label announces the presence of the device, and the device is designed so that the cut-off switch:
i. Is wired into the ignition's wiring;
ii. Is tripped and activated upon exiting of the automobile;
iii. Shall be re-set in order to start the automobile; and
iv. Is installed so as not to be visible from the driver's normal seating position.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 39 - REDUCTIONS IN PREMIUM CHARGES FOR PRIVATE PASSENGER AUTOMOBILES EQUIPPED WITH ANTI-THEFT, VEHICLE RECOVERY AND SAFETY FEATURES › Section 11:3-39.6 - Reductions in rates for safety features

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Except as (d) below may apply, every insurer writing automobile physical damage insurance shall provide a reduction in the base rates of its collision damage coverage for all private passenger automobiles equipped with one or more safety features. Reductions in the base rates shall be as follows:
1. At least five percent for a private passenger automobile equipped with one safety feature;
2. An additional 2.5 percent reduction shall be provided for each additional safety feature with which the automobile is equipped; and
3. No insurer shall be required to provide more than a 10 percent total reduction for safety features, (a)2 above notwithstanding.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 39 - REDUCTIONS IN PREMIUM CHARGES FOR PRIVATE PASSENGER AUTOMOBILES EQUIPPED WITH ANTI-THEFT, VEHICLE RECOVERY AND SAFETY FEATURES › Section 11:3-39.7 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Any insurer which fails to comply with the terms of this subchapter shall be in violation of this subchapter, and subject to the assessment of any and all penalties in accordance with the laws of this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 39 - REDUCTIONS IN PREMIUM CHARGES FOR PRIVATE PASSENGER AUTOMOBILES EQUIPPED WITH ANTI-THEFT, VEHICLE RECOVERY AND SAFETY FEATURES › Section 11:3-39.8 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter or application thereof to any person or circumstances is held invalid, the remainder of the subchapter and application of such provisions to other persons or circumstances shall not be affected thereby.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 45 - INSURERS REQUIRED TO PROVIDE SURVEY INFORMATION › Section 11:3-45.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of the subchapter is to implement 39:6A-23.1 by setting forth those procedures by which insurers shall annually submit to the Department current premium information.
(b) This subchapter shall apply to all auto insurers that have on file with the Department a current personal lines rating system for automobile insurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 45 - INSURERS REQUIRED TO PROVIDE SURVEY INFORMATION › Section 11:3-45.2 - 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:
"Auto insurer" means an entity authorized or admitted to write automobile insurance in New Jersey but does not include any residual market mechanism implemented pursuant to 17:29D-1 et seq. or any other statute.
"Automobile insurance" means insurance for private passenger automobile including one or more of the following coverages: bodily injury liability and property damage liability, comprehensive and collision coverages, uninsured and underinsured motorist coverage, personal injury protection, additional personal injury protection coverage and any other automobile insurance required by law.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Survey information" means the data annually supplied by the Commissioner to the auto insurers from which they will then issue survey quotations. This information includes, but is not limited to, the prior driving experience of the insured, the nature and extent of coverages, the deductible, the composition of household, information regarding the proposed vehicle, and other pertinent information.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 45 - INSURERS REQUIRED TO PROVIDE SURVEY INFORMATION › Section 11:3-45.3 - Annual premium survey filing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every auto insurer shall prepare and file on or before September 15 of each calendar year, with the Department, at the address set forth in (d) below, an annual premium survey reflecting premiums charged for specific automobile insurance coverage.
(b) The filing shall reflect the annual premiums by coverage as of October 1 of that calendar year and shall be predicated on survey information provided by the Commissioner to auto insurers by Bulletin on or before September 1 of each calendar year.
(c) Auto insurers shall prepare and file the information required by this subchapter in accordance with the forms contained in the Appendix and incorporated herein by reference.
(d) Completed annual premium survey forms shall be submitted to:
New Jersey Department of Banking and Insurance
Office of Property/Casualty
20 West State Street
PO Box 325
Trenton, NJ 08625-0325
Attn: Automobile Premium Comparison Survey
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 45 - INSURERS REQUIRED TO PROVIDE SURVEY INFORMATION › Section 11:3-45.4 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with the provisions of this subsection shall result in the imposition of penalties as prescribed by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to:
1. Provide for the establishment of a private passenger automobile insurance urban enterprise zone program pursuant to 17:33C-1 et seq., and for the voluntary rating tier of the PAIP pursuant to N.J.S.A. 17:29D-1i; and
2. Encourage greater availability of private passenger automobile insurance in certain urban areas of this State as designated by the Commissioner pursuant to N.J.S.A. 17:33C-2b and this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.2 - 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.
"Automobile" means an automobile as defined pursuant to 39:6A-2.
"Automobile insurance" means personal lines private passenger automobile insurance.
"Automobile insurance urban enterprise zone" or "UEZ" means a geographic area identified and designated by the Commissioner pursuant to 17:33C-2 and this subchapter.
"Automobile insurance urban enterprise zone program" or "program" means an automobile insurance urban enterprise zone program established pursuant to 17:33C-2 and this subchapter.
"Automobile insurer" means an insurer or group of affiliated insurers authorized or admitted to transact the business of personal lines private passenger automobile insurance in this State.
"Bona fide office" means an office maintained by the producer for the transaction of business that is open to the public during normal business hours, and that provides access as required by 12 U.S.C. § 12101 (the "Americans with Disabilities Act").
"CAIP" means the Commercial Automobile Insurance Plan established pursuant to 17:29D-1 and N.J.A.C. 11:3-1.
"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 any person engaged in the business of an insurance agent, insurance broker, or insurance consultant, and who is licensed pursuant to N.J.S.A. 17:22A-1 et seq.
"Located in a UEZ" or "maintain a bona fide office in a UEZ" means that the street address of the business office of the producer is located in a zip code located within a UEZ. Determination of zip code boundaries shall be based on the edition of the United States Zip Code and Post Office Directory in effect at the time of the application for eligibility.
"PAIP" means the New Jersey Personal Automobile Insurance Plan established pursuant to 17:29D-1 and N.J.A.C. 11:3-2.
"Qualified insurer" means an automobile insurer that is a qualified insurer pursuant to 17:33C-3 and this subchapter.
"Urban enterprise zone agent" or "UEZ agent" means an insurance producer who is licensed pursuant to N.J.S.A. 17:22A-1 et seq., is appointed on or after January 1, 1998 by a qualified insurer in accordance with the procedures set forth in N.J.S.A. 17:22A-15 and 11:17-2.9 to represent it in an automobile insurance urban enterprise zone under the terms of 17:33C-1 et seq., and maintains a bona fide office within that automobile insurance urban enterprise zone.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.3 - Designation of UEZ and UEZ share

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to 17:33C-2, the Commissioner has identified and designated as UEZs certain urban-based geographic areas where the Commissioner has found that automobile insurance consumers would benefit from increased access to automobile insurance as set forth below. UEZs shall be designated by municipality consisting of one or more zip codes.
(b) In determining UEZ areas, the Commissioner first determined those areas of the State that are urban, as follows:
1. The eight Urban Centers designated by the State Planning Commission, Appendix C in the most recent edition of the State Plan; and
2. Municipalities with populations in excess of 10,000 as of the 1990 census and with population densities in excess of 3,500 persons per square mile.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.4 - Qualified insurers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An automobile insurer may apply to the Commissioner to be considered a qualified insurer for purposes of participating in the UEZ program. An automobile insurer seeking to become a qualified insurer shall demonstrate that it will actively conduct business in UEZ areas by filing plans and procedures, including, but not limited to, the following:
1. A plan to increase access to automobile insurance for consumers residing in a UEZ;
2. A plan to assist newly appointed UEZ agents in developing the skills necessary to manage a successful business;
3. Procedures to monitor and evaluate the impact of efforts to expand services to urban areas;
4. Materials designed to assist consumers in understanding automobile insurance coverages;
5. The insurer's marketing plans and goals for increasing its writing of risks in automobile insurance urban enterprise zones; and
6. A certification from the insurer that it will file all reports required by this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.5 - UEZ agents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A qualified insurer may appoint one or more UEZ agents on or after January 1, 1998. Such appointments shall comply with all requirements set forth in 17:33C-4 and 17:22A-15, 11:17-2.9, and this subchapter. UEZ agent contracts shall set forth any limitation on the number of exposures that may be written by the UEZ agent pursuant to 17:33C-4. The notice of agency contract filed pursuant to 11:17-2.9 shall note that the agent is a UEZ agent whose contract includes provisions permitted by 17:33C-1 et seq. and this subchapter.
(b) The insurer shall provide UEZ agents with reasonable support services. In addition, in setting the compensation for UEZ agents, the insurer shall comply with N.J.S.A. 17:33B-18b.
(c) If the qualified insurer is a direct writer (that is, an insurer that writes business directly through its own employees without the use of contracted agents), and has an amount of in-force exposures in UEZs that exceeds 105 percent of its Statewide marketshare as of the end of a quarterly reporting period, it may request that the Commissioner permit the insurer to suspend any additional marketing efforts implemented as part of its plan submitted pursuant to 11:3-46.4.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.6 - PAIP voluntary rating tier

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to N.J.S.A. 17:29D-1i, the PAIP Plan of Operation shall provide for the establishment of a voluntary rating tier in which persons residing in UEZs may be written by certain UEZ agents and qualified producers, as set forth in 11:3-46.7. The rates utilized in the voluntary rating tier shall be the voluntary market rates in use by the insurer to which the risk is distributed.
(b) The voluntary rating tier shall not provide insurance coverage for more than five percent of the aggregate number of private passenger automobile non-fleet exposures being written in the total private passenger automobile insurance market in this State. The number of exposures written in the voluntary rating tier shall be included for purposes of determining the maximum number of overall exposures permitted to be written in the PAIP pursuant to N.J.S.A. 17:29D-1d. The Commissioner may suspend writings in the voluntary rating tier if he or she finds that total amount of exposures written in the PAIP is approaching the maximum amount permitted to be written in the PAIP pursuant to N.J.S.A. 17:29D-1d.
(c) An insurer that does not meet its goal, for qualified insurers, or UEZ share, for insurers that are not qualified insurers, shall be subject to distributions in an amount required for the insurer to meet its goal or UEZ share, as applicable, evaluated based on the insurer's quarterly reports filed pursuant to 11:3-46.1 3 in accordance with (f) below.
(d) Insurers that have, and maintain, an aggregate voluntary private passenger automobile insurance marketshare in UEZs that is at least 95 percent of the insurer's goal, if a qualified insurer, or UEZ share, if not a qualified insurer, shall be exempt from distributions pursuant to this section.
(e) An insurer shall be subject to initial distributions beginning September 1, 1998 unless the insurer has filed a plan to become a qualified insurer pursuant to 11:3-46.4 by July 1, 1998 that provides as a goal to eliminate its shortfall by March 31, 1999; and either:
1. Has written an amount of in-force exposures equal to at least 20 percent of its goal by June 30, 1998; or
2. Has filed a report with the Department prior to September 1, 1998 that demonstrates that the insurer has written an amount of in-force exposures equal to at least 30 percent of its goal as of September 1, 1998.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.7 - Qualified producers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Only UEZ agents who have met any limit on exposures that may be written in accordance with the UEZ agent's agreement with the appointing insurer pursuant to 17:33C-4, and who is certified by the PAIP, or qualified producers as set forth below, shall be permitted to submit risks from UEZs to the PAIP for coverage under the voluntary rating tier, subject to any apportionment of distributions by the PAIP pursuant to 11:3-46.1 1(h).
(b) For purposes of this subchapter, a "qualified producer" is a producer who:
1. Has been duly licensed with property/casualty authority for the three years immediately preceding the effective date of 17:33C-1 et seq.;
2. Has no affiliation with a voluntary market insurer for the placement of automobile insurance;
i. A producer shall not be deemed to have an affiliation with a voluntary market insurer if the insurer has been placed in rehabilitation or liquidation pursuant to 17:30C-1 et seq.; or has been placed under administrative supervision pursuant to 17:51A-1 et seq.;
3. Had an affiliation with a voluntary market insurer for the placement of automobile insurance that was terminated by the insurer in the last three years;
4. Conducts as of the date of application and has continuously conducted his or her business in a bona fide office in a UEZ during the three years immediately preceding January 1, 1998, supported by proper documentation;
5. Is certified by the PAIP; and
6. Demonstrates to the PAIP his or her competency, efficiency and effectiveness in the solicitation, negotiation and effectuation of automobile insurance as evidenced by any history of disciplinary actions or complaints against the producer, and other relevant factors.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.8 - Review of applications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In determining whether a producer has demonstrated competency, efficiency and effectiveness in the solicitation, negotiation and effectuation of insurance, the PAIP's review shall include, but need not be limited to, the following:
1. Any records concerning the termination of the producer's affiliation with any voluntary market insurer(s) to determine whether the reason for termination adversely reflects on the producer's competency, efficiency and effectiveness in servicing insurance business or otherwise indicates that the producer should not be qualified due to unworthiness, bad faith, lack of integrity, financial irresponsibility, dishonesty or other criteria deemed relevant by the Commissioner;
2. Any records relating to the appointment of the producer to act as a PAIP or CAIP producer, his or her performance as a PAIP or CAIP producer, and any corrective or disciplinary action taken by the PAIP or CAIP with respect to the producer;
3. Any administrative action instituted by the Department (that is, issuance of an Order to Show Cause, issuance of an order pursuant to N.J.S.A. 17:22A-20d etc.) with respect to the producer that has resulted in the imposition of fines or suspensions or revocation of license privileges, including the imposition of such sanctions based on a consent order; and
4. Upon disclosure on the application or any other document reviewed by the PAIP of such administrative actions, any records relating to administrative actions instituted by any licensing authority of this or any other state or the Federal government with respect to the producer that has resulted in the imposition of fines, or suspension or revocation of license privileges.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.9 - Disapproval standards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A producer's application to be a qualified producer under the voluntary rating tier shall be disapproved if, based on the PAIP's review as set forth in 11:3-46.8:
1. The producer failed to file a completed application with the PAIP as provided in 11:3-46.7(c);
2. The producer is determined not to meet the eligibility criteria set forth in 11:3-46.7(b)1  through 5;
3. The producer knowingly withheld material information on the application or any accompanying document or intentionally made or caused to be made any false, deceptive or fraudulent statement during the application process, or otherwise qualified or attempted to qualify by fraud or material misrepresentations; or
4. The producer has failed to comply with insurance laws or regulations and/or the producer standards established by the PAIP in such a manner or with such frequency as to demonstrate a lack of competency, efficiency and effectiveness in the solicitation, negotiation and servicing of insurance business. In making its determination under this paragraph, the PAIP shall consider the nature of any violation and how recently it occurred.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.10 - Commissions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Qualified producers shall receive commissions for risks placed in the voluntary rating tier from the insurer to which the risks are distributed. Such commissions shall be equivalent to the insurer's usual commission rate for its agents or brokers, or may be a newly established commission rate for brokers placing business in the voluntary rating tier, but in no event less than nine percent. Direct writers shall pay an amount not less than nine percent. To the extent the minimum commission required pursuant to this section exceeds the insurer's commission underlying its current rates, for every two percent that the minimum commission required exceeds the commission underlying the insurer's current approved rates, the insurer may file rule pages to provide for a one percent increase in rates for business written pursuant to 11:3-46.6. In the case of a direct writer, the insurer's commission underlying its rates shall be deemed to be zero.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.11 - Coverage application procedure

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A producer requesting coverage through the voluntary rating tier on behalf of an applicant shall file with the PAIP an application for coverage in a form acceptable to the Commissioner. The application shall contain the information required to constitute a completed written application pursuant to N.J.A.C. 11:3-44, except that a coverage selection form shall be supplied as provided in (c) below. The application shall include information regarding requested coverages, limits of coverages and tort threshold options.
(b) The assigned insurer shall review the application and determine the eligibility for coverage in accordance with time frames and other requirements set forth in N.J.A.C. 11:3-44. Quotations, accompanied by a coverage selection form and any other documents required by the insurer in accordance with its normal business practice in the voluntary market, shall be mailed or faxed to the producer and mailed to the applicant. All quotations shall be valid for a period of 30 days after the date of issuance of the quotation.
1. The insurer shall provide a quotation based on the requested limits of coverage set forth in the application. To the extent that the insurer does not offer the specific limit(s) requested, the insurer shall offer the next broadest coverage it offers.
2. Together with the quotation provided to the applicant pursuant to (b) above, the insurer shall include a coverage selection form specifying the limits of coverages to be provided pursuant to (b)1 above to be executed by the applicant.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.12 - PAIP Plan of Operation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The PAIP shall develop any amendments or supplements to the PAIP Plan of Operation as may be necessary or appropriate to provide for the implementation of 11:3-46.6, 46.7, 46.8, 46.9, 46.10, and 46.11. Such amendments or supplements shall be subject to review and approval by the Commissioner pursuant to 11:3-2.6.
(b) The PAIP governing committee shall submit to the Commissioner, for his or her approval, such amendments and supplements to the Plan of Operation no later than July 1, 1998. If the governing committee does not submit amendments or supplements within the time set forth in (a) above, or amendments or supplements acceptable to the Commissioner within 30 days after disapproval of the proposed changes, the Commissioner may promulgate such amendments or supplements and certify same to the governing committee.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.13 - Reporting requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each automobile insurer shall report on a quarterly basis its in-force private passenger automobile exposures in UEZs by zip code for the periods ending March 31, June 30, September 30, and December 31. Such reports shall be filed within 10 days of the end of each quarter and shall be in the form set forth in Exhibit C in the Appendix to this subchapter, incorporated herein by reference.
(b) In addition to (a) above, the Commissioner may from time to time order insurers to file in-force exposure data by zip code for all urban areas, regardless of whether those areas are currently designated as UEZs.
(c) Reports filed pursuant to this section shall be confidential and shall not be subject to public inspection or copying pursuant to the "Right-to-Know" law, 47:1A-1 et seq.
(d) All reports filed pursuant to this section shall be filed with the Department at the following address:
New Jersey Department of Banking and Insurance
Office of Property and Casualty
PO Box 325
Trenton, NJ 08625-0325
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 3 - AUTOMOBILE INSURANCE › Subchapter 46 - AUTOMOBILE INSURANCE URBAN ENTERPRISE ZONE PROGRAM › Section 11:3-46.14 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with this subchapter shall result in the imposition of penalties as authorized by law, including, but not limited to, a penalty up to $ 1,000 for a first violation, and up to $ 2,000 for each subsequent violation, pursuant to 17:33-2; and a fine up to $ 25,000, or suspension or revocation of an insurer's certification as a qualified insurer, pursuant to N.J.S.A. 17:33C-3c.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth procedures and requirements with respect to the New Jersey Insolvent Health Maintenance Organization Assistance Association established pursuant to 17B:32B-1 et seq.
(b) This subchapter shall apply to all member organizations of the Association pursuant to 17B:32B-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.3 - Establishment of Association and Fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to 17B:32B-1 et seq., the Association is created to administer the Fund established pursuant to 17B:32B-6 for purposes of providing payment for eligible claims under a covered health maintenance organization contract on an equitable basis to any covered individual or provider that remains unpaid.
(b) Pursuant to 17B:32B-6, the Fund shall consist of an aggregate amount of not more than $ 100,000,000 consisting of:
1. $ 50,000,000 to be deposited in the Fund pursuant to 17B:32B-17; and
2. An aggregate sum of not more than $ 50,000,000 collected through assessments on member organizations pursuant to 17B:32B-9.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION › Section 11:4-1.4 - Relief

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In accordance with N.J.S.A. 17B:32B-9e, the Association shall exempt, abate or defer, in whole or in part, the assessment of a member organization if, in the opinion of the Commissioner, payment of the assessment would endanger the ability of the member organization to fulfill its contractual obligations or place the member organization in an unsafe or unsound financial condition, as determined by indicia that relate to the ability to pay the assessment by a member organization. If an assessment is exempted, abated or deferred, in whole or in part, the amount exempted, abated or deferred shall be assessed against other member organizations in a manner consistent with N.J.S.A. 17B:32B-9c and the Association Plan of Operation approved by the Commissioner.
(b) Any member organization seeking relief from its obligation to pay assessments shall comply with 11:4-1.5 through 1.8.