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New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.15 - Assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each participating member of a joint insurance fund shall appropriate and pay to the fund its assessments as required by the joint insurance fund. During the first year of operation of a joint insurance fund these contributions shall be paid in two equal installments, the first installment payable no later than July 15 and the second installment payable no later than November 15 or in any other manner that the Commissioner in his or her discretion may direct. Subsequent years' assessments may be paid in such installments as shall be provided in the fund's bylaws, provided, however, that the full assessment shall be paid by each member no later than February 1, or in such other manner as provided in the fund's bylaws as approved by the Commissioner.
(b) Each member's annual assessment shall consist of an amount allocated for the administrative account, contingency trust fund account where appropriate, plus a specific assessment to establish and/or replenish the claim or loss retention trust fund account for each type of coverage provided by the fund and in which such member participates.
(c) The total amount of each member's annual assessments to the joint insurance fund shall be certified by the trustees to the governing body of each participant at least one month prior to the beginning of the next fiscal year. As a condition of continued participation in the joint insurance fund, each member shall pay the amount certified at such time and in such manner provided in the fund's bylaws.
(d) Unless otherwise approved by the Commissioner, the annual assessment of each fund member providing for the self-insurance of workers' compensation and employers' liability coverages shall be based upon the Experience Rating Plan provided for in the New Jersey Workers' Compensation and Employers' Liability Insurance Manual on file with the Commissioner. The Commissioner may withdraw his or her approval of any assessment if he or she finds that such assessment is unreasonable or inadequate for the members of the fund to which it applies. In taking any action under this section, the Commissioner may require that the trustees, administrator, any servicing organization or agent of the fund provide such information as he or she deems necessary.
(e) Nothing contained in this section shall preclude the assessment and payment of supplemental assessments as provided in 11:15-4.1 6.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.16 - Supplemental assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each fund shall levy upon its members an additional assessment whenever needed or so ordered by the Commissioner, to supplement the fund's claim or loss retention or administrative accounts to assure payment of the fund's obligations, including payment of benefits under the workers' compensation law.
1. The fund shall assess each participating member an additional proportionate amount, as provided in the fund's bylaws and risk management program or as directed by the Commissioner, to replenish claims or loss retention or administrative accounts.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.17 - Failure or refusal to provide required assessments

Current through Register Vol. 56, No. 14, July 15, 2024
Should any member of a fund fail or refuse to pay as directed its assessment(s) to the fund or to pay as directed any supplemental assessment(s), or should the trustees fail to assess funds required to meet the obligations of the fund, the chairman of the board of trustees, if any, or in the event of his or her failure to do so, the custodian of the fund's assets, shall notify the Commissioner in writing. Upon such notification, the Commissioner shall order the fund or member to take such remedial action as he or she deems necessary.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.18 - Individual loss reserve funds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Whenever the risk management program of a joint insurance fund requires the fund's members to individually retain a specified amount of risk, potential liability, or incurred losses, the participant shall provide for such liability, or incurred losses:
1. As a deductible to be charged to the operating expenses of the incurring participant; or
2. Through a separate item of appropriation for the loss year in its annual budget.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.19 - Certification of funds

Current through Register Vol. 56, No. 14, July 15, 2024
Prior to any commitment or agreement requiring the expenditure of funds by the joint insurance fund, the custodian of the fund's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.20 - Investments; application of investment income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The free balance of any account maintained by a joint insurance fund, whether for claim or loss retention, administrative, or contingency, shall be invested to obtain the maximum interest return practicable. All investments shall be made in accordance with the fund's cash management plan and consistent with the statutes and regulations of the State Investment Council governing the investment of surplus public monies of the State or otherwise transferred to the Director of the Division of Investment pursuant to N.J.S.A. 18A:18B-4b.
(b) The investment and interest income earned by the investment of the assets of each claim or loss retention fund account shall be allocated to each such account by fund year.
(c) The investment and interest income earned by investment of the assets of the administrative account shall be credited to that account.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.21 - Refunds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any monies for a fund year in excess of the amount necessary to fund all obligations for that fiscal year as certified by an actuary may be declared to be refundable by the fund not less than 24 months after the end of the fiscal year.
(b) The fund may seek approval from the Commissioner to make initial refund payments from a claims or loss retention fund account remaining from any year which has been completed at least 24 months by submitting a written notification to the Department, with accompanying documentation as set forth in this subsection, at least 30 days prior to the proposed refund. If the Commissioner does not disapprove, in writing, the request to make the refund within the 30 day period, the request shall be deemed approved. The Commissioner may also affirmatively approve the request prior to the expiration of the 30 day period. The written notification shall be accompanied by appropriate documentation including, but not limited to, assessment, claims and expense detail; actuarial certification that the loss and loss expense reserves are adequate for the fund to have an overall surplus for that fiscal year; and such other information that the Commissioner may require. The initial and any subsequent refund for any year from a claim or loss retention trust account may be in any amount subject to the limitation that after the refund, the remaining net current surplus in the account from which the refund is made must equal or exceed the surplus retention requirement to be calculated as follows:
1. Fund year paid losses shall be multiplied by the appropriate paid loss factor for the line of coverage and duration of maturity set forth in Exhibit E in the Appendix incorporated herein by reference;
2. Fund year unpaid claim reserves, excluding reserves for incurred but not reported claims, shall be multiplied by the appropriate unpaid claim factor for the line of coverage and duration of maturity set forth in Exhibit E in the Appendix incorporated herein by reference. Unpaid claim reserves, excluding reserves for incurred but not reported claims, shall be established at full value and not discounted.
3. The greater of the results from the calculation set forth in (b)1 and 2 above shall then be reduced by the amount of outstanding losses reported, including incurred but not reported claims, as certified by an actuary. The result of this calculation, but not less than zero, shall be the surplus retention requirement for that fund year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.22 - Disbursements and/or payment of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All disbursements, payment of claims settlements or other expenditure of funds of the joint insurance fund whether for administrative expenses or for claims purposes must be approved by a majority of the board of trustees, unless approved pursuant to (b) below.
(b) To allow the expeditious resolution of certain claims, the board of trustees may designate the fund's administrator or servicing organization as a "certifying and approving officer." The certifying and approving officer may be authorized by the board of trustees to approve for payment of any or specified types of claims in an amount not to exceed an amount approved by the Commissioner in the risk management program. The authority of the certifying and approving officer may be conditioned or restricted by the board of trustees to require prior consultation, limitation as to the types or total amount of claims or payments which may be approved, or such other procedures or restrictions as the board of trustees may deem appropriate. The authority of the certifying and approving officer may be revoked or modified at any time by the trustees.
1. Upon approval, the certifying and approving officer shall certify the amount and particulars of such approved claims to the official having custody of the fund's assets, directing that a check for payment be prepared.
2. The certifying and approving officer shall prepare a report of all claims approved by him or her since the last such report, detailing the nature and amount of the claim, the payee, the reasons supporting payment and any other pertinent information. This report shall be submitted to the board of trustees at their next scheduled meeting. The board of trustees shall review and approve the actions of the certifying and approving officer. In the event a claim approved and paid by the certifying and approving officer is not approved by the board of trustees, they shall direct appropriate action to be taken.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.23 - Excess insurance and/or reinsurance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Consistent with 11:15-4.6(a)6, each fund providing primary or underlying coverage on a self-insured or commercially insured basis shall secure excess insurance or reinsurance in a form, in an amount and by an insurer, or other entity authorized to provide such coverage in this State pursuant to law, acceptable to the Commissioner, if commercially available and not unreasonably priced, as determined by the trustees for each fund year, and as approved by the Department.
1. Any approval by the Department pursuant to (a) above shall be for a period not to exceed either the longer of 12 months from the date of approval or the end of the current fund year. Any fund seeking to extend the period of the approval shall notify the Department not later than 45 days prior to the expiration of the term of the approval. The notification shall specify the basis upon which the trustees have determined that excess insurance or reinsurance required pursuant to (a) above is not commercially available or is not reasonably priced, and shall include all actions taken by the fund to obtain required excess insurance or reinsurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.24 - Financial statement and reports

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An annual certified report in a form acceptable to the Commissioner shall be prepared by each fund, filed with the Department, and made available to each fund member on or before December 31 of each year. The report shall include:
1. An annual audited statement of the financial condition of the fund prepared by an independent certified public accountant and performed in accordance with generally accepted accounting principles, which shall include a statement of the organization of the fund indicating the persons who perform each function for the fund and the relationship and interdependency of each function, and including its balance sheet and receipts and disbursements for the preceding year.
2. Reports of outstanding liabilities by line of coverage showing the number of claims, amounts paid to date and current reserves for unpaid losses, claims and unearned assessments as certified by an actuary;
3. A certification by the presiding officer of the board of trustees that periodic reports were made to fund members in the form and manner required by 11:15-4.4(h);
4. Any material changes in information from that previously submitted; and
5. Such other information as may be requested by the Department from a particular fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.25 - Examination of funds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In addition to any examination conducted pursuant to 11:15-4.6(g), the Commissioner may conduct an examination of any fund as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the fund may be insolvent or in a financial condition detrimental to its members or the public. It shall be the duty of the fund members, trustees, and administrator to notify the Commissioner of any information indicating that any fund may be in a financial condition detrimental to the fund's members or the public.
(b) The fund's members or trustees may, upon majority vote, request that the Commissioner order an examination of the fund, or any fund member, which they, in good faith, believe may be in a financial condition detrimental to other fund members or to the public.
(c) Any examination made pursuant to 18A:18B-7 and this subchapter shall be conducted in accordance with the procedures set forth in 11:15-4.6(g).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.26 - Servicing organizations; administrator

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No servicing organization of a fund or producer appointed pursuant to 11:15-4.6(d)10, or their employees, officers or directors shall have either a direct or indirect financial interest in the administrator of that fund, or be an employee, officer or director of the administrator, unless notice of such interest has been provided to the trustees and members.
(b) No administrator of a fund, or its employees, officers or directors shall be an employee, officer or director of, or have either a direct or indirect financial interest in, a servicing organization of that fund, or an insurance producer appointed by that fund pursuant to 11:15-4.6(d)10, unless notice of such interest has been provided to the trustees and members.
(c) Each contract with a servicing organization providing claims adjustment and administration services shall include a clause stating: "Unless the trustees otherwise permit, the servicing organization shall handle to their conclusion all claims and other obligations incurred during the contract period."
(d) The fund commissioners shall notify the Department within 10 days of any determination to terminate or nonrenew any agreement with a servicing organization. The notification shall include a detailed statement that sets forth the manner and method by which claims handling and other obligations performed by the servicing organization will be provided or a statement that sets forth the reasons why the fund commissioners believe that the particular service is no longer necessary.
(e) The trustees may designate an administrator to carry out the policies established by the trustees and to provide day-to-day management of the fund. The minutes of the trustees' meetings shall detail the areas of authority delegated to the administrator.
(f) Any employee, officer or director of an administrator, servicing organization, or producer appointed pursuant to 11:15-4.6(d)10  shall disclose to the trustees any direct or indirect financial interest such employee, officer or director has in any other administrator, servicing organization or insurance producer.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.27 - Conflict of interest

Current through Register Vol. 56, No. 14, July 15, 2024
All school officials and members of their immediate families shall comply with 18A:12-21 et seq. (the "School Ethics Act"), and any other applicable law governing the conduct of members, officers or employees of school boards.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.28 - Notice and hearing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall give prior written notice of any proposed suspension, revocation of authority, cease and desist order, or other enforcement action to the trustees or member as the case may be, or to any person to whom the proposed enforcement action applies specifically. Such notice shall be served personally or by certified or registered mail upon all interested parties, shall set forth the grounds for the proposed enforcement action, and shall inform the interested party of its right to request a hearing on the proposed enforcement action.
(b) The interested party involved shall have 20 days from the mailing of the notice to request a hearing on the proposed enforcement action. Such a hearing shall be conducted in accordance with the Administrative Procedure Act, 52:14B-1 et seq., and Uniform Administrative Procedure Rules, N.J.A.C. 1:1. Failure to mail a request for a hearing within the time prescribed shall result in the suspension, revocation, monetary penalty or cease and desist order becoming effective 30 days from issuance of the original notice. In no event shall any revocation become effective prior to the date that a hearing is scheduled.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.29 - Orders

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, as provided in 11:15-4.2 8, the Commissioner may issue an order revoking or suspending a fund's authority or requiring a person or fund to cease and desist from engaging in an act or practice found to be in violation of any provision of 18A:18B-1 et seq. or this subchapter.
(b) Upon a finding, after notice and opportunity for a hearing, as provided at 11:15-4.2 8, that a fund has violated any cease and desist order, the Commissioner may revoke his or her approval of the fund.
(c) Upon a finding, after notice and opportunity for a hearing, as provided at 11:15-4.2 8, the Commissioner may issue an order requiring the trustees to dismiss an administrator or servicing organization or terminate the contract of an administrator or servicing organization because of any fraud, material misrepresentation, incompetence or untrustworthiness, misappropriation or conversion of monies or violation of any fiduciary responsibilities by such administrator or servicing organization, or any of the employees, officers or directors thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.30 - Compliance dates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Except as otherwise specifically provided in this subchapter, funds subject to this subchapter shall comply with all of the requirements contained in this subchapter commencing with the fund year immediately following June 17, 1996, or December 14, 1996, whichever is later.
(b) Unless otherwise provided by this subchapter, all information and documents and any amendments thereto required by this subchapter shall be filed within 30 days from the date such information or document is due or such change or amendment has occurred.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 4 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING PROPERTY AND LIABILITY COVERAGES › Section 11:15-4.31 - Severability

Current through Register Vol. 56, No. 14, July 15, 2024
The rules contained in this subchapter and any of the provisions thereof shall be severable, and if any of its provisions shall be held to be unconstitutional or otherwise invalid, the decision of the court shall not affect the validity of the remaining rules and regulations or any of the provisions thereof.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the requirements for the establishment, operation, oversight, modification and dissolution of joint insurance funds formed by two or more school boards for the purpose of providing contributory or non-contributory group health insurance or group term life insurance, or both, to employees or their dependents, and to any other person eligible for coverage by a member school board pursuant to 18A:18B-1 et seq.
(b) This subchapter shall apply to all school boards seeking to form a joint insurance fund for the purpose of providing contributory and non-contributory group health or group term life insurance and all joint insurance funds formed for such purpose pursuant to 18A:18B-1 et seq. and this subchapter.
(c) No school board shall join together with any other school board or school boards to act as a joint insurance fund for the purpose of providing contributory or non-contributory group health or group term life insurance except as authorized by the Commissioner in accordance with the provisions of 18A:18B-1 et seq. and this subchapter.
(d) The authority of a joint insurance fund formed for the purpose of providing contributory and non-contributory group health insurance or group term life insurance, or both, shall be limited solely to those coverages.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.3 - Agreement to join joint insurance fund; duration

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any two or more boards of education may form and become members of a school board joint insurance fund formed for the sole purpose of providing contributory or non-contributory group health and term life benefits to the members' employees and their dependents. A school board may take this action by resolution of the board.
(b) A joint insurance fund formed pursuant to 18A:18B-1 et seq. and this subchapter shall have the power to insure, contract or provide for any insurable interest of the member solely for benefits pursuant to contributory or non-contributory group health insurance or group term life insurance, or both, for employees or their dependents, or both, through self-insurance, the purchase of commercial insurance or reinsurance, or any combination thereof. The maximum risk to be retained for group term life insurance by a joint insurance fund on a self insured basis shall not exceed a face amount of $ 5,000 per covered employee or dependent or such greater amount as approved by the Commissioners of Banking and Insurance and Education. Notwithstanding any other provision of law to the contrary, the board or joint insurance fund shall be subject to the surcharge levied pursuant to section 3 of P.L. 1993, c.8 (52:14-17.3 8c) for claims paid within the retained amount. For any claims paid in excess of the retained amount, the surcharge shall be paid by the entity insuring the excess amount;
(c) The resolution shall provide for execution of a written agreement specifically conditioning membership on acceptance of the fund's bylaws as approved and adopted pursuant to 18A:18B-1 et seq. The agreement shall specify the extent of the member's participation in the fund with respect to the types of insurance coverage to be provided by the fund and shall include the duration of fund membership, if applicable. The agreement shall also specify that the fund members have not been cancelled for non-payment of insurance premiums for a period of at least two years prior to application. Members may renew their participation by the execution of a new agreement to rejoin the joint insurance fund. In lieu of filing copies of the new agreement and new indemnity and trust agreement referred to in 11:15-5.6(c)  6 for each member's renewal of membership, the fund shall file a notice with the Department which sets forth the members that have renewed membership and the respective durations of such membership, as well as the members that have not rejoined.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.6 - Bylaws and risk management program; contents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The prospective trustees of a joint insurance fund shall prepare and, after the approval by resolution of the governing body of each participating member, adopt bylaws for the joint insurance fund. The bylaws shall:
1. Set forth a statement of purpose of the group;
2. Set forth provisions for organization of the group, including governance by a board of trustees;
3. Provide for the delivery of a risk management program in conjunction with any joint self-insurance fund or funds which the board of trustees shall establish;
4. Set forth procedures to enforce the collection of any contributions or payments in default;
5. Set forth membership standards as required in 18A:18B-3;
6. Require that, for each joint self-insurance fund, a contract or contracts of specific and aggregate excess insurance or reinsurance is maintained;
7. Set forth procedures for:
i. Withdrawal from the group and a fund by a member, including any requirement that a terminated or withdrawing member provide security in a form and amount acceptable to the Commissioner or trustees, as applicable, as a guarantee for the continued payment of the member's obligations pursuant to 11:15-5.1 0(d);
ii. Termination of the group or fund and disposition of assets; and
iii. Determining the obligations, if any, of a member in the event that the group is unable to pay indemnification obligations and expenses payable from a fund administered by it;
8. Require an annual certified audit and an actuarial opinion statement on loss reserves to be prepared and filed with the Commissioner;
9. Require an annual, supplemental semi-annual, and quarterly financial reporting schedule, as applicable, to be filed on a form prescribed by the Commissioner;
10. Require that any joint self-insurance fund or funds be developed and operated in accordance with accepted and sound actuarial practices;
11. Provide that any expenditure of moneys in a fund be in furtherance of the purpose of the fund;
12. Provide for expulsion of a member;
13. Provide procedures governing trust fund accounts, including transfers, withdrawals and distribution of surplus therefrom and supplemental assessments; and
14. Set forth other provisions as desired for operation and governance of the group.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.7 - Disapproval of bylaws and risk management program

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If the Commissioner determines that the bylaws or risk management program of the fund and all other information required pursuant to 11:15-5.6, or any subsequent amendments or changes thereto, do not contain all of the information set forth in N.J.A.C. 11:15-5.6, is not submitted in the proper format set forth in N.J.A.C. 11:15-5.5, or otherwise do not meet the requirements of 18A:18B-1 et seq. or this subchapter, the Commissioner shall disapprove the bylaws or risk management program and shall notify the fund in writing, which notice shall contain the specific reasons for disapproval, and the requirements to be met before approval may be granted.
(b) If, after submission of all of the information set forth in N.J.A.C. 11:15-5.6, the bylaws and risk management program containing all of the information required by 11:15-5.6 in the format required by 11:5-5.5 are not disapproved by the Commissioner within 60 days of receipt of the supplemental information set forth in 11:15-5.6(f), the bylaws and program shall be deemed approved, pursuant to 18A:18B-4. Such approval shall become effective 60 days after the date of approval pursuant to 11:15-5.5 (c).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.8 - Suspension, termination, assumption of control, or other action by Commissioner

Current through Register Vol. 56, No. 14, July 15, 2024
(a) After notice and opportunity for a hearing, the Commissioner may suspend or terminate the authority of any joint insurance fund, or direct or take any action deemed necessary for good cause, to enable a fund to meet its obligations, cover its expected losses, or to liquidate, rehabilitate or otherwise modify its affairs if a fund:
1. Is found to be insolvent or has experienced a deterioration in financial condition to the extent that it causes an adverse effect upon the ability of the fund to pay expected losses;
2. Fails to timely pay any fee or assessment;
3. Fails to comply with any of the provisions of 18A:18B-1 et seq. or this subchapter, or with any lawful order of the Commissioner within the time prescribed; or
4. Fails to follow its approved bylaws or risk management program.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.9 - Approval of non-member school boards

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Prospective new members of the fund shall submit an application for membership to the fund's board of trustees on a form acceptable to the Commissioner. The application shall include a copy of the resolution of participation and executed indemnity and trust agreement. The trustees may approve or disapprove the application for additional members, pursuant to the admissions criteria and bylaws of the fund.
(b) Any application approved by the fund shall within 15 days of approval by the fund be filed with the Department and shall be accompanied by a revised budget with assessment detail, if the addition of the new member changes the total budget five percent from the original budget or the latest filed amended budget, as well as any amendments to fund's bylaws or risk management program as may be necessary. The fund shall file only the specific changes to the bylaws or risk management program in effect for the current fund year. In addition, the fund shall file the following information in the form of Exhibit D in the Appendix incorporated herein by reference with the Department within 15 days after approval of a new member:
1. The name and address of the new member;
2. The effective date of coverage;
3. The name of the new member's risk manager;
4. The name of the new member's trustee or contact person;
5. The lines of coverage for which the new member participates;
6. The amount of assessment, if not otherwise provided; and
7. An affirmative statement from the fund that in accepting the new member, an application has been filed, the fund has adhered to its bylaws and risk management program, and the agreement to participate and indemnity and trust agreement have been filed with the fund.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.10 - Termination and/or withdrawal of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A member of the fund may remain a member for the full term of membership, as provided in the fund's bylaws, unless terminated by the fund for nonpayment of assessments, noncompliance with risk management or underwriting standards, or for other reasons subject to the prior approval by the Commissioner as reasons for termination. However, a member shall not be deemed terminated for any reason until:
1. After 30 days written notice of the intention to terminate the member has been given by the fund to the member, which notice shall state the reasons for termination and shall be given by registered mail or certified mail, return receipt requested;
2. Like notice shall have been filed with the Department, together with a certified statement that the notice provided for by (a)1 above has been given; and
3. Thirty days have elapsed after the filing required by (a)2 above has been made.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.11 - Insolvency and/or bankruptcy of fund members

Current through Register Vol. 56, No. 14, July 15, 2024
The insolvency or bankruptcy of a member does not relieve the fund or any other member of joint and several liability for the payment of any liability incurred by the member during the period of its membership, including, but not limited to, being subject to and liable for supplemental assessments.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.12 - Voluntary dissolution of a fund

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A fund may not voluntarily dissolve, or otherwise cease to do business and distribute its assets to its members, unless and until it satisfies the following requirements:
1. A majority of the fund's members must have voted in favor of a resolution to dissolve the fund, pursuant to the written plan adopted pursuant to the procedures set forth in the fund's bylaws, at a meeting duly called for such purposes;
2. The plan of dissolution must provide for the payment of all incurred losses of the fund and its members, including all incurred but not reported losses, as certified by an actuary, before any assets of the fund or the trust fund accounts may be used for any other purpose;
3. The plan of dissolution shall contain a statement of the fund's current financial condition computed on a statutory basis and computed according to generally accepted accounting principles as attested to by an independent certified public accountant; and
4. The plan of dissolution, and such other information as may be required, must be filed with and approved in writing by the Commissioner. The plan shall be filed with the Commissioner no later than 90 days prior to the proposed effective date of dissolution.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.13 - Establishment of trust fund accounts; transfers or withdrawals prohibited

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Pursuant to the terms of the indemnity and trust agreement, each fund shall establish a separate trust fund account in accordance with 11:15-5.6(c)6  from which monies shall be disbursed solely for the payment of claims, allocated claim expenses and stop-loss insurance or reinsurance premiums retained jointly on a self-insured basis. The accounts shall be designated as claims or loss retention fund accounts.
1. Other than for the purposes specified in (a) above, or as otherwise authorized by this subchapter, no withdrawals may be effected for a claim or loss retention fund without prior written approval of the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.14 - Administrative account

Current through Register Vol. 56, No. 14, July 15, 2024
Each fund shall establish an administrative account for each fund year which shall be utilized for payment of the fund's general operating expenses, including, but not limited to, cost containment activities, data processing services and general legal expenses. A fund shall not be required to establish a separate administrative account by fund year, provided the fund provides a plan in its bylaws which provides for the accounting of all transactions by fund year.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.15 - Assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each participating member of a joint insurance fund shall appropriate and pay to the fund its assessments as required by the joint insurance fund. Assessments for contributory or non-contributory group health insurance and term life insurance may be paid in monthly installments.
(b) Each member's assessment shall consist of an amount allocated for the administrative account, contingency trust fund account when appropriate, plus a specific assessment to establish and/or replenish the claim or loss retention trust fund account for each type of coverage provided by the fund and in which the member participates.
(c) The total amount of each member's assessments to the joint insurance fund shall be certified by the trustees to the governing body of each participant at least one month prior to the next fiscal quarter. As a condition of continued participation in the joint insurance fund, each member shall pay the amount certified at the time and in the manner provided in the fund's bylaws.
(d) Nothing contained in this section shall preclude the assessment and payment of supplemental assessments as provided in 11:15-5.1 6.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.16 - Supplemental assessments

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each fund shall levy upon its members an additional assessment whenever needed or so ordered by the Commissioner, to supplement the fund's claim or loss retention accounts or administrative accounts to assure payment of the fund's obligations.
1. The fund shall assess each participating member an additional proportionate amount, as provided in the fund's bylaws and risk management program or as directed by the Commissioner, to replenish claims or loss retention or administrative accounts.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.17 - Failure or refusal to provide required assessments

Current through Register Vol. 56, No. 14, July 15, 2024
Should any member of a joint insurance fund fail or refuse to pay as directed its assessment(s) to the fund or to pay as directed any supplemental assessment(s), or should the trustees fail to assess funds required to meet the obligations of the fund, the chairman of the board of trustees or in the event of his or her failure to do so, the custodian of the fund's assets, shall notify in writing the Commissioner. Upon such notification, the Commissioner shall order the fund or member to take such remedial action as he or she deems necessary.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.18 - Certification of funds

Current through Register Vol. 56, No. 14, July 15, 2024
Prior to any commitment or agreement requiring the expenditures of funds by the joint insurance fund, the custodian of the fund's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.19 - Investments; application of investment income

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The free balance of any account maintained by a joint insurance fund, whether for administrative, contingency or claims or loss purposes, shall be invested to obtain the maximum interest return practicable. All investments shall be in accordance with the fund's cash management plan and consistent with the statutes and regulations of the State Investment Council governing the investments of surplus public monies of the State or otherwise transferred to the Director of the Division of Investment pursuant to N.J.S.A. 18A:18B-4b.
(b) The investment and interest income earned by the investment of the assets of each claim or loss retention fund account shall be allocated to each account by fund year.
(c) The investment and interest income earned by investment of the assets of the administrative and contingency accounts shall be credited to each such account.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.20 - Refunds

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A fund may seek to make refund payments from a claims or loss retention account remaining from any year which has been completed at least 12 months by filing a notification of its intent to do so with the Department with appropriate documentation, including, but not limited to, an actuarial certification that the loss and expense reserves are adequate and that monies are available for release.
(b) A refund for any fiscal year shall be paid only in proportion to the member's participation in the fund for that fiscal year. Payment of a refund on a previous year shall not be contingent on the member's continued membership in the fund after that year.
(c) At the option of the member, the refund may be retained by the fund and applied toward the member's next assessment payment.
(d) The trustees may appropriate a portion of any refund to the appropriate contingency account subject to the provisions of 11:15-5.1 3(b).
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 15 - GROUP SELF-INSURANCE › Subchapter 5 - JOINT INSURANCE FUNDS FOR SCHOOL BOARDS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS › Section 11:15-5.21 - Disbursements and/or payment of claims

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All disbursements, payments of claims settlements or other expenditure of funds of the joint insurance fund whether for administrative expenses or for claims purposes must be approved by a majority of the trustees, unless approved pursuant to (b) below.
(b) To allow the expeditious resolution of certain claims, the board of trustees may designate the fund's administrator or servicing organization as a "certifying and approving officer." The certifying and approving officer may be authorized by the board of trustees to approve for payment any or specified types of claims not to exceed an amount approved by the Commissioner in the risk management program. The authority of the certifying and approving officer may be conditioned or restricted by the board of trustees to require prior consultation, limitation as to the types or total amount of claims or payments which may be approved, or other procedures or restrictions as the trustees may deem appropriate. The authority of the certifying and approving officer may be revoked or modified at any time by the trustees.
1. Upon approval, the certifying and approving officer shall certify the amount and particulars of the approved claims to the official having custody of the fund's assets, directing that a check for payment be prepared.
2. The certifying and approving officer shall prepare a report of all claims approved by him or her since the last report, detailing the nature and amount of the claim, the payee, the reasons supporting payment and any other pertinent information. This report shall be submitted to the board of trustees at their next scheduled meeting. The board of trustees shall review and approve the actions of the certifying and approving officer. In the event a claim approved and paid by the certifying and approving officer is not approved by the board of trustees, they shall direct appropriate action to be taken.