reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS › Section 11:4-6.18 - Reserves for waiver of premium

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Where an insurer calculates tabular reserves using the 1964 CDT, 85CIDA, 85CIDB or any other table based on exposures that include contracts on premium waiver as in-force contracts rather than a table based on "active lives," reserves shall be valued on the following basis:
1. Claim reserves shall include reserves for premiums expected to be waived, valuing as a minimum the valuation net premium being waived.
2. Premium reserves shall include contracts on premium waiver as in-force contracts, valuing as a minimum the unearned modal valuation net premium being waived.
3. Contract reserves shall include recognition of the waiver of premium benefit in addition to other contract benefits provided for, valuing as a minimum the valuation net premium to be waived.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 7 - PROCEDURE FOR THE REGULATION OF CONSENT TO HIGHER RATE FILINGS › Section 11:4-7.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to establish standards and procedures whereby insurers may apply to the Commissioner to obtain approval to charge additional premium for any risk in which the developed manual premium does not adequately reflect the additional hazard being insured.
(b) This subchapter shall apply to both commercial and personal lines that utilize a manual rate that has been filed with the Department in accordance with 17:29A-1 et seq. and 17:29AA-1 et seq.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 7 - PROCEDURE FOR THE REGULATION OF CONSENT TO HIGHER RATE FILINGS › Section 11:4-7.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 7 - PROCEDURE FOR THE REGULATION OF CONSENT TO HIGHER RATE FILINGS › Section 11:4-7.3 - Filing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applications shall be filed with the Commissioner within 20 work days after the insured has signed it or within 20 work days of the inception date of the policy, whichever is earlier. All applications shall be made by filing the appropriate application form included in the Appendix to this subchapter as Exhibits A, B, and C, incorporated herein by reference. The application forms are also available on the Department's website at
www.dobi.nj.gov
. Applications shall be sent to the Department through the use of the NAIC electronic filing system SERFF (System for Electronic Rate and Form Filing).
(b) Each application shall include the following information:
1. Name and address of company, and signature by authorized company representative;
2. Name, address, New Jersey license number and signature of producer;
3. Name and address of insured;
4. Effective date and expiration date of policy;
5. Policy number, if available;
6. Coverages applied for, including, but not limited to, limits, amounts of insurance and deductibles;
7. Exposure identification class, territory, description and use of automobile;
8. Premiums:
i. The premium developed by the rating system approved for the company for the coverages applied for, identified as "Normal Premium";
ii. The additional premium to be charged in consideration of the additional hazard, identified as "Additional Premium";
iii. The total of the two amounts identified as "Premium Payable".
9. Underwriting information in support of the additional premium under (b)8ii above. In the case of automobile insurance, liability and physical damage, a copy of the abstract of driving record from the Motor Vehicle Commission shall be submitted. Such abstract is not required if the coverage applied for is excess coverage over the coverages and limits available under any residual market mechanism providing automobile insurance pursuant to statute. In the case of fire insurance, an inspection report, based upon an inspection performed by a qualified person, shall be submitted.
10. The application shall be signed by the insured and contain the following statement:
"I consent to the premium shown as 'Premium Payable' on this application which is higher than would normally apply because of the greater hazard involved."
11. The application shall contain the following statement signed by the producer of record or by an officer of the company providing the coverage:
"Under penalty of 17:29A-16 and 17:29A-22, I declare that this application was fully completed as shown, before being signed by the applicant."
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 7 - PROCEDURE FOR THE REGULATION OF CONSENT TO HIGHER RATE FILINGS › Section 11:4-7.4 - Premium charges

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Premium charges in excess of those produced by the rating system approved for the submitting company shall be reasonable and adequate and not unfairly discriminatory, and shall be proportionate to the additional hazard, subject to the following provisions on business for which coverage is available under any residual market mechanism created by statute:
1. Insurance available from these plans shall be rated in accordance with the rating systems approved for these facilities, and the procedures applicable to such business shall be followed, if written under the Consent to Higher Rate provision. Any surcharges to be applied to such business shall be documented by any required inspection report.
2. An insured qualifying for coverage under these plans shall not be offered coverage at lower limits, lower amounts or otherwise reduced coverage except at a proportionate reduction in the otherwise applicable premium.
3. If an insured eligible for insurance from these plans requests limits or amounts of insurance higher than available thereunder, the excess portion may be written at rates higher than produced by the company's rating system, subject to the standards set forth above.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 7 - PROCEDURE FOR THE REGULATION OF CONSENT TO HIGHER RATE FILINGS › Section 11:4-7.5 - Approval of applications

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner shall approve applications complying with the requirements contained in 11:4-7.1 through 7.4 on a current basis, and shall provide notice of such approval to the submitting carrier.
(b) The Commissioner shall disapprove applications that fail to comply with any of the requirements in 11:4-7.3 and 7.4, or do not meet the requirement of being reasonable and adequate and not unfairly discriminatory, and shall provide notice of such disapproval to the company, the producer of record and the insured.
(c) The company and the insured shall have the same legal remedies as are available in the case of disapproval of any rate filing.
(d) If a filing is disapproved, the policy with respect to which the filing had been made may be cancelled by the company on the basis of the premium that is applicable under the rating system approved for the company (normal premium), but such cancellations must be on a pro rata basis. However, if a disapproval is sustained upon an appeal by the insured, cancellation shall be pro rata on the basis of the "premium payable" as defined above.
(e) If the company wishes to continue the policy in force after the "consent to rate" filing has been disapproved, it may do so by charging the normal premium as of the policy's inception date.
(f) Nothing in this subchapter shall prevent a company from filing a rate that produces a premium lower than that produced by the approved rating system, including the rating systems applicable under any residual market mechanism created by statute.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
(a)
									17B:17-13.1 provides that qualified organizations as defined therein may enter into annuity agreements under conditions which are different from those which are applicable to organizations which are deemed to be insurers. This subchapter protects the interest of individual holders of annuities and their beneficiaries by requiring:
1. The use of forms which clearly set forth the conditions of the agreement being entered into;
2. The maintenance of segregated assets in such form and such amount as will protect the interest of the annuitants; and
3. The submission to the Commissioner, by the issuers of charitable annuities, of periodic reports which will enable the Commissioner to determine that the requirements of law and of this subchapter are being met.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.2 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise:
"Commissioner" means the Commissioner of the Department of Banking and Insurance.
"Deferred annuity" means an annuity where the first annuity payment is due no earlier than one year from the issue date of the contract, and the annuity is not an immediate annuity.
"Immediate annuity" means an annuity where the first annuity payment is due not more than 13 months from the issue date of the contract.
"Reserves" means the liability established to assure that future annuity benefits can be paid.
"Surplus" means the excess of admitted assets over liabilities.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.4 - Forms of agreement

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An application for a special permit shall include a copy of each form of agreement that the applicant proposes to issue to annuitants. If a special permit holder intends to change or replace an existing agreement, or add a new form of agreement, the special permit holder shall not use the new form unless it has been filed with the Commissioner at least 30 days prior to its intended use and the Commissioner has not disapproved it within that 30 day period. The new form shall be submitted to:
Office of Life and Health
Attention: Charitable Annuity Review
NJ Department of Banking and Insurance
PO Box 325
Trenton, NJ 08625-0325
(b) Each form of agreement shall include, but not be limited to, the following:
1. A distinct alphanumeric form number on each page;
2. The official name and address of the issuing charity prominently displayed;
3. The age and/or birthdate of the annuitant(s);
4. A provision for corrective action if the annuitant has made:
i. A misstatement of age; or
ii. A misstatement of age or sex if a distinction is made between male and female payout rates;
5. A statement that the agreement is governed by the laws of the State of New Jersey;
6. A clear identification of, and differentiation between, agreements that allow for immediate payments, and those for which payments are deferred;
7. A statement that payments shall terminate upon the death of the last surviving annuitant; and
8. A statement that the organization's obligation to make payment shall terminate if all annuitants are deceased prior to the contractual date that payments are scheduled to commence.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.5 - Annuity rates

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The original consideration for periodic payments payable to the holder of a charitable annuity may not be less than the net single premium, computed according to interest and mortality assumptions permitted by 17B:19-1 et seq. for guaranteed periodic payments, plus a life insurance net single premium, computed according to the same assumptions for an amount of death benefit equal to one-half of such original consideration. For this purpose the original consideration shall include the gross amount paid by the annuitant to the special permit holder in order to provide the annuity payments and the residue.
(b) An applicant for a special permit shall submit, with its application to the Commissioner, a schedule of its annuity rates and a demonstration that the rates meet the requirements of (a) above for each form of annuity that it proposes to issue.
(c) A special permit holder which adopts rates for a proposed new form of annuity or which proposes to change the rates on its existing annuities shall submit such rates and a demonstration that the rates meet the requirements of (a) above to the Commissioner for his approval before they become effective.
(d) The Commissioner shall waive the requirement for a demonstration from the special permit holder that the rates meet the requirements of (a) above if the special permit holder uses the rates of the American Council on Gift Annuities and these rates meet the requirements of (a) above.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.6 - Surplus and reserves

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each special permit holder shall have and maintain segregated assets at least equal to the sum of:
1. The reserves on its outstanding agreements calculated in accordance with the provisions of N.J.S.A. 17B:19; and
2. A surplus equal to $ 100,000 or to ten per cent of the amount in paragraph 1 above, whichever is greater.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.7 - Compliance with investment requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The segregated assets held by a special permit holder shall be invested pursuant to the standards set forth at 3B:20-11.1 et seq. An application for a special permit shall include the applicant's plan of operation for the segregated account. The plan of operation shall include, but not be limited to, the following:
1. A statement of the amount of the gift to be placed in the segregated account. If such amount is less than the entire gift, the method for determining such amount;
2. Standards for monitoring the adequacy of the segregated account to meet the requirements of 11:4-8.6 on a continuous basis;
3. A contingency plan for additional sources of funding if the segregated account falls below the statutorily required minimum amount; and
4. An investment plan for the segregated account, which shall include:
i. The person(s) responsible for oversight of the investments, and whether such responsibility is to be delegated;
ii. The allocation of assets by investment categories;
iii. The standards for investment quality; and
iv. The duration and liquidity of assets.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.8 - Annual report

Current through Register Vol. 56, No. 14, July 15, 2024
(a) As of December 31 of the calendar year in which a special permit is issued, and as of December 31 of each succeeding calendar year, the holder of a special permit shall submit a report to the Commissioner. Such report shall be submitted to the Commissioner within 120 days following the end of the calendar year to which the report applies. The annual report shall be in such form as the Commissioner shall prescribe within three months prior to the end of each preceding calendar year. Subject to approval by the Commissioner, a special permit holder may file its annual report on a fiscal year basis.
(b) Each special permit holder shall submit, as part of the annual report, a statement by a qualified actuary setting forth his or her opinion as to the adequacy of reserves. A qualified actuary for the purpose of this subsection means a member in good standing of the American Academy of Actuaries, or a person who has otherwise demonstrated his or her actuarial competence to the satisfaction of the Commissioner. The Commissioner shall waive the requirement for the actuarial opinion if a special permit holder demonstrates to the satisfaction of the Commissioner that it has the appropriate software and technical expertise to calculate the required reserves, and that waiving this requirement would not be hazardous to the operations of the segregated account.
(c) Each special permit holder shall submit a copy of the workpapers used to calculate the required reserves.
(d) Each special permit holder shall respond on a timely basis to any inquiry of the Commissioner, or his designee, regarding the annual report.
(e) Each special permit holder shall submit, with the annual report of the segregated account required in (a) above, a copy of the applicant's or, where not available, the applicant's parent organization's, most recent audited financial statements and the Independent Auditors Report.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.9 - Effect on previously filed forms

Current through Register Vol. 56, No. 14, July 15, 2024
Forms previously filed or approved by the Commissioner pursuant to 17B:17-13.1 that are not in compliance with this subchapter shall be refiled with the annual report for calendar year 2004 or the first fiscal year ending after December 31, 2004.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.10 - Separability of provisions

Current through Register Vol. 56, No. 14, July 15, 2024
If any provision of this subchapter or the application thereof to any person or circumstance is held invalid, the invalidity shall not affect the provisions or applications of this subchapter which can be given effect without the invalid provision or application, and for this purpose the provisions of the subchapter are separable.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 8 - CHARITABLE ANNUITIES › Section 11:4-8.11 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure to comply with the provisions of this subchapter will subject any special permit holder to the penalties provided by N.J.S.A. 17B:17-13.1d and any other penalties available to the Commissioner.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 9 - PERSONAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:4-9.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter establishes data requirements and filing procedures for participating insurers in rating organizations or advisory organizations to adopt or modify a rating organization's or advisory organization's approved prospective loss costs.
(b) This subchapter applies to all rating organizations and advisory organizations which file prospective loss costs and all insurer filings which adopt or modify a rating organization's prospective loss cost filing for personal lines property/liability insurance made pursuant to 17:29A-1 et seq. This subchapter does not apply to private passenger automobile insurance rate filings.
(c) All filings made pursuant to this subchapter shall be made in accordance with 17:29A-1 et seq., N.J.A.C. 11:1-2 and 11:1-32.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 9 - PERSONAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:4-9.2 - 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:
"Advisory organization" means any group, association or other organization of insurers, whether located within or outside this State, that assists insurers or rating organizations in ratemaking by the collection and furnishing of loss or expense statistics.
"Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance.
"Department" means the New Jersey Department of Banking and Insurance.
"Expenses" means that portion of a rate attributable to commissions and brokerage, other acquisition expenses, general expenses, taxes, licenses, and fees.
"Loss costs multiplier" means the adjustment reflecting expenses, profit loading and any modifications that the insurer uses on the loss costs to produce final rates.
"Minimum premium" means the smallest amount of premium for which an insurer will issue coverage under a given policy.
"Prospective loss costs" means that portion of a rate that does not include provisions for expenses (other than loss adjustment expenses) or profit, and are based on historical aggregate losses and loss adjustment expenses adjusted through development to their ultimate value and projected through trending to a future point in time.
"Rate" means the unit charge by which the measure of exposure or the amount of insurance specified in a policy of insurance or covered thereunder is multiplied to determine the premium. The unit charge may be expressed as a single number or as a prospective loss cost and an adjustment to account for the treatment of expenses, profit and variations in loss experience.
"Rating organization" means every person or persons, corporation, partnership, company, society, or association engaged in the business of ratemaking for two or more insurers.
"Supplementary rate information" means any manual or plan of rates, statistical plan, classification, rating schedule, rating rule and any other rule used by an insurer in making rates. This includes policy-writing rules, rating plans, territory codes and descriptions, and rules which include factors or relativities such as increased limits factors, classification relativities or similar factors used to determine the rate in effect or to be in effect.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 9 - PERSONAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:4-9.3 - Prospective loss cost filing requirements for rating organizations and advisory organizations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Rating organization or advisory organization advisory prospective loss cost filings shall be submitted to the Commissioner and shall include the advisory prospective loss costs and the underlying loss data and other supporting actuarial information for any calculations or assumptions underlying those loss costs. Filings of prospective loss costs shall be filed and become effective in accordance with 17:29A-1 et seq. and N.J.A.C. 11:1-2.
(b) Rating organizations or advisory organizations that file prospective loss cost filings with the Commissioner shall not develop or file minimum premiums.
(c) Rating organizations and advisory organizations shall provide the Department with printed manuals of prospective loss costs, as well as rules and other supplementary rating information filed and approved pursuant to 17:29A-1 et seq., and may provide this information to their member/subscriber insurers upon request.
(d) Rating organizations and advisory organizations shall continue to develop and file rules, relativities and other supplementary rate information on behalf of their member/subscriber insurers.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 9 - PERSONAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:4-9.4 - Prospective loss costs filing requirements for insurers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order for an insurer to incorporate a rating organization's or advisory organization's approved prospective loss costs to establish its own rates, an insurer shall:
1. Be a participating insurer in the rating organization; and
2. File its loss costs multiplier using the Filing Adoption Form (as set forth in Appendix A to this subchapter and incorporated herein by reference). An insurer's loss costs multiplier shall be filed and become effective in accordance with 17:29A-1 et seq. and N.J.A.C. 11:1-2. An insurer's final rates shall be a combination of the approved prospective loss costs and the approved loss costs multiplier.
i. An insurer may file modifications to the rating organization's approved prospective loss costs filing based on its own anticipated experience by using the Filing Adoption Form. Supporting documentation shall be filed for any modification (upwards or downwards) to the rating organization's prospective loss cost filings.
ii. An insurer's approved loss costs multiplier shall remain in effect until the insurer withdraws the multiplier or until a revised Filing Adoption Form is filed by the insurer and approved by the Department.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 9 - PERSONAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Section 11:4-9.5 - Penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Rating organizations, advisory organizations and insurers which fail to comply with the filing submission requirements of this subchapter shall be subject to penalties as provided by law.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 9 - PERSONAL LINES INSURANCE: PROSPECTIVE LOSS COSTS FILING PROCEDURES › Appendix B

Current through Register Vol. 56, No. 14, July 15, 2024
NEW JERSEY FORM NA--1
NON-ADOPTION OF PROSPECTIVE LOSS COST
1.
Insurer:
.......................
NAIC#:
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
.......................
2.
Rating Organization Affiliation: ........................................
3.
Line of Insurance: ......................................................
4.
Rating Organization Designation Number: .................................
5.
Effective Date of Non-Adoption: .........................................
6.
Rating Organization Designation Number
Currently Being Used: ...................................................
7.
Effective Date of Use: ..................................................
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 11 - LIFE INSURANCE DISCLOSURE › Section 11:4-11.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this subchapter is to require insurers to deliver information to purchasers of life insurance that will improve the buyer's ability to select the most appropriate plan of life insurance for the buyer's needs and improve the buyer's understanding of the basic features of the policy that has been purchased or is under consideration for purchase.
(b) This subchapter does not prohibit the use of additional material that is not a violation of this subchapter or any other New Jersey statute or regulation.
(c) Except for the exemptions specified in (d) below, this subchapter shall apply to any solicitation, negotiation or procurement of life insurance occurring within this State. 11:4-11.3(b)  shall apply only to an existing nonexempt policy held by a policyowner residing in this State. This subchapter shall apply to any issuer of life insurance contracts, including fraternal benefit societies.
(d) This subchapter shall not apply to:
1. Individual and group annuity contracts;
2. Credit life insurance;
3. Group life insurance;
4. Life insurance policies issued in connection with pension and welfare plans as defined by, and which are subject to, the Federal Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§
											1001 et seq., as amended; or
5. Variable life insurance, as defined in this subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 11 - LIFE INSURANCE DISCLOSURE › Section 11:4-11.3 - Duties of insurers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The generally applicable requirements are as follows:
1. The insurer shall provide a Buyer's Guide to all prospective purchasers, prior to accepting the applicant's initial premium or premium deposit. However, if the policy for which application is made contains an unconditional refund provision of at least 10 days, the Buyer's Guide may be delivered with the policy or prior to delivery of the policy; and
2. The insurer shall provide a policy summary to prospective purchasers where the insurer has identified the policy form as one that will not be marketed with an illustration. The policy summary shall show guarantees only. It shall consist of a separate document with all required information set out in a manner that does not minimize or render any portion of the summary obscure. Any amounts that remain level for two or more years of the policy may be represented by a single number if it is clearly indicated what amounts are applicable for each policy year. Amounts referenced in paragraph 5 of the definition of "policy summary" in 11:4-11.2 shall be listed in total, not on a per thousand or per unit basis. If more than one insured is covered under one policy or rider, death benefits shall be displayed separately for each insured or for each class of insureds if death benefits do not differ within the class. Zero amounts shall be displayed as a blank space. Delivery of the policy summary shall be consistent with the time for delivery of the Buyer's Guide as specified in (a)1 above.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 11 - LIFE INSURANCE DISCLOSURE › Section 11:4-11.4 - General regulations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each insurer shall maintain, at its home office or principal office, a complete file containing one copy of each document authorized and used by the insurer pursuant to this subchapter for a period of three years following the date of its last authorized use unless otherwise provided by this subchapter.
(b) An agent shall inform the prospective purchaser, prior to commencing a life insurance sales presentation, that he or she is acting as a life insurance agent and the full name of the insurer the agent is representing. In sales situations in which an agent is not involved, the insurer shall identify its full name.
(c) An insurance producer shall not use terms such as "financial planner," "investment advisor," "financial consultant," or "financial counseling" in such a way as to imply that he or she is primarily engaged in an advisory business in which compensation is unrelated to sales unless that is actually the case. This provision is not intended to preclude persons who hold some form of formal recognized financial planning or consultant designation from using this designation even when they are only selling insurance. This provision also is not intended to preclude persons who are members of a recognized trade or professional association, and having such terms as part of its name, from citing membership providing that a person citing membership, if authorized only to sell insurance products, shall disclose that fact. This provision does not permit persons to charge an additional fee for services that are customarily associated with the solicitation, negotiation or servicing of policies.
(d) Any reference to non-guaranteed elements shall include a statement that the item is not guaranteed and is based on the company's current scale of non-guaranteed elements (use appropriate special term such as "current dividend" or "current rate" scale). If a non-guaranteed element would be reduced by the existence of a policy loan, a statement to that effect shall be included in any reference to non-guaranteed elements. A presentation or depiction of a policy issued after July 6, 1998 (the effective date of N.J.A.C. 11:4-52, Life Insurance Illustrations) that includes non-guaranteed elements over a period of years shall be governed by that subchapter.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 11 - LIFE INSURANCE DISCLOSURE › Section 11:4-11.5 - Failure to comply/penalties

Current through Register Vol. 56, No. 14, July 15, 2024
Failure of an insurer, its producer, or other authorized representative or agent to provide or deliver to a buyer a Buyer's Guide, an in force illustration, a policy summary or policy data, or any other information required by this subchapter to be provided or delivered to buyers shall constitute an omission that misrepresents the benefits, advantages, conditions or terms of an insurance policy and may result in the imposition of penalties as prescribed by the Unfair Trade Practices Act, 17B:30-1 et seq., and any other penalties provided by the laws of this State.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 12 - STUDENT LIFE INSURANCE › Section 11:4-12.1 - Student life insurance solicitation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose is to avoid any link or implication of association between a school or university and an insurance company soliciting life insurance unless specific endorsement by the school has been made.
(b) Student life insurance is life insurance offered to a person because he/she is enrolled in an institution offering a post high school education.
(c) Requirements governing the envelope in which a solicitation is mailed, delivered or offered are as follows.
1. A return address must appear in the front upper left corner of the envelope and must provide the full name and street address of the company, agent or broker soliciting the insurance, who must be identified as such. Example of a suitable return address is: Ann Doe, Insurance Agent, 00 Main Street, Chester, New Jersey 08001.
2. The return address may not use the term "office of".
3. The envelope may be addressed to "The Parents of Joan Smith" or to specifically named parents, that is, "Mr. & Mrs. Smith". The address may not include any combination of words that indicates that the correspondence is coming from the school itself rather than the insurance company or agent, nor may it imply that the school has endorsed the material and supplied the company with information about the student. Examples of unacceptable modes of address include, but are not limited to, the following:
i. "The Parents of Registered Freshman Joan Smith";
ii. "The Parents of Cornell University Student Joan Smith";
iii. "The Parents of Joan Smith, Yale Sophomore";
iv. "Tom Jones, Yale Senior".
4. If the term "Student Insurance Forms Enclosed" is used on the envelope, it must appear on one continuous line. For example, it is impermissible to divide the words so that "student insurance" appears on one line and "forms enclosed" on the next.
5. The slogan which often appears on an envelope to the left of the postal meter stamp may not focus on or mention education. Neutral slogans, such as "Buy Government Bonds" or "Support Your Local United Fund", are acceptable.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 13 - GROUP STUDENT HEALTH INSURANCE › Section 11:4-13.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This rule prohibits certain provisions of group student health insurance policies and certificates which are unjust, unfair, inequitable, misleading, contrary to law or contrary to public policy of this State.
(b) The rule shall apply to all student health insurance policies or subscriber contracts delivered or issued for delivery after January 1, 1978.
(c) The group student health insurance continues to be subject to subchapter 13, the group coverage discontinuance and replacement rules.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 13 - GROUP STUDENT HEALTH INSURANCE › Section 11:4-13.2 - 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.
"Carrier" means any entity subject to the insurance laws and rules of this State, or subject to the jurisdiction of the Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital or health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services. For purposes of this subchapter, carriers that are affiliated carriers shall be treated as one carrier.
"Essential health benefits" means the categories of health care services required to be covered as specified at 45 CFR 156.110.
"Group student health insurance" is any general coverage accident and/or sickness insurance provided on a group basis to the students of a school.
"Preexisting condition" means a health condition that manifested itself on or before the effective date of coverage.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 13 - GROUP STUDENT HEALTH INSURANCE › Section 11:4-13.3 - Prohibited provisions

Current through Register Vol. 56, No. 14, July 15, 2024
Preexisting conditions shall not be excluded from coverage; carriers shall not limit coverage in any way based upon a preexisting condition.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 13 - GROUP STUDENT HEALTH INSURANCE › Section 11:4-13.4 - Rate and form filing requirements for fully insured student health plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Carriers offering student health plans shall adhere to the following requirements for the filing of rates and forms:
1. Each carrier shall submit separate rate and policy form filings in System for Electronic Rate and Form Filing (SERFF) for each student health plan offered, identifying the filings using H22 Student Health Insurance TOI and H22.000 Student Health Insurance sub-TOI;
2. Forms shall be submitted as follows:
i. Forms shall be submitted at least 90 days prior to the effective date of the policy and shall include a certification that the form complies with the essential health benefits set forth in the benchmark plan selected by New Jersey in accordance with 45 CFR 156.100; or
ii. Forms shall be submitted through SERFF, consistent with (a)1 above, and shall include a certification that a previously filed form, identified in the certification by its form number and filing date, complies with the essential health benefits set forth in the benchmark plan selected by New Jersey in accordance with 45 CFR 156.100.
3. Student health plan rate filings shall be submitted at least 90 days before the effective date of the rates;
4. Student health plan rate filings must be submitted for all rate changes and shall include Parts I, II, and III of the Rate Review Justifications explained at
http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/RRJ-Instructions-Manual-20150401-Final.pdf
; and
5. Carriers shall confirm in the actuarial certification submitted with Part III of the Rate Review Justification that the rates for New Jersey do not subsidize the carrier's student health plans in other states, and carriers shall also specify in the actuarial memorandum the following details:
i. Rate increase by plan and explanation of variation if it is not the same for all plans;
ii. Three years of experience and a description of the basis, which may be school specific;
iii. Explanation of adjustments to base data for unusually high or low volume of large claims;
iv. Show run-out date and incurred but not reported (IBNR) assumption;
v. Support for the trend assumptions, including adjustments made for large claims amounts;
vi. Services included in "other" category;
vii. Adjustments and support for the following factors:
(1) Changes in benefits, if any;
(2) Changes in morbidity, if any;
(3) Demographics changes, if any;
(4) Network changes, if any; and
(5) Other changes, if any.
viii. Credibility assigned to experience and credibility methodology used;
ix. Source and development of manual rate if experience is not 100 percent credible;
x. A rating example;
xi. Quality improvement expenses;
xii. Explanation of any variation in administrative costs by plan; and
xiii. Actuarial value screenshots demonstrating compliance with 60 percent minimum.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 14 - HOME HEALTH CARE INSURANCE COVERAGE › Section 11:4-14.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
These rules apply to individual and group health insurance policies which provide coverage for the costs of daily room and board while confined in a hospital or skilled nursing facility. They do not apply to hospital indemnity policies which provide additional income while the insured is hospitalized. These rules also do not apply to Medicare complement policies since Medicare provides home health care.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 14 - HOME HEALTH CARE INSURANCE COVERAGE › Section 11:4-14.2 - 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.
"Home health care" means those nursing and other home health care services rendered to a person in his place of residence, under the following conditions:
1. On a part-time and intermittent basis, except when full-time or 24-hour services are needed on a short-term (no more than three-day) basis; and
2. If continuing hospitalization would otherwise have been required if home health care were not provided; and
3. Pursuant to a physician's written order and under a plan of care established by the responsible physician in collaboration with a home health care provider. The benefit may require that the care plan be reviewed by the physician after each 30 days following commencement of home health care, that the physician not be related to the home health care provider by ownership or contract, and that the physician certify that continued confinement in a hospital or skilled nursing facility would otherwise be required. All care plans shall be established within 14 days following the commencement of home health care.
"Home health care services" means any of the following services which are medically necessary for achievement of the care plan set forth for the patient and which are provided for the care of the patient:
1. Nursing care (furnished by or under the supervision of a registered nurse);
2. Physical therapy;
3. Occupational therapy;
4. Medical social work;
5. Nutrition services;
6. Speech therapy;
7. Home health aide services;
8. Medical appliances and equipment, drugs and medications, laboratory services and special meals to the extent such items and services would have been covered under the policy if the covered person had remained in a hospital;
9. Any diagnostic and therapeutic service, including surgical services, performed in a hospital outpatient department, a doctor's office or any other licensed health care facility, to the extent that such service would have been covered under the policy if performed as inpatient hospital services, provided that such service is delivered as part of the home health care plan.
"Home health care provider" means an agency which is licensed by the Commissioner of the Health as a home health agency.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 14 - HOME HEALTH CARE INSURANCE COVERAGE › Section 11:4-14.3 - Home health care benefits required

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Minimum coverage rules are as follows:
1. The policy may require no more than three continuous days of hospitalization or skilled nursing facility care prior to provision of home health care benefits.
2. The home health care services listed in paragraphs 1 through 7 of the definition of home health care services must provide for at least 60 home health care visits in any calendar year or in any continuous period of 12 months.
3. Any visit by a member of a home health care team on any day shall be considered as one home health care visit.
4. If the policy contains a number of days during which home health care benefits must commence following hospital discharge, that number of days may not be less than three.
5. The services and supplies listed in paragraphs 1 through 8 of the definition of home health care services shall be furnished by a home health care provider and the charges for such services and supplies shall be made by the home health care provider.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 14 - HOME HEALTH CARE INSURANCE COVERAGE › Section 11:4-14.4 - Exclusions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter does not impose an obligation to pay benefits for physician's services in connection with home health care except for those benefits required under paragraph 9 of the definition of home health care services.
(b) Home health care services including those of home health aides need not be reimbursable to the extent they have been provided for persons in the household other than the patient.
(c) Policy exclusions relating to worker's compensation, employer's liability laws, Medicare, mandatory no-fault automobile insurance, veteran's hospitals, military service, and so forth, applicable to hospital and skilled nursing facility confinement benefits may also apply to home health care benefits.
(d) Benefits need not be payable if no charge is normally made for a home health care service.
(e) Policy provisions relating to coordination of benefits may apply to home health care services to the same extent that they apply to other benefits provided by the policy.
(f) The policy may require that home health care services will be provided only to residents of New Jersey.
New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 4 - ACTUARIAL SERVICES › Subchapter 16 - MINIMUM STANDARDS FOR INDIVIDUAL HEALTH INSURANCE › Section 11:4-16.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this regulation is to implement 17B:26-45 so as to provide reasonable standardization and simplification of language, terms and coverages to facilitate understanding and comparisons; elimination of provisions which may be misleading or unreasonably confusing in connection with either the purchase of insurance or the settlement of claims; elimination of provisions which may be contrary to the health care needs of the public; elimination of coverages which are so limited in scope as to be no substantial economic value to the holders thereof; and elimination of unfair renewal practices which are contrary to the health care needs and economic well-being of the public.