New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 15 - GROUP SELF-INSURANCE
Subchapter 3 - JOINT INSURANCE FUNDS FOR LOCAL GOVERNMENT UNITS PROVIDING GROUP HEALTH AND TERM LIFE BENEFITS
Section 11:15-3.23 - Stop-loss insurance and/or reinsurance
Current through Register Vol. 56, No. 6, March 18, 2024
(a) Each fund providing primary or underlying coverage on a self-insured basis shall secure stop-loss insurance or reinsurance in a form and amount acceptable to the Commissioner from an insurer authorized or admitted to transact life or health insurance, as applicable, in the State.
(b) Certificates of stop-loss insurance and/or reinsurance showing policy limits and other information shall be available for the inspection of each member and shall be filed with the Commissioner.
(c) Losses in excess of the established self-insurance retention amount shall be borne by the stop-loss carrier(s) according to the terms and conditions of the stop-loss contract(s).
(d) Any proposed change in the terms or limits of stop-loss insurance and/or reinsurance shall be submitted to the Department and the Department of Community Affairs for approval at least 30 days prior to the effective date of the proposed change.
(e) The Commissioner shall waive the requirement set forth in (a) above if such stop-loss insurance or reinsurance is not commercially available or is unreasonably priced, as determined by the fund's executive committee for each fund year, and as approved by the Department and the Department of Community Affairs, and the fund otherwise demonstrates to the Commissioner that it has made adequate provision for excess losses.