Current through Register Vol. 56, No. 18, September 16, 2024
(a) No carrier
shall cease to issue or nonrenew an individual plan, plan option, or
deductible/copayment option required or permitted to be offered by
11:20-3.1 until the carrier
submits a notice of intent to withdraw a plan, plan option, or
deductible/copayment option to the Department and the Commissioner approves
such withdrawal in accordance with the provisions of this subchapter.
(b) A carrier may cease to issue and nonrenew
an individual plan pursuant to this section only if:
1. The deductible/copayment option is not
required to be offered pursuant to
11:20-3.1(b);
or
2. In the case of a
deductible/copayment option required to be offered pursuant to
11:20-3.1, the carrier meets its
obligations to offer at least three standard individual plans and required
deductible/copayment options either by offering the plans as indemnity plans or
by making the plan or plans available through or in conjunction with a
selective contracting arrangement to all New Jersey residents.
(c) A carrier may cease to issue
and nonrenew a standard plan option pursuant to this section by offering
another approved plan option. Examples of plan options include, but are not
limited to, a carrier's option to offer autologous bone marrow transplant
coverage in either the policy or contract or in a rider, and an HMO's option to
offer plans subject to deductible and coinsurance provisions.
(d) A carrier that seeks to withdraw a plan,
plan option, or deductible/copayment option pursuant to this section shall
provide the Department with written notification of its intent to withdraw a
plan, plan option, or deductible/copayment option. The notice of intent to
withdraw a plan, plan option, or deductible/copayment option shall be sent to
the Department at the address set forth in
11:20-6.4(a), and
shall include the following information:
1.
The name of the carrier;
2. The
name, address, telephone number, and fax number of the carrier's representative
responsible for the application for plan, plan option or deductible/copayment
option withdrawal;
3. A specific
description of the reasons the carrier is withdrawing the plan, plan option, or
deductible/copayment option;
4. A
statement of the number of in force plans affected by the withdrawal;
5. Copies of the carrier's most recent
enrollment status report filed pursuant to N.J.A.C. 11:20-17;
6. Copies of a nonrenewal notice the
applicant intends to send to its policy or contractholders. Nonrenewal notices
for policy or contractholders shall contain the following information:
i. A statement that the carrier has elected
to nonrenew the plan, plan option, or deductible/copayment option;
ii. The date upon which the plan, plan
option, or deductible/copayment option shall be nonrenewed;
iii. A statement that the plan, plan option,
or deductible/copayment option is being nonrenewed under the authority of this
subchapter;
iv. A notice that the
carrier shall make available a replacement plan, plan option, or
deductible/copayment option;
v. A
statement that the policy or contractholder may contact his or her producer, if
any, for additional information regarding the plan, plan option, or
deductible/copayment option withdrawal; and
vi. The name, address and telephone number of
the employee or agent of the carrier who may be contacted for assistance and
information regarding the plan, plan option, or deductible/copayment option
withdrawal; and
7.
Copies of the proposed nonrenewal notices the applicant intends to send to its
producers. Nonrenewal notices for producers shall contain the following
information:
i. A statement that the carrier
has elected to nonrenew the plan, plan option, or deductible/copayment
option;
ii. The date upon which the
plan, plan option, or deductible/copayment option shall be
nonrenewed;
iii. A statement that
the plan, plan option, or deductible/copayment option is being nonrenewed under
the authority of this subchapter;
iv. A notice that the carrier shall make
available a replacement plan, plan option, or deductible/copayment
option;
v. The name, address and
telephone number of the employee or agent of the carrier who may be contacted
for assistance and information regarding the withdrawal; and
vi. The date upon which the carrier will
begin to cease to issue the plan, plan option, or deductible/copayment
option.
(e)
The Department shall review the notice of intent to withdraw a plan, plan
option, or deductible/copayment option to determine whether it complies with
the filing requirements of (d) above. The Department shall notify the carrier
within 30 days of receipt of a notice of intent to withdraw a plan, plan option
or deductible/copayment option, of any deficiencies and the requirements which
are necessary to bring the notice into compliance with this section. The
Department shall notify the carrier in writing that the withdrawal is either
approved or disapproved.
(f) A
carrier which has submitted a notice of intent to withdraw a plan, plan option,
or deductible/copayment option shall:
1. Not
more than 60 days following the Commissioner's approval of a plan, plan option,
or deductible/copayment option withdrawal cease issuing the individual plan,
plan option, or deductible/copayment option;
2. Not more than 60 days following the
Commissioner's approval of a plan, plan option, or deductible/copayment option
withdrawal, and not less than 90 days in advance of the effective date of the
nonrenewal on the anniversary date of the plan, plan option, or
deductible/copayment option, mail a notice, in the same format submitted to the
Department pursuant to (d)6 above, to every policy or contractholder, informing
the policy or contractholder that the plan, plan option, or
deductible/copayment option will be nonrenewed on the anniversary
date;
3. Following the initial
notice to each policy or contractholder, send a subsequent notice confirming
the nonrenewal to each policy or contractholder, which notice shall be included
with a monthly premium bill or premium notice issued prior to the date of
nonrenewal or, where no monthly premium statement is transmitted, send a notice
at least 30 days prior to nonrenewal; and
4. Not less than 90 days in advance of the
effective date of the nonrenewal on the anniversary date of the plan or plan
option, or deductible/copayment option, mail a notice, in the same format
submitted to the Department pursuant to (d)7 above, to the producer of record,
if any, for each policy or contract.
