New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM
Subchapter 24 - PROGRAM COMPLIANCE
Section 11:20-24.6 - Good faith effort to market individual health benefits plans

Universal Citation: NJ Admin Code 11:20-24.6

Current through Register Vol. 56, No. 24, December 18, 2024

(a) In order for the Board to determine whether a member that is a small employer carrier as defined in N.J.S.A. 17B:27A-17 has offered and made a good faith effort to market the standard health benefits plans pursuant to N.J.S.A. 17B:27A-19a, every small employer carrier shall submit to the Board, at the address specified at N.J.A.C. 11:20-2.1(h), on or before May 1 of each year, a report detailing the activities the small employer carrier undertook during the prior calendar year to market at least three of the standard health benefits plans, whether through the Marketplace or off the Marketplace, or in the case of an HMO, the standard individual HMO plan. If a member offers one or more standard health benefits plans with rider, the member may include information regarding efforts to market the standard health benefits plan with rider in the report.

(b) The report shall include only those marketing activities that were in direct support of the sale of individual health benefits plans whether through the Marketplace or off the Marketplace during the prior year, even if the effective date of the policy issued as a result of the activities was in the reporting year.

(c) The Board will review the report submitted by each member to determine whether the small employer carrier has demonstrated that it made a good faith effort to market the standard individual health benefits plans including standard health benefits plans with rider, if applicable, and provide written notice of its determination to the member within 45 days of a completed filing.

1. The Board will find that a small employer carrier has marketed in good faith if:
i. The carrier provides evidence that it listed at least three standard individual health benefits plans, or in the case of an HMO, the HMO plan, on the carrier's standard application for individual coverage in the prior calendar year and demonstrates how the individual application was made available to individual consumers during the prior calendar year;

ii. The carrier provides evidence that it has undertaken at least one individual consumer directed marketing effort in direct support of the sale of the standard individual health benefits plans or standard health benefits plans with rider during the prior calendar year. Examples of marketing efforts include, but are not limited to: print media such as newspapers and magazines; marketing through licensed producers, where the efforts to encourage the producer to sell the plan can be demonstrated through use of notices, brochures, faxes, or other communications advising the producers of the availability of the plans; or information specific to the standard individual health benefits plans on the carrier's website. Carriers may undertake one or more of these marketing efforts, or may use any other method that is in direct support of the sale of the standard individual health benefits plans provided such other method is an outbound consumer marketing approach; and

iii. The carrier did not provide information stating that the carrier did not offer individual health benefits plans in New Jersey or did not provide misinformation regarding eligibility for such plans.

2. A small employer carrier will be found to have not made a good faith effort if the report does not meet the standards set forth in (c)1 above or if the member fails to submit a report by May 1 of each year.

(d) Small employer carriers found not to have demonstrated that they satisfied the requirement to make a good faith effort to market the plans will be required to withdraw from the small employer market pursuant to N.J.A.C. 11:21-16 within 60 days following receipt of a determination from the Board that the carrier was found to have not made a good faith effort to market the standard individual health benefits plans.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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