New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM
Subchapter 7 - LOSS RATIO AND REFUND REPORTING REQUIREMENTS
Section 11:20-7.4 - Contents of the Loss Ratio Report

Universal Citation: NJ Admin Code 11:20-7.4

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

(a) A Loss Ratio Report form set forth at Appendix Exhibit J shall be completed by August 15 of each year by each member and shall include the following information with respect to standard health benefits plans and basic and essential health care services plans:

1. The reporting member's name and address;

2. The member's net earned premium for the preceding calendar year; and

3. A statement of the member's total losses incurred consisting of:
i. Claims paid during the preceding calendar year, regardless of the year incurred;

ii. Less residual reserve set on June 30 of the preceding calendar year for claims incurred prior to January 1 of the preceding calendar year;

iii. Less claims paid from January 1 through June 30 of the preceding calendar year for claims incurred prior to January 1 of the preceding calendar year as reported in the preceding calendar year's Loss Ratio Report;

iv. Plus claims paid from January 1 through June 30 of the reporting year for claims incurred prior to January 1 of the reporting year;

v. Plus residual reserve for claims incurred prior to January 1 of the reporting year, not paid as of June 30 of the reporting year;

4. The member's loss ratio (determined by dividing the total losses incurred in (a)3 above by the net earned premium as determined in (a)2 above) calculated as a percentage to one decimal place (for example, 81.2 percent); and

5. Certification by a member of the Society of Actuaries, Casualty Actuarial Society, or American Academy of Actuaries that the information provided in the Loss Ratio Report is accurate, complete and that the carrier is in compliance with the requirements of N.J.S.A. 17B:27A-9 in accordance with this section.

(b) The residual reserve reported in (a)3ii and v above shall be calculated as 3.3 percent of the combination of (a)3i, iii and iv above.

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