New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM
Subchapter 7 - LOSS RATIO AND REFUND REPORTING REQUIREMENTS
Section 11:20-7.5 - Refund plan
Universal Citation: NJ Admin Code 11:20-7.5
Current through Register Vol. 56, No. 24, December 18, 2024
(a) If the loss ratio determined in N.J.A.C. 11:20-7.4 is less than 80 percent, the member shall include with the Report a plan to be approved by the Commissioner for a refund to policy and contractholders of an amount equal to the difference between 80 percent of reported premiums and reported claims.
(b) The refund plan shall conform with the following:
1. Refunds shall
be made to all contractholders who were covered for any period during the
preceding calendar year whose refund is $ 5.00 or greater.
2. The refund amount per contractholder may
be determined by multiplying the earned premium from each contractholder's
standard health benefits plan and rider or basic and essential health care
services plan and rider by the percentage resulting from dividing the total
refund calculated in accordance with (a) above by the carrier's total net
earned premium from the standard health benefits plans and basic and essential
health care services plans, or on the basis of a practical and equitable
alternative formula proposed by the carrier and approved by the
Commissioner.
3. Refund payments
shall be made within 60 days of written approval of the refund plan by the
Commissioner.
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