New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM
Subchapter 8 - THE IHC PROGRAM ASSESSMENT REPORT
Section 11:20-8.3 - Calculation of net earned premium and determination of program membership

Universal Citation: NJ Admin Code 11:20-8.3

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

(a) In Part C of the N.J.A.C. 11:20 Appendix Exhibit K Assessment Report, each member shall set forth its total net earned premium from plans issued, continued, or renewed for all affiliated carriers during the preceding two-year calculation period through the 2017-2018 calculation period. Thereafter, each member shall set forth its total net earned premium from plans issued, continued, or renewed for all affiliated carriers during the preceding calendar year on Part C of the N.J.A.C. 11:20 Appendix Exhibit K. Net earned premium reported in Part C of N.J.A.C. 11:20 Appendix Exhibit K shall be consistent with the data set forth on the N.J.A.C. 11:20 Appendix Exhibit K Part C Premium Data Worksheet(s).

(b) In Part C of the N.J.A.C. 11:20 Appendix Exhibit K Assessment Report, each carrier with no net earned premium in the preceding two-year calculation period or preceding calendar year, as appropriate, shall assert its status as a non-member by checking the box designated for non-members on the N.J.A.C. 11:20 Appendix Exhibit K Assessment Report. Carriers either with no net earned premium or whose Section 3 Calculation of Net Earned Premium on the N.J.A.C. 11:20 Appendix Exhibit K Part C Premium Data Worksheet is equal to 0 are non-members.

(c) Through the 2017 and 2018 two-year calculation period, every carrier, whether a member or not, shall complete an N.J.A.C. 11:20 Appendix Exhibit K Part C Premium Data Worksheet for each affiliate and shall attach each Worksheet to its N.J.A.C. 11:20 Appendix Exhibit K Assessment Report.

1. In Section 1 of the Premium Data Worksheet, the carrier shall report the total accident and health premium reported on its annual statement blank for each calendar year of the two-year calculation period.

2. In Section 2 of the Premium Data Worksheet, the carrier shall report the total net earned premium in each calendar year of the two-year calculation period for each of the excepted types of coverage which are specifically identified in Section 2 of the Worksheet.

3. In Section 3 of the Premium Data Worksheet, the carrier shall calculate the affiliate's net earned premium by subtracting the total excepted premium totals reported in Section 2 from the accident and health premium totals reported in Section 1 of the Worksheet.

4. The carrier shall report the aggregated two-year net earned premium on Exhibit K Part C by taking the sum of each affiliate's two-year net earned premium total as calculated on the Exhibit K Part C Premium Data Worksheet.

(d) Beginning with the N.J.A.C. 11:20 Appendix Exhibit K filing due April 1, 2020, for the 2019 calendar year, every carrier, whether a member or not, shall complete an N.J.A.C. 11:20 Appendix Exhibit K Part C Premium Data Worksheet for each affiliate and shall attach each Worksheet to its N.J.A.C. 11:20 Appendix Exhibit K Assessment Report.

1. In Section 1 of the Premium Data Worksheet, the carrier shall report the total accident and health premium reported on its annual statement blank for the calendar year.

2. In Section 2 of the Premium Data Worksheet, the carrier shall report the total net earned premium for the calendar year for each of the excepted types of coverage that are specifically identified in Section 2 of the Worksheet.

3. In Section 3 of the Premium Data Worksheet, the carrier shall calculate the affiliate's net earned premium by subtracting the total excepted premium totals reported in Section 2 from the accident and health premium totals reported in Section 1 of the Worksheet.

4. The carrier shall report the net earned premium on N.J.A.C. 11:20 Appendix Exhibit K Part C as calculated on the N.J.A.C. 11:20 Appendix Exhibit K Part C Premium Data Worksheet.

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