Current through Register Vol. 56, No. 18, September 16, 2024
(a) A carrier
shall continue and renew a nonstandard health benefits plan in accordance with
this subchapter unless the carrier has:
1.
Filed a request to withdraw the nonstandard health benefits plan in accordance
with the requirements of N.J.A.C. 11:21-13, and the request has been approved
by the Commissioner; or
2. The
carrier has filed a notice of withdrawal from the small employer market in
accordance with the requirements of N.J.A.C. 11:21-16 and N.J.S.A.
17B:27A-23e.
(b) Renewal
of a nonstandard health benefits plan shall be provided at the request of a
small employer that is covered by the nonstandard health benefits plan issued
by the carrier at the time that the request is made.
1. A request made by a small employer that
was covered by the nonstandard health benefits plan issued by the carrier, but
who is not so covered at the time that the request is made, shall not be deemed
a request for renewal.
2. A request
made of a carrier by a small employer to renew a nonstandard health benefits
plan issued by and inforce under another carrier at the time the request is
made shall not be deemed a request for renewal.
(c) Notwithstanding (b) above, a carrier
shall not be required to renew a nonstandard health benefits plan under the
following circumstances:
1. Nonpayment or
payment beyond expiration of the grace period, if any, of the required premium
by the policyholder, contractholder or employer;
2. The policyholder, contractholder or
employer has performed an act or practice that constitutes fraud or made an
intentional misrepresentation of material fact under the terms of the
coverage;
3. The small employer
fails to meet either the participation or contribution requirements;
4. In the case of nonstandard health benefits
plans issued to or through an association, trust or other multiple employer
arrangement, for a small employer if the small employer ceases to be a member
of the association, trust or other multiple employer arrangement but only if
such coverage is terminated uniformly without regard to any health
status-related factor relating to any covered individual;
5. The small employer has decided to cease
offering and to nonrenew a particular type of nonstandard health benefits plan
in the small employer market, or as permitted or required pursuant to
17B:27A-19; or
6. In the case of a health maintenance
organization plan issued to a small employer, an eligible person no longer
resides, lives or works in the carrier's approved service area, but only if
coverage is terminated uniformly without regard to any health status-related
factor of covered individuals; or a small employer no longer has any enrollee
in connection with such plan who lives, resides or works in the service area of
the carrier and the carrier would deny enrollment with respect to such plan
pursuant to
17B:27A-26.
(d) In the event that a small employer is
being nonrenewed pursuant to (c)4 above, the carrier shall provide notice to
the small employer that the same standard health benefits plan(s) available to
the small employer through the association, trust or other multiple employer
arrangement are available from the carrier directly along with the other
standard health benefits plans and rider options that the carrier offers to
other small employers.
