New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Subchapter 13 - NONSTANDARD PLANS: WITHDRAWAL OF PLANS
Section 11:21-13.3 - Restricted withdrawal and marketing

Universal Citation: NJ Admin Code 11:21-13.3

Current through Register Vol. 56, No. 18, September 16, 2024

(a) A carrier, association, multiple employer arrangement or out-of-State trust shall not withdraw a nonstandard health benefits plan without prior approval of the Commissioner if there was one or more policies or contracts inforce under that nonstandard health benefits plan on December 31, 1993, and one or more small employers continued to be covered under that nonstandard health benefits plan as of January 1, 1994, except as (b) below applies.

(b) A carrier may withdraw a nonstandard health benefits plan without obtaining prior approval pursuant to this subchapter if the carrier is effecting withdrawal from the small employer market in accordance with N.J.A.C. 11:21-16.

(c) A carrier shall market all open nonstandard health benefits plans made available through an association, trust or other multiple employer arrangement to all small employers members within that association, trust or other multiple employer arrangement, and the employees of such small employers.

(d) A carrier shall not market a closed nonstandard health benefits plan either directly or through an association, out-of-State trust or multiple employer arrangement.

(e) An association, multiple employer arrangement or out-of-State trust may market an open nonstandard health benefits plan, but if it does market an open nonstandard health benefits plan to its members' employees and dependents it shall offer coverage to all eligible employees and their dependents within the membership of the association, multiple employer arrangement or out-of-State trust, and in no instance shall actual or expected health status be used in determining membership.

1. An association, multiple employer arrangement or out-of-State trust that markets an open nonstandard health benefits plan shall also market at least one standard health benefits plan in accordance with 11:21-11.6.

2. In no instance shall a closed nonstandard health benefits plan be marketed.

3. No carrier shall be relieved of its obligation to market all of the standard health benefits plans by virtue of marketing at least one standard health benefits plan through an association, multiple employer arrangement or out-of-State trust.

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