New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Subchapter 13 - NONSTANDARD PLANS: WITHDRAWAL OF PLANS
Section 11:21-13.4 - Request to withdraw nonstandard health benefits plans

Universal Citation: NJ Admin Code 11:21-13.4

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

(a) A carrier may submit to the Commissioner a completed request to withdraw one or more closed and open nonstandard health benefits plan(s) at any time except that a carrier shall not:

1. Submit more than one request to withdraw at any one time, but may amend its request to withdraw, if necessary;

2. Submit a request to withdraw a nonstandard health benefits plan that the carrier added to its portfolio of health benefits plans in accordance with 11:21-11.8 within the first 12 month period following the effective date of the carrier's obligation pursuant to contracts issued under that nonstandard health benefits plan; or

3. Submit a request to withdraw while a request for relief pursuant to N.J.A.C. 11:20-11 or 11:21-15 is pending.

(b) A carrier may submit a single filing to request withdrawal of more than one closed and open nonstandard health benefits plans, but shall clearly specify each nonstandard health benefits plan for which a withdrawal is sought, with separate proofs of unreasonable financial burden submitted for each nonstandard health benefits plan.

(c) A carrier shall submit five copies of each request to withdraw in loose leaf form, inserted into two-ring or three-ring binders, tabbed or otherwise indexed to correspond to the exhibits set forth below.

1. A cover letter stating:
i. The name of the carrier, and the name, title, telephone number and telefax number of a contact person familiar with the filing to whom the Department may direct any additional questions;

ii. A clear specification of the nonstandard health benefits plan(s) which the carrier is seeking to withdraw, including the market name(s), form number(s), and the date(s) the form filing(s) was (were) approved by the Department; and

iii. A statement of facts relied upon as the basis under which the request is sought, including the specific factor(s) upon which the Commissioner may find that maintaining the nonstandard health benefits plan(s) represents an unreasonable financial burden to the carrier;

2. If the carrier intends to establish that renewal of an open nonstandard health benefits plan is an unreasonable financial burden for the carrier, then the carrier shall provide the following:
i. A statement certified to by an officer of the carrier that the total number of lives eligible for small employer health benefits plans covered under the open nonstandard health benefits plan during the 12 month period immediately preceding the date of submission of the request to withdraw was 1,000 or fewer, including only employees and not dependents; or a demonstration that the actual loss ratio of the open nonstandard health benefits plan is 100 percent, or greater, for the 12 month period preceding the date of submission of the request to withdraw;

ii. A detailed explanation, with supporting documentation, of the projected effect that continuation of the nonstandard health benefits plan(s) would have on the immediate and long term financial condition of the carrier;

iii. The most recent financial examination report, whether conducted by the carrier's state of domicile or other state;

iv. A statement addressing whether the carrier is planning to modify its method of doing business in any way, including, but not limited to, new acquisitions or new restructuring;

v. Three-year financial projections beginning with the calendar year of the date of the filing assuming both that the request to withdraw is granted and that it is denied;

vi. A description of any relief from obligations imposed by this State or any other state granted or in effect within the preceding 12 months, and the basis upon which such relief was granted; and

vii. Any other information the Commissioner may specifically deem relevant to the consideration of the particular carrier's request.

(d) The request to withdraw shall be accompanied by the form of the notice of nonrenewal to be provided to policyholders, contractholders, and certificateholders, which notice shall be in compliance with 11:21-13.6(a).

(e) Carriers requesting to withdraw a nonstandard health benefits plan shall concurrently provide notice of the request to the SEH Program at the address specified at 11:21-1.3.

(f) At the time of the filing of the request to withdraw, the carrier shall specify the number of policies, contracts and certificates issued under each nonstandard health benefits plan that is the subject of the request to withdraw, the approximate number of lives covered under each such nonstandard health benefits plan, and the approximate number of small employers covered under each such nonstandard health benefits plan.

(g) Carriers submitting a request to withdraw shall submit that request to:

SEH Program

Request to Withdraw Nonstandard Plans

Life and Health Division

New Jersey Department of Banking and Insurance

PO Box 325

Trenton, NJ 08625-0325

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.