Current through Register Vol. 56, No. 18, September 16, 2024
(a) No carrier
shall cease to issue or nonrenew a standard small employer health benefits
plan, plan option or copayment/deductible option required or permitted to be
offered pursuant to N.J.A.C. 11:21-3 until the carrier submits a notice of
intent to withdraw a plan, plan option or copayment/deductible option with the
Commissioner in accordance with the provisions of this subchapter.
(b) A carrier may cease to issue and nonrenew
a standard small employer health benefits plan pursuant to this section only
if:
1. The copayment/deductible option is not
required to be offered pursuant to
11:21-3.1(b) or
(c); or
2. In the case of a copayment/deductible
option required to be offered pursuant to
11:21-3.1, the carrier meets its
obligation to offer the standard small employer plans and required
copayment/deductible options either by offering the plans as indemnity plans or
by making the plan or plans available through or in conjunction with a
selective contracting arrangement to all New Jersey small employer
groups.
(c) A carrier
may cease to issue and nonrenew a standard plan option pursuant to this section
by offering another approved plan option. Examples of plan options include, but
are not limited to, a carrier's option to calculate the family deductible based
on a two times individual or three times aggregate basis, and an HMO's option
to offer prescription drug coverage with either a $ 15.00 copayment or with 50
percent coinsurance.
(d) A carrier
that seeks to withdraw a plan, plan option or copayment/deductible option
pursuant to this section shall provide the Commissioner with written
notification of its intent to withdraw a plan, plan option or
copayment/deductible option. An original and two copies of the notice of intent
to withdraw a plan, plan option or copayment/deductible option shall be sent to
the attention of: SEH Withdrawal Notice, Life and Health Division, New Jersey
Department of Banking and Insurance, PO Box 325, Trenton, New Jersey
08625-0325, and shall include the following information:
1. The name of the carrier;
2. The name, address, telephone number, and
fax number of the carrier's representative responsible for the application for
plan, plan option or copayment/deductible option withdrawal;
3. A specific description of the reasons the
carrier is withdrawing the plan, plan option or copayment/deductible
option;
4. Copies of a nonrenewal
notice the applicant intends to send to its policy or contractholders.
Nonrenewal notices for policy or contract holders shall include the following
information:
i. A statement that the carrier
has elected to nonrenew the plan, plan option or copayment/deductible
option;
ii. The date upon which the
plan, plan option or copayment/ deductible option shall be
nonrenewed;
iii. A statement that
the plan, plan option or copayment/ deductible option is being nonrenewed under
the authority of this subchapter;
iv. A statement that the policy or
contractholder may contact his or her producer, if any, for additional
information regarding the plan, plan option or copayment/deductible option
withdrawal; and
v. The name,
address and telephone number of the employee or agent of the carrier who may be
contacted for assistance and information regarding the plan, plan option or
copayment/deductible option withdrawal; and
5. Copies of the proposed nonrenewal notices
the applicant intends to send to its producers. Nonrenewal notices for
producers shall contain the same information as the notices to policy and
contract holders.
(e)
The Commissioner shall review the notice of intent to withdraw a plan, plan
option or copayment/deductible option to determine whether it complies with the
filing requirements of (d) above. The Commissioner shall notify the carrier, in
writing, of any deficiencies and the requirements that are necessary to bring
it into compliance with this section.
(f) A carrier which has submitted a notice of
intent to withdraw a plan, plan option or copayment/deductible option shall:
1. Not more than 60 days after the date of
the notice of intent to withdraw the plan, plan option or copayment/deductible
option, cease issuing the standard small employer health benefits plan, plan
option or copayment/deductible option;
2. Not more than 60 days following the date
of notice of intent to withdraw the plan, plan option or copayment/deductible
option, and not less than 90 days in advance of the effective date of the
nonrenewal on the anniversary date of the plan, plan option or
copayment/deductible option, mail a notice, in the same format submitted to the
Commissioner pursuant to (d)4 above, to every policy or contract holder,
informing the policy or contract holder that the plan, plan option or
copayment/deductible option will be nonrenewed on the plan's anniversary
date;
3. Following the initial
notice to each policy or contractholder, send a subsequent notice of the
nonrenewal to each policy or contractholder which notice shall be included with
a monthly premium bill or premium notice issued prior to the date of
nonrenewal, or, where no monthly premium is transmitted, send a notice at least
30 days prior to nonrenewal; and
4.
Not less than 90 days in advance of the effective date of the nonrenewal on the
anniversary date of the plan, plan option or copayment/deductible option, mail
a notice in the same format submitted to the Commissioner pursuant to (d)5
above, to the producer of record, if any, for each policy or
contract.
