Current through Register Vol. 56, No. 18, September 16, 2024
(a)
Following approval of a final audited Program statement, the Board shall
determine the final administrative expense total for the fiscal year, if any.
1. Each member's final assessment shall be
reduced by any interim assessment paid by the member or credited to the member
by the Board.
2. Each member's
final assessment shall be reduced by any deferred assessments paid by assessed
carriers in proportion to the original additional assessment made to cover the
deferred amount.
3. Members shall
be assessed for a proportionate share of the final administrative expenses for
the fiscal year on the basis of health benefits plan earned premiums for the
calendar year that includes the first six months of the fiscal year. The
administrative expense assessment for each member shall be equal to the total
of all administrative expenses for the fiscal year multiplied by the ratio of
that member's earned premium for health benefits plans to the earned premium
for health benefits plans of all members of the calendar year that includes the
first six months of the fiscal year.
i.
Beginning in Fiscal Year 2005, if a member's proportionate share of the interim
assessment or final administrative assessment is less than $ 5.00, the member
shall not be assessed and the amounts uncollected will be reapportioned
proportionally, based on market share, among the member carriers.
(b) The Board may make
an interim assessment of members for reasonable and necessary organizational
expenses and to cover anticipated interim operating expenses. At the discretion
of the Board, interim assessments may be made on a monthly basis or such other
periodic basis as necessary to ensure the availability of funds to meet
operating expenses.
(c) ssessment
amounts are due and payable upon receipt by a member of the invoice for the
assessment. Payment shall be by bank draft made payable to the Treasurer--State
of New Jersey, SEH Program, and mailed to the Executive Director at the address
in 11:21-1.3
.
1. Members shall be subject to payment of an
interest penalty on any assessment, or portion of an assessment, not paid
within 45 days of the date of the invoice for the assessment, unless the member
has been granted a deferral by the Commissioner of the amount not timely paid
as permitted by N.J.S.A. 17B:27A-32c.
i. The
interest rate shall be 1.5 percent of the assessment amount not timely paid per
month, accruing from the date of the invoice for the assessment.
ii. Payment of an assessment, or portion of
an assessment, for which an interest penalty amount has accrued, shall include
the interest penalty amount accrued as of the invoice date; otherwise, payment
shall not be considered to be in full.
iii. The interest so collected shall be
applied in the assessment of the final administrative expenses as set forth in
(a)3 above to reduce the liability of those members that were not subject to
the payment of an interest penalty.
2. Carriers that dispute whether they are
subject to an assessment, or dispute the amount of assessment for which they
have been determined liable by the Board, shall be assessed for and make
payment of the full amount of the assessment invoice, including any interest
penalty accruing thereon, until such time as the dispute has been resolved in
favor of that carrier, or, if a contested case, the Board has rendered a final
determination in favor of that carrier in accordance with the Administrative
Procedure Act,
52:14B-1 et seq.
3. A member may request that the Commissioner
grant a deferral of its obligation to pay an assessment in accordance with
N.J.A.C. 11:21-15.
i. If a member files a
proper request for deferral within 15 days after the date of the invoice, that
member may make payment of the amount of the assessment invoice to be held in
an interest bearing account in accordance with the procedures set forth herein,
pending final disposition by the Commissioner of the deferral
request.
ii. If the member
withholds payment, as permitted herein and the Commissioner denies the request
for deferral, the member shall be subject to payment of the interest penalty
set forth herein, accruing from the date of the invoice for the
assessment.
4. Amounts
deferred by the Commissioner or subject to dispute, which dispute is resolved
in favor of the carrier, shall be redistributed among all other members
proportionately.
(d) The
Executive Director shall coordinate with the Department and other appropriate
parties, including State agencies, regarding fiscal administrative matters, and
develop appropriate procedures for such matters, and disburse funds for
administrative expenses upon the directive of the Board.
1. Amounts of assessment in dispute or
subject to deferral request, including any interest penalty paid by a carrier
pursuant thereto, shall not be disbursed by the Executive Director until such
time as the dispute has been settled against the disputing carrier, or the
deferral denied, except that any portion of an assessment not in dispute or
subject to the deferral request, or portions no longer disputed or subject to a
deferral request, may be disbursed immediately according to Board
directive.
2. Amounts of assessment
disputed or subject to deferral wherein the dispute is settled in favor of the
disputing carrier, or a deferral is granted, shall be returned to the
appropriate carrier within 15 days of the date that the Executive Director
receives notice of the determination by the Board or the Commissioner, as
applicable along with the proportionate amount of interest penalty, if any,
paid by the carrier for late payment of the amount.
(e) A member requesting a deferral from the
Commissioner of an assessment amount shall concurrently provide notice of such
request in duplicate to the Executive Director in order to preserve its right
to the moneys owed and paid pursuant to the invoice for assessment.
(f) If a member determined liable for an
assessment fails to pay the full amount of the assessment and applicable
interest, if any, within 60 days after the date of the invoice, and has neither
submitted notice that it is seeking a deferral from the Commissioner, nor
requested a hearing, the Board may provide to the Commissioner a notice of the
member's failure to make payment along with a recommendation to revoke the
member's authority to write any health benefits plans or other health coverage
in this State or to take such other action against the carrier as may be
authorized by law. A copy of this notice shall be sent to the member by
registered mail at the same time that the notice is sent to the Commissioner.
In accordance with the Act, failure to pay assessments shall be grounds for
removal of a member's authority to write health coverage of any kind in this
State.
