New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Subchapter 7 - PROGRAM COMPLIANCE
Section 11:21-7.11 - Guaranteed renewal
Universal Citation: NJ Admin Code 11:21-7.11
Current through Register Vol. 56, No. 18, September 16, 2024
(a) All health benefits plans that are issued or renewed on or after January 1, 1994, must be guaranteed renewable at the option of the policy or contract holder or small employer, except that a carrier may discontinue a health benefits plan pursuant to (b) below or nonrenew a health benefits plan pursuant to (c) below.
(b) A carrier may discontinue a health benefits plan only if:
1. The policyholder,
contract holder, or employer has failed to pay premiums or contributions in
accordance with the terms of the health benefits plan or the carrier has not
received timely premium payments; or
2. The policyholder, contract holder, 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.
(c) A carrier may nonrenew a health benefits plan only if:
1. The number of employees covered under the
health benefits plan is less than the number or percentage of employees
required by participation requirements under the health benefits policy or
contract unless renewal coincides with an employer open enrollment period.
Minimum participation rates are calculated once per year at the time of initial
group submission and subsequently at the time of renewal;
2. The small employer fails to comply with a
small employer carrier's employer contribution requirements unless renewal
coincides with an employer open enrollment period. Minimum contribution rates
are calculated once per year at the time of initial group submission and
subsequently at the time of renewal;
3. The carrier files with the Commissioner to
withdraw from the small employer market and meets the requirements of N.J.A.C.
11:21-16;
4. The small employer
ceases its membership in an association or trust of employers where the health
benefits plan was issued in connection with such membership;
5. The carrier receives approval to cease
offering and renewing a particular type of a plan and meets the requirements of
N.J.A.C. 11:21-13;
6. The SEH Board
discontinues a particular standard health benefits plan or plan option;
or
7. In the case of a health
maintenance organization plan issued to a small employer:
i. An eligible person who no longer resides,
lives, or works in the carrier's approved service area, but only if coverage is
terminated under this paragraph uniformly without regard to any health
status-related factor of covered individuals; or
ii. A small employer that 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.
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.
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