New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Subchapter 7 - PROGRAM COMPLIANCE
Section 11:21-7.14 - Permissible rate classification factors
Universal Citation: NJ Admin Code 11:21-7.14
Current through Register Vol. 56, No. 18, September 16, 2024
(a) For health benefits plans issued or renewed on or after January 1, 2014, a carrier shall not differentiate premium rates charged to different small employers for the same health benefits plan except on the basis of age and geography in accordance with the following restrictions:
1. Rates shall vary by age for each covered
person age 21 or older. There shall be a per child rate for children under age
21 with a limit applied to the number of children rate equal to three times the
child rate.
2. Geographic
categories shall be limited to six territories, each consisting of the areas
covered by the counties listed below. A carrier shall determine which territory
applies to a small employer on the basis of the address of the small employer's
principal place of business. The six territories are the following:
i. Territory A consists of Essex, Hudson, and
Union counties;
ii. Territory B
consists of Bergen and Passaic counties;
iii. Territory C consists of Monmouth,
Morris, Sussex, and Warren counties;
iv. Territory D consists of Hunterdon,
Middlesex, and Somerset counties;
v. Territory E consists of Burlington,
Camden, and Mercer counties; and
vi. Territory F consists of Atlantic, Cape
May, Ocean, Salem, Cumberland, and Gloucester counties.
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