New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 21 - SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Subchapter 9 - INFORMATIONAL RATE FILING REQUIREMENTS PURSUANT TO THE SMALL EMPLOYER HEALTH BENEFITS PROGRAM
Section 11:21-9.6 - Errors in rate quotations and rate calculation

Universal Citation: NJ Admin Code 11:21-9.6

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

(a) Any carrier that quotes, bills or collects a premium to or from a small employer that is less than the rate shown in the carrier's informational SEH rate filing in effect at the time the premium is billed or collected shall:

1. Provide written notice to the small employer of the error as soon as possible but no later than 30 days after discovery of the error;

2. Be prohibited from charging, collecting, offsetting or otherwise recouping the amount of the undercharges; and

3. Continue to charge the erroneous rate for a period of at least 60 days from the date the written notice of the error is received by the small employer.

(b) Any carrier that quotes, bills or collects a premium to or from a small employer that is more than the rate shown in the carrier's informational SEH rate filing in effect at the time the premium is billed or collected shall:

1. Immediately cease charging the incorrect rate and charge the correct rate;

2. Provide written notice to the small employer of the error as soon as possible but no later than 30 days after discovery of the error; and

3. Send the small employer a refund or post a premium credit within 30 days after discovery of the error for the full amount of all overcharges.

(c) If more than 50 small employer groups were undercharged or overcharged as a result of the error, a carrier shall provide the Department at the address listed at 11:21-9.4(a) with a certification describing the nature and scope of the error, including a list of all small employers affected and a sample copy of the notice to all small employers.

(d) The requirements of this section shall not apply to any deviation in rates from the filed rates that is less than one-quarter of one percent (.25 percent) or that arises from a rounding error of less than $ 1.00.

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