New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 23 - THIRD-PARTY ADMINISTRATORS
Subchapter 3 - THIRD PARTY ADMINISTRATORS
Section 11:23-3.5 - Funds to be maintained in separate accounts
Current through Register Vol. 56, No. 6, March 18, 2024
(a) All funds remitted to an administrator by a benefits payer licensed or authorized to do business in this State shall be held by the third party administrator in a separate account maintained in the name of the benefits payer, or in a separate account maintained jointly in the names of the benefits payer and the administrator.
(b) If funds have been collected by the administrator from a provider or enrollee on behalf of a benefits payer, they shall be promptly deposited into a separate account maintained in the name of the benefits payer or an account maintained jointly in the names of the benefits payer and the administrator, or remitted to the benefits payer, as provided in the contract. Funds shall not be commingled with any other funds of the administrator or other clients of the administrator. Copies of all records pertaining to the collection of funds shall be made available to the benefits payer as provided in the contract.
(c) If an account is jointly held by the administrator and the benefits payer, it shall be maintained in a State or Federally chartered insured depository institution, and the administrator shall provide the benefits payer with a monthly accounting of all transactions in that account.
(d) A benefits payer shall have the responsibility to make available to the administrator funds necessary to enable the administrator to pay claims in a timely manner, as provided in the contract. An administrator shall not be liable to any party for the failure of the benefits payer to make funds available to pay claims.
