New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 23 - THIRD-PARTY ADMINISTRATORS
Subchapter 4 - SUSPENSION OR REVOCATION OF LICENSE OR REGISTRATION
Section 11:23-4.1 - Suspension or revocation of license; grounds and penalties
Universal Citation: NJ Admin Code 11:23-4.1
Current through Register Vol. 56, No. 6, March 18, 2024
(a) The Commissioner may suspend or revoke a license or registration issued pursuant to the Act if he or she finds that the third party administrator:
1. Is in an unsound financial
condition;
2. Is using methods or
practices in the conduct of its business that render its further transaction of
business in this State hazardous or injurious to the benefits payers with which
it has contracted or the public;
3.
Has failed to pay any judgment rendered against it in this State within 60 days
after the judgment has become final;
4. Has violated any lawful rule or order of
the Commissioner or any provision of State law;
5. Has refused to be examined or to produce
its accounts, records and files for examination, or if any of its officers have
refused to supply information with respect to its affairs, or has refused to
perform any other legal obligation as to an examination, when required by the
Commissioner;
6. Has, without just
cause, refused or failed to pay proper claims or perform services arising under
its contracts;
7. At any time fails
to meet any requirement, on the basis of which issuance of the initial license
could have been refused had that failure then existed and been known to the
Commissioner;
8. Has been convicted
of, or has entered a plea of guilty or nolo contendere to a felony or crime of
the first, second or third degree in this State, without regard to whether
adjudication was withheld;
9. Has
had a credential as a third party administrator suspended, revoked or
non-renewed for cause in another state;
10. Has willfully reimbursed enrollees for
benefits not eligible under the benefits payer's benefits plan;
11. Has provided false or inaccurate
information in the certification provided with an initial application for
licensure or registration pursuant to
11:23-2.2(a) or
in any other submission to the Department; or
12. Has contracted with or on behalf of a
self-funded multiple employer welfare arrangement (MEWA) which is not
registered pursuant to
17B:27C-1 et seq.
(b) If the Commissioner finds that one or more grounds exist for the suspension or revocation of a license or registration issued under the Act, the Commissioner may, in lieu of or in addition to suspension or revocation, impose a fine upon the administrator.
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