New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 24 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter 11 - FINANCIAL STANDARDS AND REPORTING
Section 11:24-11.3 - Reserve liabilities
Universal Citation: NJ Admin Code 11:24-11.3
Current through Register Vol. 56, No. 24, December 18, 2024
(a) An HMO shall maintain at all times reserve liabilities in an amount sufficient to provide for:
1. All claims incurred, whether reported
or unreported, which are unpaid and for which the HMO is or may become liable,
including the expense of adjustment or settlement of those claims;
2. Continued health care services to members
for which a consideration has been received, or a consideration is due but
unpaid; and
3. Continued health
care services under the HMO contract to members who, on the date of termination
of the HMO contract, are confined in an inpatient facility until discharge from
the facility.
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