New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 24B - ORGANIZED DELIVERY SYSTEMS
Subchapter 4 - MANAGEMENT AGREEMENTS WITH CARRIERS
Section 11:24B-4.12 - Review and approval of management agreements

Universal Citation: NJ Admin Code 11:24B-4.12

Current through Register Vol. 56, No. 24, December 18, 2024

(a) Management agreements submitted with the initial application for certification or an application for licensing shall be subject to the standards for submission, review and approval as set forth at N.J.A.C. 11:24B-2.

(b) Amendments to forms of management agreements shall be submitted to the Department for review and approval no less than 60 days prior to the date that the ODS intends to use any amendment.

(c) The Department shall approve or disapprove the management agreement form within 60 days of the date of receipt of the form, unless the Department extends its review period for an additional 30 days by notifying the ODS in writing of the extension.

1. In the event that the Department does not affirmatively approve or disapprove the form, or notify the ODS of the extension of the review period, prior to the end of the 60-day period, the form may be deemed approved.

2. Notwithstanding (c)1 above, neither an ODS nor a carrier shall effectuate any amendment to a management agreement deemed approved unless the ODS has submitted a statement in writing to the Department that it is deeming the amended form approved in accordance with (c)1 above, stating the date of deemed approval, and that the ODS is using it accordingly.

(d) If the Department disapproves an amendment to a management agreement, the Department shall notify the ODS in writing, specifying the reasons for the disapproval.

(e) Failure of an ODS to respond to the Department's questions regarding a management agreement within 20 business days of the date of the Department's written inquiry will result in the Department suspending any further action on the submission, and the time period for approval or deemed approval being tolled.

1. In the event that the Department determines that a submission file has become inactive, the Department shall notify the ODS in writing of the determination, which shall effectively result in disapproval of the submission.

2. A written statement from an ODS that it is deeming an amended form to be approved in accordance with (c)1 above shall have no effect following a determination that a submission file is inactive.

(f) An ODS may reactivate review of a file determined by the Department to be inactive at any time by submitting a statement in writing that it desires the submission to be reactivated, and in the same written notice, responding to the Department's written inquiry issued prior to the review of the submission being suspended.

1. Notwithstanding reactivation of the review, approval of the management agreement form shall not be deemed at any time subsequent to reactivation.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.