New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION
Section 11:4-1.8 - Disposition of request for relief

Universal Citation: NJ Admin Code 11:4-1.8

Current through Register Vol. 56, No. 6, March 18, 2024

(a) When the Commissioner determines pursuant to N.J.S.A. 17B:32B-9e that payment of the assessment would endanger the ability of the member organization to fulfill its contractual obligations or, based on indicia that relate to the ability to pay the assessment by the member organization, would place it in an unsafe or unsound financial condition, the Commissioner shall notify the Association of such finding and direct the Association to exempt, abate or defer the obligation of the member organization, as set forth in (b) below. If the Commissioner decides to defer, in whole or in part, a member organization's obligation to pay assessments, the member shall remain liable to the Association for the amount deferred. The Commissioner shall find that a member is or would be unable to meet its contractual obligations or be placed in an unsafe or unsound financial condition if:

1. The member has been placed in rehabilitation or liquidation pursuant to 17B:32-31 et seq. or such similar law of the member's state of domicile;

2. The member has been placed under administrative supervision pursuant to 17:51A-1 et seq. or such similar law of the member's state of domicile; or

3. The Commissioner finds based solely on indicia of N.J.A.C. 11:2-27 that relate to the ability to pay the assessment that the member is or would be placed in a hazardous financial condition.

(b) If the Commissioner determines that relief should be granted, the member organization's obligation shall be exempted, abated or deferred, as follows:

1. Except as provided at (b)2 below, the Commissioner shall in all cases direct the Association that the member's obligation shall be deferred pending a quarterly review of the member's financial condition. The deferral shall be deemed to be an exemption two years from the date the obligation was originally due, unless the Commissioner, prior to that date, determines that the member's financial condition has improved such that payment of the assessment, or a portion thereof, will not result in the member being or becoming in a hazardous financial condition. If a member is required to pay a portion of its obligation prior to the expiration of the two-year period, the remainder shall be deferred, and shall be deemed exempt at the expiration of the two-year period in the same manner as provided in this paragraph for deferred obligations.

2. The Commissioner shall direct the Association that the member organization's obligation be exempted, and thus no obligation thereafter shall be deemed to exist for the particular obligation for which the exemption was granted, if the member is in liquidation or rehabilitation pursuant to 17B:32-31 et seq., or similar statutes of the member's state of domicile, at the time the request is made. An exemption granted under this paragraph shall be for the entire obligation and no obligation thereafter shall exist for the particular obligation for which the exemption was granted; provided that the determination whether to grant an exemption from a future obligation shall be considered at the time such obligation becomes due based on the member's financial condition at that time.

3. The Commissioner shall direct that the member's obligation to pay the full amount of the assessment be abated if he or she determines that payment of some amount will not result in the member being or becoming in a hazardous financial condition. The amount which is not abated shall be deferred in the same manner provided by (b)1 above.

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