New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 1 - NEW JERSEY INSOLVENT HEALTH MAINTENANCE ORGANIZATION ASSISTANCE ASSOCIATION
Section 11:4-1.9 - Rates

Universal Citation: NJ Admin Code 11:4-1.9

Current through Register Vol. 56, No. 18, September 16, 2024

(a) In determining its schedule of charges or rates filed with the Commissioner pursuant to N.J.S.A. 26:2J-8b, or filed in accordance with any other law requiring such filing, no member organization shall include the amount paid or to be paid as assessments under 17B:32B-1 et seq., or any portion of that amount, unless the Commissioner specifically determines that exclusion of those assessments in determining its schedule of charges or rates will significantly and adversely affect the organization by precluding it from earning a constitutionally adequate rate of return, or as otherwise set forth in (c) below. Each member organization shall annually file a certification to the Commissioner that the member organization has not included any amounts assessed in its schedule of charges or rates, unless permitted to do so pursuant to this section.

(b) No member organization shall be permitted to include the amount paid or to be paid as assessments unless it first requested relief from payment of such assessment, and such request was denied, pursuant to this subchapter. However, a request for relief shall not be required provided the filer files a request to include assessments paid in its schedule of charges or rates that includes the information set forth at 11:4-1.6 in the format of 11:4-1.5, wherein the filer recognizes that the Department shall review the information filed to determine whether relief is warranted pursuant to 11:4-1.8

(c) The Commissioner shall find that exclusion of assessments in determining the member organization's schedule of charges or rates will significantly and adversely affect the organization if the member organization demonstrates that it is unable to earn a constitutionally adequate rate of return after paying the assessment. Alternatively, the Commissioner may consider in determining whether the exclusion of assessments will significantly and adversely affect the organization if the member organization demonstrates that:

1. Its net worth will be below that required by N.J.A.C. 8:38-11.1 after payment of the assessment; and

2. For the three-year period immediately following payment of the assessment, its net worth will be less than that required by N.J.A.C. 8:38-11.1 if the assessment is not included in the member's schedule of charges or rates.

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