New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 16 - MINIMUM STANDARDS FOR INDIVIDUAL HEALTH INSURANCE
Section 11:4-16.9 - Forms submission requirements

Universal Citation: NJ Admin Code 11:4-16.9

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

(a) General rules include:

1. Within 120 days after the effective date of this regulation, each issuer shall submit a list of all individual health insurance forms currently filed which meet the requirements contained herein. An executive officer of the company shall certify that the forms listed comply with this regulation.

2. Each form submitted for filing by the commissioner shall be accompanied by an individual health insurance report as specified in (c) below.

3. Each submission shall include a description of the marketing arrangements for the form(s). This description should specify the intended use and purpose of the form, the methods by which the form will be sold, and the segment of the general public that is expected to make up the largest portion of applicants. If the form will be solicited by mail or any mass marketing scheme, the submission shall also include copies of advertising materials.

4. The application form and any riders, endorsements or amendments which are required to be attached at issue shall be included with the submission.

5. Each form shall be filled in with hypothetical data as for specimen issue.

6. Each rider, amendment or endorsement shall specify the forms with which it will be used and shall indicate any changes in benefits, coverages, exclusions or rates that will result.

7. A rubber stamp endorsement shall be shown on a specimen policy page as it will appear in actual use.

8. Wording in any form which is to be considered variable shall be appropriately indicated, and any alternate wording shall be included with the submission.

(b) Rules concerning additional material required for submission include:

1. This department does not sanction wholesale terminations of individual policies in this State. Therefore, whenever a form is submitted which reserves to the insurer the right to nonrenew the policy for a reason stated in 11:4-16.4(a)17, the insurer shall include with the submission a letter from an officer of the company agreeing to the following conditions:
i. That the insurer has designed the policy, rates, underwriting and issue procedures so that it will not be necessary to exercise such right of nonrenewal;

ii. That in the remote chance the insurer does find it necessary to exercise such right, it shall give this department full information as to the reasons for nonrenewal and at least 90 days notice prior to taking any nonrenewal action;

iii. That the insurer will discuss with this department all possible alternatives, including the remedy of offering appropriate substitute coverage which gives full credit for all prior waiting periods; and

iv. That such action will only be taken as a last resort.

2. The insurer shall include with the submission of forms that include an option to purchase additional insurance an agreement to send the notice required by 11:4-16.6(c)20 iv.

3. The insurer shall include with the submission of forms that meet the requirements of N.J.A.C. 11:16-4.6(f)2 an agreement to send the notice required by 11:4-16.6(f)2 iv.

4. The insurer shall include with the submission of forms which provide benefits that fluctuate with the cost of living (consumer price index) any advertising or promotional material including instructions to its agents. Such material shall make it clear that the benefit is not necessarily protection against increases in the cost of living.

5. In submitting forms where the premium may be paid through credit card facilities, the insurer shall agree that the premium will be considered paid when the credit card facility is billed.

6. Where policies are to be sold through vending machines, the insurer shall agree to the following:
i. That a record will remain in the vending machine; and

ii. That the insurer will canvass the machines after each and every accident and notify all applicable beneficiaries.

(c) Individual health insurance report rules are:

1. A copy of the individual health insurance report required by paragraph (a)2 above will be furnished to each insurer by this department.

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.
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