New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 18 - INDIVIDUAL HEALTH INSURANCE RATE FILINGS
Section 11:4-18.5 - Loss ratio standards

Universal Citation: NJ Admin Code 11:4-18.5

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

(a) For new forms, the benefits provided are presumed reasonable in relation to the premiums charged if the anticipated loss ratio meets the following standards:

1. For over 65 coverage, the ratio is at least 65 percent;

2. For accident only coverage, the ratio is at least 50 percent;

3. For short term nonrenewable trip policies which do not cover loss due to sickness, the ratio is at least 40 percent;

4. For coverage other than as listed in 1, 2 and 3 above and which are:
i. Collectively renewable insurance, the ratio is at least 60 percent;

ii. Guaranteed renewable insurance or nonrenewable for stated reasons only insurance, the ratio is at least 55 percent;

iii. Noncancellable insurance or noncancellable and guaranteed renewable insurance, the ratio is at least 50 percent.

5. For any insurance not listed in (a)1 through (a)4 above, the ratio is at least 55 percent.

(b) With respect to filings of rate revisions for previously approved policy forms, benefits shall be deemed reasonable in relation to premiums if both the anticipated loss ratio and the aggregate loss ratio satisfy these loss ratio standards.

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