Current through Register Vol. 56, No. 24, December 18, 2024
(a) No carrier
shall deliver or issue for delivery in this State any Medicare supplement
policy or certificate, any written application therefor, or any printed rider
or endorsements to be applied thereto, unless the forms thereof have been
submitted to and filed by the Commissioner.
1. At the expiration of 30 days after
submission, the form shall be deemed filed unless affirmatively disapproved for
filing by the Commissioner prior thereto.
2. If any such form is disapproved for filing
by the Commissioner during the said 30-day period, it may not be delivered or
issued for delivery unless and until such disapproval for filing is withdrawn.
Such disapproval shall be subject to review in accordance with the
Administrative Procedure Act,
N.J.S.A. 52:14B-1 et seq. and the Uniform
Administrative Procedure Rules, N.J.A.C. 1:1.
3. The Commissioner may extend the 30-day
period no more than another 30 days if written notice is provided to the
insurer before the expiration of the initial 30 day period, in which event all
but this paragraph shall apply to the extended period.
4. Forms filed by or deemed filed by the
Commissioner may subsequently be withdrawn from filing. Insurers shall have the
right to a hearing in accordance with the Administrative Procedure Act,
N.J.S.A. 52:14B-1 et seq., and the Uniform
Administrative Procedure Rules, N.J.A.C. 1:1. An insurer may continue to
deliver or issue for delivery such forms until a final decision in accordance
with the withdrawal is rendered, following the request for a hearing, or, if no
hearing is requested, delivery or issuance for delivery of such forms may
continue no later than 30 days following notice of the withdrawal of that
form.
(b) Disapproval
for filing, or withdrawals of approval of the filing of any form, must be
stated in writing with the grounds therefor included in the statement, in
accordance with the rules of this State.
(c) No carrier shall use or revise premium
rates for a Medicare supplement policy or certificate unless the rates, rating
schedule and supporting documentation have been submitted to and filed by the
Commissioner in accordance with the provisions of this subsection, (a) and (b)
above, and N.J.S.A. 11:4-23.1 1. Pursuant to
N.J.S.A. 17:29A-53, and in accordance with
N.J.A.C. 11:1-45, notices of requests for prior approval rate increases shall
be given to individual policyholders, and to group policyholders so as to
enable them to notify certificateholders of the filing of the rate increase
request. As set forth in N.J.S.A. 52:27EE-48, the Public Advocate, Division of
Rate Counsel may intervene in Medicare supplement rate filings which seek a
rate increase in excess of seven percent. Intervention by the Public Advocate,
Division of Rate Counsel shall be in accordance with the procedures set forth
below.
1. Pursuant to N.J.S.A. 52:27EE-48,
any revised rate submissions which implement a rate increase exceeding seven
percent shall be concurrently submitted to the Department of the Public
Advocate, Division of Rate Counsel, at the following address:
Department of the Public Advocate
Division of Rate Counsel
31 Clinton Street
11th Floor
P.O. Box 46005
Newark, NJ 07101
2. The Public Advocate, Division of Rate
Counsel, may intervene in Medicare supplement rate filings seeking increases of
more than seven percent, by filing a Notice of Intervention with the
Commissioner and the filer no later than 30 days after its receipt of the rate
submission. If a Notice of Intervention is filed by the Public Advocate,
Division of Rate Counsel, the Commissioner shall automatically receive an
additional 30 days to review the rate submission, thus creating a total 60-day
period for review of rate increases where the Public Advocate has intervened.
The Public Advocate's Notice of Intervention shall constitute written notice of
this automatic 30-day extension to the filer. The Commissioner may extend the
review period for an additional 30 days upon written notice to the filer and
the Public Advocate before expiration of the 60-day automatic extension period,
pursuant to (a)3 below.
3. The
Public Advocate, Division of Rate Counsel, shall provide the Commissioner and
the filer with its report and recommendations no later than 30 days after its
receipt of the rate increase submission.
4. After the filing of its Notice to
Intervention, the Public Advocate, Division of Rate Counsel, shall have the
authority to participate as an intervenor in any hearings conducted by the
Commissioner pursuant to N.J.S.A. 11:4-23.1 1(f).
(d) The Commissioner shall not file, and
carriers shall not submit for filing, more than one Medicare supplement policy
or certificate form of each type for each standard Medicare supplement benefit
plan, except as the Commissioner may otherwise approve in accordance with (d)2
below.
1. For the purposes of this
subchapter, "type" shall mean an individual policy, and a group policy, and at
such time as a Medicare Select program shall become effective in this State, an
individual Medicare Select policy, and a group Medicare Select
policy.
2. The Commissioner may
approve carriers, individually, to offer up to four additional policy or
certificate forms of the same type for the same standard Medicare supplement
benefit plan. Such forms shall be subject to the filing requirements of this
section. The four additional policy or certificate forms of the same type shall
be limited to one additional form of the same type for:
i. The inclusion of Innovative
Benefits;
ii. The addition of
either a direct response or an agent marketing method;
iii. The addition of either guaranteed issue
or underwritten coverage; and
iv.
The offering of Medicare supplement coverage to persons eligible for Medicare
by reason of disability.
(e) A carrier shall not discontinue offering
any policy or certificate form filed by the Commissioner on or after the
effective date of this subchapter unless such form has been withdrawn from
filing pursuant to (a)4 above, or the carrier provides notice of discontinuance
of offer to the Commissioner at least 30 days prior to such discontinuance, in
writing.
1. Discontinuance subject to notice
to the Commissioner shall include the following:
i. Failure to actively offer for sale a
policy or certificate form for more than 12 consecutive months;
ii. Sale or transfer of Medicare supplement
policies or certificates to another carrier; and
iii. Revisions in the rating structure or
methodology applicable to a Medicare supplement policy or certificate form
which has not been otherwise submitted to and filed by the Commissioner in
accordance with N.J.S.A. 11:4-23.1 1.
2. Carriers shall not submit for filing a new
form for any Medicare supplement plan of the same type for which the carrier
has discontinued issue of a policy or certificate for a period of five years
following the notice of discontinuance to the Commissioner. The Commissioner
may waive some or all of the five year period, in his or her
discretion.
(f) Except
for policies or certificates assumed under an assumption reinsurance agreement,
the experience of all policy or certificate forms of the same type for a
standard Medicare supplement benefit plan shall be combined for purposes of the
refund or credit calculation set forth at
N.J.A.C. 11:4-23.1 1(d).
(g) When outpatient prescription drug
benefits are removed from a Medicare supplement policy or certificate delivered
or issued for delivery in this State as required by the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003, the form used to endorse or
amend the policy or certificate must be submitted to and filed by the
Commissioner in accordance with (a) above.
