Current through Register Vol. 56, No. 6, March
18, 2024
(a) An insurer
or HMO seeking relief from any assessment imposed pursuant to section 4 of P.L.
1995, c.229 shall submit to the Department a request for such relief no later
than 15 days prior to the due date of payment of the assessment.
(b) Each request shall be in loose leaf form
inserted into two-ring or three-ring binders tabbed or otherwise indexed to
correspond to the exhibits set forth in (f) below. The loose leaf sheets used
in the request shall be eight and one-half inches wide and 11 inches long and
punched for two-ring or three-ring binders, as appropriate.
(c) All insurers and HMOs requesting relief
pursuant to this rule shall submit five copies of each request in the format
set forth in (b) above.
(d) If a
request fails to materially comply with the filing format and information
requirements set forth in this section, the Department shall notify the insurer
or HMO that its request for relief is deficient and is denied on such grounds.
The notice shall also set forth any information or other action required to
cure the deficiency. The insurer or HMO shall submit the additional information
or otherwise submit a filing in accordance with the format requirements
specified in this rule within 15 days of receipt of the Department's notice of
deficiency. Failure to submit within 15 days the information necessary in the
proper format to cure the deficiency shall result in the request being
denied.
(e) All requests for relief
or other information required pursuant to this section shall be filed with the
Department at the following address:
Under 50 Plan--Request for Relief
New Jersey Department of Banking and Insurance
Division of Solvency Regulation
20 West State Street
PO Box 325
Trenton, New Jersey 08625
(f) When requesting relief from assessments
imposed pursuant to section 4 of P.L. 1995, c.229, an insurer or HMO shall
provide with its request the following information in a clear, concise and
complete manner:
1. A cover letter stating:
i. The name of the applicant;
ii. The form of relief and, if a deferral of
less than the full amount, the specific amount/percentage of relief which the
applicant is requesting;
iii. A
statement of facts relied upon as the basis under which relief is sought,
including the specific reasons for which the Commissioner may find that the
applicant is or would be placed in a financially impaired position;
and
iv. The name, title, telephone
number and telefax number of a contact person familiar with the filing to whom
the Department may direct additional questions;
2. A detailed explanation, with supporting
documentation, of the projected effect that fulfillment of the obligation would
have on the immediate and long term financial condition of the applicant unless
relief is granted as requested;
3.
The most recent financial examination report, whether conducted by the
applicant's state of domicile or another state;
4. A statement addressing whether the
applicant is planning to modify its method of doing business in any way
including, but not limited to, new acquisitions or new restructuring;
5. If the applicant is a member of a holding
company system, the following shall be provided:
i. A list of all members of the holding
company system;
ii. A list of all
intercompany transactions for the period beginning January 1 in the year of the
filing to the date of the quarterly statement immediately preceding the date of
filing, in the format set forth in the statutory annual statement filed by the
applicant; and
iii. A copy of the
applicant's organizational chart;
6. An actuarial opinion attesting to the
adequacy of reserves specifically for all accident and health lines of
business, and for all lines of business which the applicant transacts, in the
format of and satisfying all requirements for the actuarial opinion and
memorandum required to be submitted as a part of the annual statement filed by
the applicant;
i. If the applicant is an HMO,
the applicant shall obtain and file an actuarial opinion which complies with
the requirements set forth in (f)6 above;
7. A report signed by the attesting actuary
referred to in (f)6 above, which includes, in summary form if necessary, all
data utilized, a complete explanation of methods and assumptions and sufficient
additional narrative to account for any features of the data or circumstances
necessary for proper interpretation;
8. A copy of the annual statement of the
applicant, including all accompanying exhibits, filed with this State
immediately preceding the date of the relief filing;
9. Copies of all quarterly statements for the
period beginning January 1 in the year of the filing to the quarterly statement
immediately preceding the date of the filing;
10. A description of any relief from
obligations imposed by this State or any other state granted or in effect
within the preceding 12 months, and the basis upon which such relief was
granted; and
11. Any other
information the Commissioner may deem relevant to the consideration of the
request.
(g) All data or
information contained in the request for relief filed pursuant to this section
shall be confidential and not be subject to public disclosure or copying
pursuant to the "Right to Know" law,
47:1A-1 et seq., except for the
following, but only upon written, specified request and following 10 days'
written notice by the Department to the applicant:
1.
11:4-23A.1 2(f)1i and ii--cover
letter with name of applicant and describing relief sought;
2.
11:4-23A.1 2(f)1iv--name, title,
telephone number and telefax number of person familiar with the
filing;
3.
11:4-23A.1 2(f)3--most recent
financial examination information report;
4.
11:4-23A.1 2(f)5i and ii--list of
members of holding company system and intercompany transactions for period
preceding date of filing;
5.
11:4-23A.1 2(f)8--annual statement
filed immediately preceding date of filing; and
6.
11:4-23A.1 2(f)11--additional
information required by the Commissioner to evaluate a particular
filing.
(h) When the
Commissioner determines pursuant to section 4 of P.L. 1995, c.229, that the
applicant is or would be placed in a financially impaired condition through
imposition of an assessment obligation, the Commissioner shall notify the
applicant that its duty to fulfill the applicable obligation shall be waived,
or deferred in whole or in part, as appropriate.
(i) The Commissioner shall find that an
applicant is or would be financially impaired if:
1. The applicant has been placed in
rehabilitation or conservation pursuant to
17B:32-31 et seq., or such
similar law of the applicant's state of domicile;
2. The Commissioner finds that the applicant
is in hazardous financial condition, as determined pursuant to N.J.A.C.
11:2-27; or
3. The Commissioner
finds that fulfillment of the obligation from which relief is sought would
place the applicant in a hazardous financial condition, as determined pursuant
to N.J.A.C. 11:2-27.
(j)
If the Commissioner denies an applicant's request for relief made pursuant to
this section, or if the applicant objects to the terms of the relief granted,
the applicant may request a hearing on the Commissioner's determination within
seven days from the date of receipt of such decision as follows:
1. A request for a hearing shall be in
writing and shall include:
i. The name,
address, and daytime telephone number of a contact person familiar with the
matter;
ii. A copy of the
Commissioner's determination;
iii.
A statement requesting a hearing; and
iv. A concise statement describing the basis
for which the applicant believes that the Commissioner's findings of fact are
erroneous.
2. The
Commissioner may, after receipt of a properly completed request for a hearing,
provide for an informal conference between the applicant and such personnel of
the Department as the Commissioner may direct, to determine whether there are
material issues of fact in dispute.
3. The Commissioner shall, within 30 days of
a properly completed request for a hearing, determine whether the matter
constitutes a contested case, pursuant to the Administrative Procedure Act,
52:14B-1 et seq.
i. If the Commissioner finds that the matter
constitutes a contested case, the Commissioner shall transmit the matter to the
Office of Administrative Law for a hearing consistent with the Uniform
Administrative Procedure Rules, N.J.A.C. 1:1.
ii. In a matter which has been determined to
be a contested case, if the Commissioner finds that there are no good-faith
disputed issues of material facts and the matter may be decided on the
documents filed, the Commissioner may notify the applicant in writing as to the
final disposition of the matter.
