New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 23A - MEDICARE SUPPLEMENT-UNDER 50 COVERAGE
Section 11:4-23A.5 - Plan of operation

1. The internal organization and proceedings of the governing board;

2. Procedures to select, appoint, terminate and compensate a contracting carrier to service the Under 50 Plan coverage;

3. Procedures in accordance with section 4 of P.L. 1995, c.229 for the equitable sharing of any losses incurred by the Under 50 Plan;

4. Procedures for handling complaints and appeals to the governing board;

5. Procedures for individuals to apply for coverage;

6. Procedures for cancellation or nonrenewal of coverage, including refunds of unearned premium;

7. Procedures for the collection, investment and disbursement of funds; and

8. Such other provisions as are deemed necessary by the governing board for the proper operation of the Under 50 Plan.

1. If the Commissioner disapproves all or part of the plan of operation or an amendment, the Commissioner shall return same to the governing board with a statement that sets forth the reasons for disapproval and may include other recommendations the Commissioner may wish to make.

2. If the governing board does not submit a plan of operation within the time provided by these rules, or a new plan of operation which is acceptable to the Commissioner within 30 days after the disapproval of a proposed plan, the Commissioner may promulgate a temporary plan of operation and certify same to the governing board, which shall remain in effect until such time as the Commissioner approves and certifies to the governing board a permanent plan of operation proposed by the governing board.

3. The governing board shall review the plan of operation at least annually and may propose amendments to the plan of operation for review and approval by the Commissioner. The Commissioner may review the plan of operation at any time and may recommend amendments to the governing board.