New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 28 - GROUP COORDINATION OF BENEFITS
Section 11:4-28.9 - Excess and other nonconforming provisions
Universal Citation: NJ Admin Code 11:4-28.9
Current through Register Vol. 56, No. 6, March 18, 2024
(a) A plan with order of benefit determination rules which comply with this subchapter (complying plan) shall coordinate its benefits with a plan that declares itself "excess" or "always secondary" or which uses order of benefit determination rules which are inconsistent with those contained in this subchapter (noncomplying plan) on the following basis:
1. If the complying plan is the primary plan,
it shall pay or provide its benefits on a primary basis;
2. If the complying plan is the secondary
plan, it shall:
i. Attempt to secure the
necessary information from the noncomplying plan to make the determination of
the complying plan's liability as the secondary plan; or
ii. Assume the primary position and pay its
benefits as the primary plan, if the noncomplying plan is unwilling to act as
the primary plan or does not supply the information necessary for the complying
plan to determine its benefits as a secondary plan.
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