New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 30 - ACCELERATED DEATH BENEFITS
Section 11:4-30.8 - Terms of accelerated death benefit contract provisions

1. Accelerated death benefit provisions shall specify the procedure to be followed to accelerate the payment of death benefits. Insurers are subject to 17B:25-11 with respect to any delay in processing requests to accelerate the payment of death benefits.

2. If the policy lapses due to nonpayment of premium, the owner or insured shall have the right to reinstate the accelerated death benefit provision on the same, or more favorable, terms as contained in the individual policy or group certificate.

3. Accelerated death benefit provisions shall provide that when the conditions for payment are met, including the occurrence of a qualifying event, the payment of all or a portion of the death benefit will be accelerated. The provision may limit the percentage or dollar amount of the benefits whose payment may be accelerated.

4. Accelerated death benefit provisions shall describe the effect of exercise of the option to accelerate payment on the death benefit premiums, expenses and interest charges if applicable, cash values, loan values and coverage on another insured, where applicable.

5. Accelerated death benefit provisions shall be permitted in group life insurance policies and certificates only if the insured has all rights of ownership concerning election and receipt of the accelerated death benefit.

1. Accelerated death benefit provisions may include the right of the insurer to require a second or third medical opinion to confirm benefit eligibility. The second and third medical opinions will be at the insurer's expense. The second medical opinion may include a physical examination by a physician or other medical provider acting within the scope of their licensure designated by the insurer. These provisions may also specify that in the case of conflicting opinions, eligibility for the accelerated death benefit shall be determined by a third medical opinion that is provided by a physician or other medical provider acting within the scope of their licensure that is mutually acceptable to the owner and the insurer.

2. The insurer may include in the accelerated death benefit provision a waiver of premium for the underlying policy upon the occurrence of a qualifying event regardless of whether a waiver of premium provision is contained in the underlying policy.

3. The insurer may deduct an expense charge in determining the accelerated death benefit provided that such expense charge is disclosed in the policy and actuarial memorandum.

4. The insurer may impose a premium charge or a cost of insurance charge for the provision.

5. The insurer may specify any of the following conditions that would have to be met by the policy owner or certificate holder before requesting payment of an accelerated death benefit:

1. Accelerated death benefit provisions that contain exclusions or restrictions as to coverage which are not also exclusions or restrictions in the policy.

2. Accelerated death benefit provisions that require the cause of the terminal condition first manifest itself or be diagnosed after issuance of the policy or the group certificate.

3. Accelerated death benefit provisions that contain a waiting period requirement (except in the case of presumed, as opposed to diagnosed, terminal illness).

4. Accelerated death benefit provisions that require the policy or the group certificate be in force past the incontestable period.

5. Accelerated death benefit provisions that place restrictions on the use of the benefit.

6. Accelerated death benefit provisions that upon exercise of the option to accelerate less than 100 percent of the death benefits require the insured to forfeit the residual coverage.

7. Accelerated death benefit provisions that place an aggregate limit which caps the total accelerated death benefits payable for all policies or certificates issued by the insurer and its subsidiaries and affiliates.