Current through Register Vol. 56, No. 24, December 18, 2024
(a) An insurer
may deliver or issue for delivery in this State a form providing life, health
or annuity benefits, and accompanying rates if applicable, without obtaining
prior approval from the Commissioner pursuant to this subchapter provided the
form is set forth in this section as a type eligible for file and use and is
filed with the Commissioner pursuant to the procedures set forth at
N.J.A.C. 11:4-40.1 0, or the form is
specifically exempt from compliance with this subchapter.
(b) The following types of non-variable
individual life insurance forms shall be eligible for file and use pursuant to
this section:
1. Scheduled premium term
policies without cash values, other than universal/flexible-factor forms,
multiple-life forms with survivorship benefits, limited death benefit forms,
policies with re-entry options, single premium forms, field issued forms or
funeral insurance;
2. Accidental
death benefit;
3. Business
exchange/substitute insured;
4.
Cost of living benefit;
5. Option
to purchase additional insurance;
6. Waiver of premium;
7. Spouse and/or child rider; and
8. Applications.
(c) The following types of non-variable
individual annuity forms shall be eligible for file and use pursuant to this
section:
1. Immediate annuities, other than
structured settlement, field issued forms or funeral insurance;
2. Scheduled premium deferred annuities,
other than structured settlement, field issued forms or funeral
insurance;
3. Flexible premium
deferred annuities, other than structured settlement, field issued forms or
funeral insurance;
4. Waiver of
premium; and
5.
Applications.
(d) The
following types of individual health insurance forms shall be eligible for file
and use pursuant to this section:
1. Business
buyout, keyperson and overhead expense disability income policies;
2. Medical expense conversion policies in
which a portion of the premium is chargeable to or subsidized by the group
policy from which conversion is made;
3. Benefit riders for use with the type of
policies set forth at (d)1 and 2 above; and
4. Applications other than those used with
medicare supplement and long-term care policies.
(e) The following types of non-variable group
life insurance forms shall be eligible for file and use pursuant to this
section:
1. Policies and certificate forms
which provide life insurance benefits only, and which do not provide cash
values or loan values other than funeral expense;
2. Retired lives reserve contracts;
3. Benefit riders for use with the type of
policies set forth at (e)1 and 2 above; and
4. Applications and evidence of coverage
forms.
(f) The following
types of group health insurance forms shall be eligible for file and use
pursuant to this section:
1. Policies,
certificates and evidence of coverage which provide only temporary disability
benefits pursuant to
N.J.S.A. 34:15-1 et seq.;
2. Policies and certificates which provide
only disability income benefits for loss due to both accident and sickness and
which are sold exclusively to employer groups;
3. Benefit riders for use with the type of
policies set forth at (f)1 and 2 above; and
4. Applications and evidence of coverage
forms.
(g) In the month
of September or October of each year, the Department shall conduct a hearing
pursuant to P.L. 1995, c.73 for the purpose of determining the specific types
of forms eligible for file and use pursuant to this section.
1. The hearing shall be preceded by a notice
of hearing published in the New Jersey Register at least 30 days prior to the
date of the hearing, which notice shall include information concerning the date
by which, and the person to whom, written public comment may be made. Notice
shall also be provided to persons who have previously requested receipt of such
notice.
2. The notice published in
the New Jersey Register and as otherwise provided pursuant to (g)1 above shall
also request that persons who wish to testify at the hearing provide the
Department with timely notice of this intention, including a brief summary of
the subject matter of their testimony.
3. The notice shall indicate whether the
hearing shall address the merits of maintaining all forms currently on the file
and use eligibility list, or whether the hearing will consider only specific
additions, deletions or clarifications regarding the list.
4. The hearing shall be conducted by a
hearing officer designated by the Commissioner. The length of testimony
permitted at the hearing and the receipt of questions from the floor will be
within the discretion of the hearing officer.
5. A transcript of the hearing shall be made
and a copy thereof shall be made available to any interested person upon
request and payment of the appropriate fee.
6. The record of the hearing shall include
the following:
i. Timely-received written
public comments;
ii. The transcript
of the hearing; and
iii. Any other
information which the hearing officer may deem relevant.
7. The record and transcript of the hearing
shall be public records pursuant to
N.J.S.A. 47:1A-1 et seq. except to the
extent that any information is submitted pursuant to a statute or rule
providing for confidentiality.
8.
Upon review of the file and use eligibility list hearing record, the
Commissioner shall determine within 30 days whether any modifications should be
made by rule to the current list.
9. If the Commissioner determines during the
term of a duly promulgated file and use eligibility list that changed
conditions require a modification of the list, the Commissioner may amend the
list by rule following a hearing conducted pursuant to this
subsection.
