New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 41 - STANDARDS FOR INDIVIDUAL LIFE INSURANCE POLICY FORMS
Section 11:4-41.3 - General standards
Universal Citation: NJ Admin Code 11:4-41.3
Current through Register Vol. 56, No. 24, December 18, 2024
(a) No individual life insurance policy, rider, application or endorsement shall contain provisions which are unjust, unfair, inequitable, misleading, contrary to law or to the public policy of this State.
(b) The following approval standards shall apply to all individual life insurance forms:
1. All forms shall include a provision for a
period of time during which the policy may be reviewed and subsequently
cancelled by the policyholder free of charge or penalty.
i. This period of free review shall be no
less than 10 days, and shall not exceed one year from the date the policy was
received by the policyholder.
ii.
Policies which provide for a cash value which is equal to the return of all
gross premiums paid shall be considered to contain an extended free review
period or additional review period. The provision which allows for such a
defined cash value is subject to the time limits of (b)1i above.
2. All forms shall include a
provision for a grace period within which overdue premiums may be paid and the
policy shall continue in force.
i. Payment of
the overdue premium shall be effected on the date of mailing of the payment by
the policyholder and may be made at any time during the grace period.
ii. The grace period provision shall not
require receipt of the premium by the insurer within the grace period. The
policyholder shall have the entire period within which to remit payment. The
insurer may rely on the postmark to determine payments.
iii. Premiums due during a grace period may
be subjected to an interest charge not exceeding six percent per annum for the
number of days of grace elapsing before the payment of the premium. Any such
interest charge shall be so stated within the grace period provision.
iv. If a claim arises during a grace period,
any premium due or overdue together with interest owed, if any, may be deducted
from the amount payable under the policy. If such a deduction is to be
effective, the grace period provision shall include a statement to that
effect.
v. For all policies which
remain in force by payment of a required or stipulated premium, the grace
period shall be no less than 30 days.
vi. For account value policies kept in force
by a policy value exceeding zero, the grace period shall be determined by one
of the following two methods:
(1) No less
than 30 days following the date on which the policy value is equal to zero;
or
(2) No less than 60 days
following the first monthly deduction date for which the policy value is
insufficient to provide an entire additional month of insurance.
vii. The grace period provision
shall not allow the grace period to be preempted by a termination of the policy
due to excessive loans, but shall be in addition to any and all protections
provided to the policyholder under the policy loan provisions set forth at (b)7
below.
3. All forms
shall include a provision that the policy shall become incontestable by the
insurer, except for nonpayment of premiums, after the policy has been in force
during the lifetime of the insured for a period of no more than two years from
the date of the policy's issue.
i. The
periods for incontestability and suicide shall commence upon the earliest of
the date of issue, the policy date and any other effective date. As used in
this subchapter, the date of issue or date of the policy's issue shall be
deemed to be the earliest of the date of issue, the policy date and any other
effective date described in the form, except in the case of backdating to save
age where the date of issue or date of policy's issue shall be the date on
which coverage becomes effective.
ii. For modifications increasing the death
benefits of the policy, or reducing the premiums of the policy, the following
limits upon the right to contest apply:
(1)
If the insurer intends to retain a right to contest claims following such
modifications in the policy which are based upon additional evidence of
insurability, the form shall contain a statement to that effect. Otherwise,
such right is deemed waived.
(2) If
the insured is reclassified as a non-smoker at a reduced premium based upon
additional evidence of insurability, the insurer may reserve a right to contest
the policy for no more than an additional two years following the date of
reclassification, but only with regard to the amount of insurance attributable
to the reduction in premium.
(3) If
increased amounts of insurance are purchased subject to additional evidence of
insurability, the insurer may reserve a right to contest the policy for no more
than an additional two years following the date of the purchase of the
increase, but only limited to the actual increase in insurance.
(4) Insurers shall not retain any right of
contest when modifications to the policy occur without additional evidence of
insurability, such as corridor or cost of living increases.
iii. The standards for policies
which provide a re-entry or requalification feature set forth at
N.J.A.C. 11:4-41.1 4 are expressly
incorporated herein.
iv. The
following are standards for any contestability and suicide provisions which
commence following a change of plan or conversion:
(1) If evidence of insurability is not
required for change of plan or conversion and such change or conversion occurs
within two years from the original date of issue, then the insurer may continue
to contest the original application for two years from the original date of
issue (provided that the original application is part of the new
policy).
(2) If evidence of
insurability is required for a change of plan or conversion, contestability
shall be limited only to the evidence given in the application for the new
policy for the two-year period following its issue. If the original application
is made part of the application for the new policy, evidence included in such
original application shall not be contestable after two years from the original
date of issue.
(3) For any change
of plan or conversion not involving an increase in the amount at risk, the
period for death by suicide under the new policy shall begin as of the date of
issue of the original policy. A new two-year period may be imposed on any
increase in the amount at risk.
(4)
The provision describing the change of plan or conversion shall clearly state
whether or not evidence of insurability is required for the change of plan or
conversion, and shall include details of any new contestable or suicide period
following such change of plan or conversion.
v. The following requirements apply to
substitute insured options:
(1) The
substitution may result in a suicide and contestable period applying to the
substitute insured.
(2) The minimum
amount which shall be payable upon a contested claim or death by suicide for a
substitute insured shall be at least equal to the cash value of the original
policy as of the date of substitution plus premiums paid to the date of death,
adjusted for loans, dividends, or partial surrenders.
(3) The option shall disclose whether a new
period for contestability or suicide commences upon substitution, and shall
describe the settlement for a contested claim or death by suicide.
4. All forms shall
include a provision that the policy and any application therefore, if a copy of
the application is attached to or endorsed upon the policy, shall constitute
the entire contract between the parties, and that all statements contained
therein shall, in the absence of fraud, be deemed representations and not
warranties. This provision shall additionally include a statement that any
applications for modifications in the policy, which are to be based upon
additional evidence of insurability, shall be attached to the policy in order
to become part of the contract between the parties, or the insurer shall be
deemed to have waived any right to contest any modification made on the
policy.
5. All forms shall include
a provision for the redetermination of benefits on a policy if the age of the
insured or of any other person whose age is considered in determining the
premium or benefits of the policy has been misstated.
i. For benefits arising from the payment of
required or stipulated premiums, the insurance benefit shall be reduced or
increased to the amount of coverage that would have been purchased by the
premiums paid based on the corrected age.
ii. If the misstatement of age results in an
issue age which is not within the insurer's range of insurance issue ages for
that policy form, the insurer shall extrapolate a premium and benefit. The
provision for misstatement of age shall not state that the policy will be
rescinded and the premiums refunded.
iii. For benefits arising from the account
value on account value policies, the insurer shall provide for adjustment of
benefits by one of the two methods below:
(1)
The insurer may recalculate all policy values since the inception of the policy
to the extent that the recalculation, in and of itself, shall not result in
termination of the policy prior to the date of death. The amount payable at
death on the policy after recalculation shall not be less than the cash value
would have been on the date of death based upon the misstated age. The insurer
shall assume when making an adjustment at the time of surrender, maturity, or
death that the death benefit in all preceding years is the actual death benefit
which would have been paid under the corrected age of the insured had death
occurred in any preceding year.
(2)
The insurer may provide that the adjusted death benefit shall be that amount
which would have been purchased at the correct age in consideration of the most
recent mortality charge, in which instance the insurer shall not make any
retrospective recalculations to the accumulation value or cash surrender value.
The insurer may adjust future months' deductions so as to reflect the corrected
age.
iv. If the insurer
includes a provision for policy adjustments utilizing (b)5iii(1) above, the
insurer shall include in the submission an actuarial memorandum prepared by a
certified actuary with examples of the method for recalculation since
inception.
v. An account value
policy, which stays in force through the payment of required or stipulated
periodic premiums and which provides a guarantee of benefits if these premiums
are paid, shall adjust the guaranteed benefits in accordance with (b)5i and ii
above. Benefits arising from the account value shall be adjusted in accordance
with one of the methods set forth in (b)5iii above.
vi. The policy provision concerning
adjustment due to misstatement of age shall describe how all policy benefits
are redetermined.
6. All
participating policy forms shall contain a provision that beginning on or
before the end of the third policy year, the insurer shall annually ascertain
and apportion the divisible surplus, if any, accruing on the specified dividend
date, which may be the policy anniversary date.
i. At the option of the policyholder,
dividends on all policies shall be:
(1)
Payable in cash; or
(2) Applied to
any of such other dividend options as provided for under the policy.
ii. The policy provision shall
disclose which specific dividend option shall become effective if the
policyholder makes no option election within the election period.
iii. The election period shall be specified
on the policy as no less than 30 days following the date on which the dividend
is due and payable.
iv. Insurers
may use the direct recognition of loans in the calculation of dividends. Such
methodology may be used without disclosure in the form.
7. All forms, other than those for term
insurance in which no policy loan is provided, shall include a provision
setting forth the descriptive loan value of the policy and the terms for any
policy loan, including automatic premium loans, if so permitted under the
policy.
i. The policy loan interest rate
shall be stated in the policy either as a fixed maximum interest rate or as a
variable rate of interest.
ii. If
the interest rate is expressed as a variable interest rate, the policy shall
contain a description of the manner in which the rate is calculated and a
statement that the rate of interest shall not exceed the higher of the
following:
(1) Moody's Corporate Bond Yield
Average, based on the Monthly Average Corporates for the calendar month ending
two months before the date on which the rate is determined; or
(2) The rate used to compute the cash
surrender values under the policy during the loan period plus one percent per
annum.
iii. The
provision shall include a statement setting forth the frequency at which the
interest rate will be redetermined.
(1) The
frequency shall be no less than once every 12 months, but no greater than once
every three months.
(2) If the rate
is redetermined more frequently than annually, or annually on other than a
policy year basis, the policy form shall include a statement that the policy
shall not terminate in any policy year solely as a result of a change in the
interest rate during that year.
iv. The provision shall reserve to the
insurer the right to defer the granting of a loan, other than for the payment
of premium to the insurer, for six months after submission of a policy loan
application.
v. If the policy
provides for automatic premium loans, the form shall include a statement as to
whether the automatic premium loan is subject to policyholder election.
(1) The form shall be clear in describing the
premium mode to be loaned automatically and shall state what shall occur if the
loan value available is insufficient for the designated premium mode.
(2) Automatic premium loans based on a
day-to-day calculation shall be calculated in accordance with correct actuarial
principles so that the first approximation shall allow for the proportionate
increase in cash value due to the crediting of a partial premium.
(3) Any submission of a form providing for
day-to-day coverage under an automatic premium loan shall contain a numerical
demonstration that the method of calculating such coverage is actuarially
sound.
vi. Where
termination may occur due to excessive debt, the form shall state that the
policyholder will be provided with a notice of termination no later than 30
days prior to the date of termination. This notice shall be in addition to the
grace period provided under the policy when the policy value becomes zero due
to excessive indebtedness in accordance with (b)2 above. Termination due to
excessive indebtedness shall not preempt such a grace period.
vii. If the interest rate is expressed as a
variable interest rate, the insurer shall:
(1) Notify the policyholder in writing of the
initial rate of interest at the time of a cash loan or as soon thereafter as
practicable, but in no event later than 30 days following the loan.
(2) Notify the policyholder in writing of the
initial rate of interest on the initial automatic premium loan as soon as
practicable, but no later than 30 days following the loan.
(3) Notify the policyholder in writing at
least 10 days prior to the effective date of any increase in the interest
rate.
8. All
forms which require or allow a specified premium to be paid at specified
intervals in order for the policy to remain in force shall include a provision
for reinstatement of the policy upon written application therefor at any time
within three years from the due date of the first premium in default.
i. The provision may exclude reinstatement
if:
(1) The policy has been surrendered for
its cash surrender value;
(2) The
policy was not surrendered, but its cash surrender value has been exhausted;
or
(3) The paid-up term insurance,
if any, has expired.
ii.
Any requirement by the insurer for new evidence of insurability shall be stated
clearly in the reinstatement provision.
iii. The provision shall state the amount to
be paid to reinstate the policy, and shall include references to the following,
as applicable:
(1) Payment of premiums in
arrears;
(2) Payment (or
reinstatement) of any loans;
(3)
Interest at a specified rate on (b)8iii(1) and (2) above.
iv. If the policy has a variable policy loan
interest rate, then the reinstatement provision shall describe the loan
interest rate which will be applied to any loans reinstated or paid upon
reinstatement of the policy.
v. An
account value policy which stays in force as long as the policy value is
positive may include a reinstatement provision, which shall comply with (b)8ii
and iv above, in addition to the following:
(1) Reinstatement shall be offered for a
period of three years from the date of default.
(2) The form shall clearly describe the
amount necessary to reinstate. The company may require that monthly deductions
be paid in advance for a specified number of future months, and that the
monthly deduction for any grace period be paid. Monthly deductions cannot be
charged for the period of default beyond the grace period.
(3) The form shall state whether minimum
premium guarantees, if any, will be reinstated or may otherwise be reinstated
subject to payment or prepayment of additional premiums.
(4) If the policy imposes surrender charges
on the account value, the reinstatement provision shall state whether and in
what manner surrender charges will be imposed on the reinstated policy.
Otherwise, no surrender charges shall be applicable with respect to the
reinstatement policy.
9. All forms shall include a provision which
sets forth the premiums payable at all durations in order to maintain the
policy in force.
i. Forms shall not include
any provision which permits the insurer to arbitrarily refuse premium
payments.
ii. Forms shall include
any upper and/or lower dollar limits on premium payments, which the insurer may
waive in a uniform and non-discriminatory manner upon written notice of any new
limits to the owner. The form shall describe the initial limits and the
required written notice of any new limits.
iii. The maximum premium payment for a
flexible premium life insurance policy shall not be lower than the amount which
will continue to qualify the policy as life insurance or the amount necessary
to keep the policy in force, if greater.
iv. Payment of premiums may be made by credit
card. Submissions of forms which permit payment by credit card shall include a
certification from an officer of the insurer that the premium will be
considered paid when the credit card facility is billed.
v. If, in order to prevent lapse of a policy,
a premium is paid automatically by charging against the policy's loan value,
the insurer shall provide written notice to the policyholder. Said notice shall
include the amount of the loan and the interest rate, and shall be mailed no
later than 30 days after the end of the grace period of the premium paid by
loan.
vi. The following
requirements apply to policies with a vanishing premium option:
(1) The option shall be presented as one of
the non-forfeiture options available on non-payment of premium. The option
shall not be automatic. If this option is not elected by the owner, one of the
traditional non-forfeiture options shall be provided.
(2) The reinstatement provision shall clearly
apply to policies in force under the vanishing premium option.
(3) While this provision is in effect, the
policy shall limit additional premium payments to the amount necessary to
restore the account value to an amount sufficient to provide paid-up life
insurance on a current assumption basis.
(4) If no additional premiums are made and
the account value no longer provides continued coverage on a current basis, the
coverage shall be deemed extended term.
(5) The period of extended term coverage on a
guaranteed basis shall not be less than would be obtained by applying the cash
surrender value as a net single premium under a traditional extended term
option.
vii. The
following requirements apply to policies with an option to suspend premiums:
(1) An option to suspend premiums shall be
presented as a premium option exercised to maintain the policy in force on a
premium-paying basis.
(2) Premiums
shall be paid only from the excess of the actual cash value over the guaranteed
cash value. Premiums shall not be paid from the guaranteed cash value. The
prospective guaranteed cash value shall be maintained since the policy is being
maintained on a premium paying basis.
(3) When an additional premium is due in
order to keep the policy in force on a premium paying basis, the insurer shall
mail a notice to the policyholder no sooner than 30 days before the premium due
date. A grace period of 60 days from the mailing date of the notice shall be
provided for payment of the premium. The additional premium due cannot exceed
the guaranteed premium for the policy. The premium mode, for purposes of
premium due date and amount of premium, shall be that selected by the
policyholder.
(4) If the additional
premium to keep the policy in force on a premium-paying basis is not paid
within the grace period, the usual non-forfeiture provision shall apply unless
automatic premium loan has been included to protect against lapse. These
provisions shall include rights to reinstatement required by law for lapsed
policies.
(5) Additional premiums
shall not be permitted after the policy has lapsed and entered into a
non-forfeiture mode.
viii. Account value policies kept in force by
a policy value exceeding zero shall be permitted to contain a minimum guarantee
provision. Account value policies which use the account value less surrender
charge to determine lapse shall also be permitted to contain a minimum premium
test provision. The following requirements shall apply to minimum guarantee
provisions and minimum premium test provisions:
(1) Minimum guarantee provisions shall
indicate that, on a guaranteed basis, the policy value at the end of the
guarantee period may be insufficient to keep the policy in force unless an
additional payment is made at that time. A similar provision, if applicable, is
required for policies with minimum premium tests. This requirement shall not be
applicable to minimum guarantee premiums or test premiums if the policy value
at the end of the guarantee period (assuming payment of the minimum guarantee
or test premiums and guaranteed credits and charges) is sufficient to prevent
lapse. This will typically be the case for minimum premium tests if the
surrender charges are zero by the end of the guarantee period.
(2) Any policy to which (b)9viii(1) above
applies shall indicate, one the same page as a minimum guarantee premium or
minimum test premium, the maximum amount (based on policy guarantees) required
to be paid at the end of the guarantee period to keep the policy in force
assuming continuation of the initial death benefit, payment of minimum
guarantee premiums, and no policy loans or partial withdrawals. This
requirement applies only to those policies to which requirement (b)9viii(1)
above applies.
(3) The minimum
premiums shall be measured cumulatively rather than payable on a periodic
basis. The minimum premium test shall not be made periodically, but shall only
be made at the time of lapse. However, the required cumulative minimum premiums
and cumulative premiums paid may be adjusted with interest at the guaranteed
crediting rate.
(4) The policy
shall provide for a grace period with respect to payment of minimum premium
consistent with
N.J.S.A. 17B:25-3. (For example, the 61
day grace period usually found in flexible premium universal life policies
should allow the minimum premiums to be paid to keep the contract in force as
an alternative to the monthly deduction or other amount specified.)
(5) If the minimum premium guarantee allows a
policy to remain in force with a negative account value, then no interest may
be "credited" to that account value (resulting in an interest charge), and the
cost of insurance charge cannot increase the net amount at risk to reflect the
negative account value.
(6) The
grace period for the policy shall be coordinated with the grace period provided
for the minimum premium. The amount required to avoid lapse shall be the amount
required to fund the minimum premium or the amount required to pay any balance
due for the cost of insurance, whichever is less. This required amount is the
amount to be deducted from any death claim during the grace period.
10. All forms shall
contain a provision describing the settlement of a claim which becomes payable
by reason of the death of the insured.
i. In
addition to due proof of death, the insurer may require surrender of the policy
or proof of the interest of the claimant, or both, and shall state in the
claims payment provision if such document or information is required. If the
insurer requires a claim form to initiate a claim, the provision shall so
state.
ii. The insurer shall
specify in the claims payment provision that settlement shall be made within 60
days after receipt of the document or information requested in (b)10i
above.
11. All forms
shall include a title appearing on the face page of the policy which shall
briefly describe the policy, shall not be misleading and shall state if the
form is participating or nonparticipating or words of similar
meaning.
12. All forms may contain
a provision addressing contestability and liability limitations of the policy
following reinstatement. If the form does not contain such a provision, the
policy shall be incontestable from the date of reinstatement, and limitations
on liability shall be waived.
i. The
provision for contestability of the reinstated policy shall be no less
favorable than the provision for contestability of the policy following
original issue.
ii. The provision
may restrict liability of the insurer on a reinstated policy which is effective
from the date of reinstatement, but which restricts or excludes liability only
to the extent that such liability is excluded or restricted on the policy as
originally issued.
13.
The form may contain language that permits the insurer unilaterally to amend or
modify the form to satisfy any applicable law. However, the owner shall be
permitted to refuse any such change unless noncompliance would cause the
contract to be null and void or fail to comply with New Jersey or Federal
Law.
14. The form shall be amended
or endorsed to reflect any changes or modifications made to the form subsequent
to issue.
Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.