Current through Register Vol. 56, No. 18, September 16, 2024
(a) By
September 5, 2004, a self-funded MEWA operating in this State prior to June 7,
2004, shall file an application for initial registration with the Commissioner.
A self-funded MEWA that was not operating in this State prior to June 7, 2004,
shall not commence operations in this State until it submits an application for
initial registration to the Commissioner, and said application is approved. The
application for registration shall be on a form prescribed by the Commissioner
available on the Department's website at
http://www.state.nj.us/dobi/division_insurance/mewaapps.htm,
and shall include the following:
1. A
certification of an officer, director or trustee of the self-funded MEWA that
states:
i. The name of the self-funded MEWA,
which shall not include the terms "insurance," "mutual," "casualty," "surety,"
"indemnity," "HMO," "assurance" or any other name likely to mislead;
ii. The names and addresses of the employers
who are members of the self-funded MEWA;
iii. The names and addresses of the trustees
or other persons responsible for the operations of the self-funded
MEWA;
iv. The mailing address and
telephone number at which communications to the self-funded MEWA are to be
received;
v. The eligibility
requirements for membership in the association, if any, to which the
self-funded MEWA provides a health benefit plan or plans; and
vi. The fees, if any, charged for membership
in the association, if any, to which the self-funded MEWA provides a health
benefit plan or plans;
2. A completed Checklist and Certification
with information regarding administration, underwriting requirements, and
coverage services that assists the Department in verifying compliance with
N.J.S.A.
17B:27A-48can be found on the Department's
website at:
www.state.nj.us/dobi/division_insurance/lifehealthmain.html;
3. A specimen form of the notice to
be provided to employers and employees pursuant to N.J.S.A.
17B:27C-7e;
4. A copy of the trust
agreement or other organizational documents relating to the self-funded MEWA,
including the agreement to establish a separate trust account for the health
benefits plans;
5. A copy of any
documents executed by an employer to become a member of the association, if
any, to which the self-funded MEWA provides a health benefit plan or plans;
and/or obtain coverage from the self-funded MEWA, including the application for
membership in the self-funded MEWA;
6. A description of the eligible employers
that constitute the association, if any, to which the self-funded MEWA provides
a health benefit plan or plans, including their common or similar type of trade
or business; the common trade association, professional association or other
associations;
7. Biographical
affidavits, on a form prescribed by the Commissioner, for all trustees and
other persons responsible for the operations of the self-funded MEWA;
8. The names and addresses of all
administrators and servicing organizations responsible for the operations of
the self-funded MEWA with respect to its health benefits plans;
9. The most recent audited financial
statement of the self-funded MEWA;
10. Three-year financial projections for the
separate trust account to be established pursuant to
11:4-56.8(a);
11. If applicable, an actuarial opinion,
prepared by a qualified actuary, that the reserves for health benefits are
adequate;
12. If applicable, a
calculation of the regulatory action level RBC;
13. A demonstration that the applicant will
be able to provide the deposit required by N.J.S.A. 17B:27C-5a;
14. A demonstration, such as a binder, that
the applicant will obtain "stop-loss" coverage as defined at
17B:27A-17 or
11:4-40.2, as applicable, as
required by N.J.S.A. 17B:27C-5b and this subchapter at
11:4-56.8(g); and
an actuarial certification with supporting documentation that the retention
level for stop-loss coverage is based on sound actuarial principles;
and
15. Any other information from
a particular applicant deemed necessary by the Commissioner to determine
compliance with the requirements of
17B:27C-1 et seq. and this
subchapter.
(b) Filings
described in (a) above shall be submitted to:
Att: Self-funded MEWA Registration
NJ Department of Banking and Insurance
20 West State Street
PO Box 325
Trenton, NJ 08625-0325
(c) The Commissioner shall review an
application for registration and notify the applicant in writing of any
deficiencies contained therein within 60 days of receipt. An applicant shall
address any deficiencies in its application within 60 days of notice thereof.
Upon written request from the applicant and for good cause shown, the
Commissioner may extend this 60-day time frame to correct any deficiencies in
an application an additional 60 days. The Department shall notify the applicant
in writing of its response to any such request.
(d) Upon receipt and review of a complete
application, the Commissioner shall approve the application if he or she finds
that the MEWA meets the following standards:
1. All of the required application materials
described in (a) above have been filed;
2. The persons responsible for conducting the
MEWA's affairs are competent, trustworthy, possess good reputations and have
appropriate experience, training and education;
3. The applicant has demonstrated that all
the requirements of
17B:27C-1 et seq. and this
subchapter have been met, including compliance with all applicable small
employer health benefits laws and financial requirements. In the case of (e)
below, the applicant has demonstrated that it will comply with these
requirements; and
4. The
Commissioner is satisfied that the plan of operation of the separate trust
account is sound, supports the continuing operations of the MEWA, and complies
with N.J.S.A. 17B:17C-1 et seq. and this subchapter on an ongoing
basis.
(e) Within 15
days of notification to the applicant by the Commissioner that the application
has been approved, and prior to the issuance of the registration, the applicant
shall:
1. Deposit with the Commissioner
securities, as defined at and pursuant to the provisions of
17B:18-37 and N.J.A.C. 11:2-32,
having a market value of $ 200,000 as required by
17B:27C-5;
2. Provide a signed copy of the stop-loss or
reinsurance agreement; and
3.
Provide evidence that the separate trust account for the health benefit plans
has been established.
(f) Upon receipt of the materials listed in
(e) above, the Commissioner shall issue an initial registration to the
applicant.
