New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 6 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS
Section 11:4-6.14 - Specific standards for morbidity for valuation of specified individual contract health insurance benefits
Universal Citation: NJ Admin Code 11:4-6.14
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Minimum morbidity standards for valuation of specified individual contract health insurance benefits are as follows:
1. For
disability income benefits due to accident or sickness use:
i. When calculating contract reserves:
(1) For contracts issued on or after January
1, 1965 and prior to January 1, 2001: The 1964 Commissioners Disability Table
(64 CDT), incorporated herein by reference.
(2) For contracts issued on or after January
1, 2001:
(A) The 1985 Commissioners
Individual Disability Tables A (85CIDA), incorporated herein by reference;
or
(B) The 1985 Commissioners
Individual Disability Tables B (85CIDB), incorporated herein by
reference.
(3) For
contracts issued from January 1, 1999 through December 31, 2000:
(A) Optional use of either the 1964 Table or
the 1985 Tables.
(B) Each insurer
shall elect, with respect to all individual contracts issued in any one
statement year, whether it will use Tables A or Tables B as the minimum
standard. The insurer may, however, elect to use the other tables with respect
to individual contracts issued in any subsequent statement year.
ii. When calculating
claim reserves use:
(1) For claims incurred
on or after January 1, 2002:
(A) The 85CIDA
Tables with claim termination rates multiplied by the following adjustment
factors:
(B) The 85CIDA Table so adjusted for the
computation of claim reserves shall be known as 85CIDC (The 1985 Commissioners
Individual Disability Table C).
(2) For claims incurred prior to January 1,
2002, each insurer may elect which of the following to use as the minimum
standard:
(A) The minimum morbidity standard
in effect for contract reserves on currently issued contracts, as of the date
the claim is incurred; or
(B) The
standard as defined in (a)1ii(1) above applied to all open claims.
(C) Once an insurer elects to calculate
reserves for all open claims on the standard defined in (a)1ii(1) above all
future valuations shall be on that basis.
2. For hospital benefits, surgical
benefits and maternity benefits (scheduled benefits or fixed time period
benefits only):
i. When calculating contract
reserves use:
(1) For contracts issued on or
after January 1, 1955, and before January 1, 1986: The 1956 Intercompany
Hospital Tables and the 1956 Intercompany Surgical Tables, (incorporated herein
by reference).
(2) For contracts
issued on or after January 1, 1986: The 1974 Medical Expense Tables,
(incorporated herein by reference).
ii. When calculating claim reserves use: No
specific standard. See (a)5 below.
3. For cancer expense benefits (scheduled
benefits or fixed time period benefits only):
i. When calculating contract reserves use:
(1) For contracts issued on or after January
1, 2001, and, at the option of the insurer, contracts issued on or after
January 1, 1986: The 1985 NAIC Cancer Claim Cost Tables, (incorporated herein
by reference).
ii. When
calculating claim reserves use: No specific standard. See (f) below.
4. For accidental death benefits:
i. When calculating contract reserves use:
(1) On contracts issued on or after January
1, 1966: The 1959 Accidental Death Benefits Table, (incorporated herein by
reference).
ii. When
calculating claim reserves use the actual amount incurred.
5. For other individual contract benefits.
i. When calculating contract reserves for all
other individual contract benefits, morbidity assumptions are to be determined
as provided in the reserve standards.
ii. When calculating claim reserves for all
benefits other than disability, claim reserves are to be determined as provided
in the standards.
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