N.J.A.C. 11:2 — INSURANCE GROUP (Subchapter 1 to 43)

This subchapter establishes the procedures, requirements and standards which govern the application of foreign and alien insurers engaged in the business of life and health insurance for a certificate of authority to transact the business of insurance in this State. Notes N.J. Ad…

This subchapter applies to all foreign and alien insurers that apply for a certificate of authority to transact the business of life and health insurance in this State. The filing requirements contained in this subchapter shall not apply to the continuation, renewal or timely rei…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Commissioner" means the Commissioner of the Department of Banking and Insurance of this State. "Committee on Admissions" means the advi…

(a) In order for a foreign or alien insurer to be admitted as a life and health insurer in this State, the requirements in this section shall be satisfied in addition to any other requirements in this subchapter or any other provision of law. 1. The applicant shall satisfy the Co…

(a) Prior to the acceptance of a final application for a certificate of authority in this State, all foreign and alien insurers who desire to transact the business of life and health insurance in this State shall submit, as a preliminary application, a letter of intent, which sha…

(a) After the submission of the letter of intent as required by N.J.A.C. 11:2-1.5, the applicant, upon notice from the Department, shall file the following items: 1. A copy of its charter as currently in force, certified by the lawful custodian of the original document; 2. A copy…

(a) Upon receipt of a final application, the Commissioner shall conduct a thorough background investigation and review which shall include the information contained in N.J.A.C. 11:2-1.4, 1.5 and 1.6, inquiries regarding claims settlement practices and any other information which,…

If any provisions of this subchapter or the application thereof to any person or circumstance is held invalid, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected thereby. Notes N.J. Admin. Code § 11:2-1.8 …

(a) The purpose of this subchapter is to formalize standards to be followed in order to avoid misleading and deceptive advertising in the health insurance business. (b) The proper promotion, sale and expansion of health insurance are in the public interest, and these rules shall …

An advertisement shall not directly or indirectly make unfair or incomplete comparisons of policies or benefits or otherwise falsely disparage competitors, their policies, services or business methods. Notes N.J. Admin. Code § 11:2-11.10

(a) An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits. (b) Such advertisements by direct mail insurers shall indicate that the insurer is licensed in a specif…

(a) The identity of the insurer shall be made clear in all of its advertisements. (b) An advertisement shall not use a trade name, service mark, slogan, symbol or other device which has the capacity and tendency to mislead or deceive as to the true identity of the insurer. Notes …

An advertisement of a particular policy shall not state or imply that prospective policyholders become group or quasi-group members and as such enjoy special rates or underwriting privileges, unless such is the fact. Notes N.J. Admin. Code § 11:2-11.13

An advertisement shall not state or imply that a particular policy or combination of policies is an introductory, initial or special offer and that the applicant will receive advantages by accepting the offer, unless such is the fact. Notes N.J. Admin. Code § 11:2-11.14

§ 11:2-11.15 - Reserved Notes N.J. Admin. Code § 11:2-11.15

An advertisement shall not contain untrue statements with respect to the time within which claims are paid or statements which imply that claim settlements will be liberal or generous beyond the terms of the policy. Notes N.J. Admin. Code § 11:2-11.16

An advertisement shall not contain statements which are untrue in fact or by implication misleading with respect to the insurer's assets, corporate structure, financial standing, age or relative position in the insurance business. Notes N.J. Admin. Code § 11:2-11.17

(a) All advertisements, regardless of by whom written, created or designed, shall be the responsibility of the insurer sponsoring the same. (b) Every insurer shall at all times maintain complete control over the content, form and method of dissemination of all advertisements of i…

Failure to comply with the provisions of this regulation shall constitute a violation of the Insurance Laws of this State and shall subject any individual or company so failing to comply to all the penalties provided by law. Notes N.J. Admin. Code § 11:2-11.19

Advertisements shall be truthful and not misleading in fact or in implication. Words or phrases the meaning of which is clear only by implication or by familiarity with insurance terminology shall not be used. Notes N.J. Admin. Code § 11:2-11.2

This regulation supersedes in its entirety the Regulation which was previously issued by the Insurance Department on February 1, 1956. Notes N.J. Admin. Code § 11:2-11.20

This regulation shall become effective upon the date of publication of its adoption in the New Jersey Register. Notes N.J. Admin. Code § 11:2-11.21

If any provision of clause of this regulation or the application thereof to any person or situation is held invalid, such invalidity shall not affect any other provision or application of the regulation which can be given effect without the invalid provision or application, and t…

(a) Words, phrases or illustrations shall not be used in a manner which misleads or has the capacity and tendency to deceive as to the extent of any policy benefit payable, loss covered or premium payable. (b) An advertisement relating to any policy benefit payable, loss covered …

An advertisement which refers to renewability, cancellability or termination of a policy, or which refers to a policy benefit, or which shows or illustrates time or age in connection with eligibility of applicants or continuation of the policy, shall disclose the provisions relat…

All information required to be disclosed by these rules shall be set out conspicuously and in close conjunction with the statements in which such information relates or under appropriate captions of such prominence that it shall not be minimized, rendered obscure or presented in …

(a) Endorsements used in advertisements shall be genuine, represent the current opinion of the author, be applicable to the policy advertised and be accurately reproduced. The insurer, in using an endorsement, adopts as its own all of the statements contained therein, and the adv…

(a) An advertisement relating to the dollar amounts of claims paid, the number of persons insured, or similar statistical information relating to any insurer or policy shall not be used unless it accurately reflects all of the relevant facts. (b) Such an advertisement shall not i…

An offer in an advertisement of free inspection of policy or offer of a premium refund is not a cure for misleading or deceptive statements contained in such advertisement. Notes N.J. Admin. Code § 11:2-11.8

(a) When a choice of the amount of benefits is referred to, an advertisement shall disclose that the amount of benefits provided depends upon the plan selected and that the premium will vary with the amount of the benefits. (b) When an advertisement refers to various benefits whi…

The purpose of this regulation is to prescribe rules to prevent abuses in connection with the sale of personal property-liability insurance in this State pursuant to mass marketing plans, while preserving for consumers the potential benefits of this form of marketing. Notes N.J. …

Every insurer, agent or broker selling insurance pursuant to a mass marketing plan shall, prior to sale, make full and fair disclosure to prospective employee and member insureds of all features of such plan, whether favorable or unfavorable, including, but not limited to, premiu…

(a) No insurer shall use underwriting standards for individual risk selection in a mass marketing plan which are, on the whole, either less restrictive, unless written with an appropriate charge as contemplated by the insurer's filed rates, or more restrictive than the standards …

(a) The failure of an employer, association, organization or other group to remit premiums when due for any reason (including but not limited to interruption or termination of employment or membership) shall not be regarded as "nonpayment of premium" by any employee or member ins…

An insurer, agent or broker selling insurance pursuant to a mass marketing plan shall, with respect to any employees or members who apply for but are denied insurance under such plan and are not otherwise insured, assist such persons in their efforts to obtain insurance through a…

(a) Any employer, association, or organization domiciled or principally located in New Jersey may be eligible for a mass marketed insurance plan if 25 or more employees or members are enrolled to participate upon inception of the plan. (b) Size of group and number of participant …

If any provision of this regulation or the application thereof to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this regulation, and to this end each Section of this regulation is declared to be severable. Notes N.…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Mass marketing plan" means a method of selling personal property-liability insurance wherein: 1. Such insurance is offered to employees…

This regulation shall be applicable only to insurance policies issued or renewed in this State and is in addition to, and not in substitution for, other applicable requirements of the insurance law and Department regulations. The requirements of this regulation are not applicable…

No insurer shall sell insurance pursuant to a mass marketing plan to members of any association or organization formed principally for the purpose of obtaining such insurance. Notes N.J. Admin. Code § 11:2-12.4

(a) Premiums under a mass market plan shall comply with the filing requirements and with the standards in the insurance law, including the standards that rates not be excessive, inadequate, or unfairly discriminatory. Rates shall not be deemed to be unfairly discriminatory becaus…

An insurer selling insurance pursuant to mass marketing plans shall maintain separate statistics as to loss and expense experience pertinent to each individual plan only if such individual plan provides some rate or coverage advantage not available from the same insurer on a nonp…

No person shall act as an insurance agent or an insurance broker in connection with a mass marketing plan for any kind of insurance unless such person is duly licensed, under N.J.S.A. 17:22A-26 et seq. as an insurance agent or broker for such kind of insurance in such insurance p…

No insurer shall sell insurance pursuant to a mass marketing plan if it is a condition of employment or of membership in an association, organization or other group that any employee or member purchase insurance pursuant to such plan, or if any employee or member shall be subject…

(a) No insurer shall sell insurance pursuant to a mass marketing plan if: 1. The purchase of insurance available under such plan is contingent upon the purchase of any other insurance, product or service; or 2. The purchase or price of any other insurance, product, or service is …

(a) The purpose of this subchapter is to set forth requirements regarding the discontinuance and replacement of all group life, accident and health insurance policies and contracts, group dental plan organization contracts, group dental service corporation contracts and group hea…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Carrier" means a life insurance company or any entity subject to the insurance laws and rules of this State, or subject to the jurisdic…

(a) If a policy or contract provides for automatic discontinuance after a premium or subscription charge has remained unpaid through the grace period allowed for such payment, the carrier shall be liable for valid claims for covered losses incurred and services or supplies provid…

(a) Any written notice of discontinuance provided pursuant to N.J.A.C. 11:2-13.3 by the carrier to the group policy holder or contractholder shall include a statement that, unless otherwise provided in the policy or contract, the carrier shall not be liable for claims for losses …

(a) Every group policy or other contract subject to these rules hereafter issued, or under which the level of benefits is hereafter altered, modified or amended, shall provide a reasonable provision for extension of benefits in the event of total disability which exists as of the…