N.J.A.C. 11:4 — ACTUARIAL SERVICES (Subchapter 1 to 62)

(a) All forms, rates, loss ratio reporting and advertisements submitted for filing with or by the Commissioner shall be submitted to the Office of Life and Health Actuarial Services, New Jersey Department of Insurance, PO Box 470, Trenton, New Jersey 08625-0470. (b) Annual report…

Failure to comply with the terms of this subchapter may result in the assessment of any and all penalties available in accordance with the laws of this State. Notes N.J. Admin. Code § 11:4-23.22 Recodified from N.J.A.C. 11:4-23.21 by R.1999 d.38, effective 12/28/1998 (to expire F…

If any provision of this subchapter or the application thereof to any person or circumstance is held to be invalid for any reason, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected thereby. Notes N.J. Adm…

(a) For all policies with policy years beginning on or after May 21, 2009, the following provisions concerning the use of genetic information and requests for genetic testing shall apply: 1. An issuer of a Medicare supplement policy or certificate shall not deny or condition the …

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. "Aggregate loss ratio" means the ratio of the accumulated value of past benefits (from the original effective date of the form to the dat…

(a) No policy or certificate may be advertised, solicited or issued for delivery in this State as a Medicare supplement policy or certificate unless such policy or certificate contains definitions or terms which conform to the requirements of this section. 1. "Accident," "acciden…

(a) No policy or certificate shall be advertised, solicited, delivered or issued for delivery in this State as a Medicare supplement policy if the policy or certificate contains limitations or exclusions that are more restrictive than those of Medicare, except with respect to pre…

(a) No policy or certificate shall be advertised, solicited, or issued for delivery in this State as a Medicare supplement policy if it does not meet the minimum standards contained in this section. (b) The following general standards apply to Medicare supplement policies and cer…

(a) All policies delivered or issued for delivery in this State prior to January 4, 1993, and all certificates delivered or issued for delivery in this State on or after July 15, 1991 but prior to January 4, 1993 as a Medicare supplement policy or certificate, shall meet the mini…

(a) No policy or certificate shall be advertised, solicited, delivered or issued for delivery in this State as a Medicare supplement policy on or after January 4, 1993 and with an effective date for coverage prior to June 1, 2010 unless it complies with the standards of N.J.A.C. …

(a) No policy or certificate shall be advertised, solicited, delivered or issued for delivery in this State as a Medicare supplement policy or certificate with an effective date for coverage on or after June 1, 2010 unless it complies with the standards of N.J.A.C. 11:4-23.6 and …

(a) Carriers shall not deny or condition the effectiveness or issuance, nor discriminate in the pricing, of Medicare supplement policies or certificates based on the health status, claims experience, receipt of health care by, or medical condition of an applicant if the applicati…

(a) The purpose of this subchapter is to establish a mechanism to provide Plan C coverage of the standardized Medicare supplement plans to persons under 50 years of age residing in this State who are enrolled in Medicare due to disability, or due to end stage renal disease. (b) E…

(a) Every insurer and HMO providing health benefits plans or health maintenance organization subscriber contracts in this State shall be liable for an assessment to pay its equitable share of any net loss incurred by the Under 50 Plan in the previous calendar year, unless the ins…

(a) Any person may petition for appeal to the Commissioner from an adverse decision of the governing board by filing a request in writing within 20 days of the date of receipt of the written decision of the governing board. 1. The written request to appeal shall set forth the fac…

(a) An insurer or HMO seeking relief from any assessment imposed pursuant to section 4 of P.L. 1995, c.229 shall submit to the Department a request for such relief no later than 15 days prior to the due date of payment of the assessment. (b) Each request shall be in loose leaf fo…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Applicant" means an individual who, at the time of application to the Under 50 Plan, has not attained the age of 50 years. In the event t…

(a) There is created in the State of New Jersey a plan to provide Medicare Supplement Plan C coverage of the standardized Medicare supplement plans to New Jersey residents under 50 years of age who are enrolled in Medicare due to disability or due to end stage renal disease to be…

(a) The Under 50 Plan shall be administered by a governing board composed of eight directors, one of whom shall be the Commissioner or the Commissioner's designee, one of whom shall be the contracting carrier upon its selection and appointment by the governing board, and six of w…

(a) The plan of operation shall provide for the fair, reasonable and equitable administration of the Under 50 Plan and shall include: 1. The internal organization and proceedings of the governing board; 2. Procedures to select, appoint, terminate and compensate a contracting carr…

(a) The Under 50 Plan shall not deny or condition the issuance or renewal, nor discriminate in the pricing of coverage because of the health status, claims experience, receipt of health care or medical condition of an applicant if the application for coverage is submitted under t…

The rates for Under 50 Plan coverage shall be no greater than the lowest rate charged by the contracting carrier for Medicare Supplement Plan C policies or contracts issued by the contracting carrier to persons 65 years of age or older. Notes N.J. Admin. Code § 11:4-23A.7

(a) By March 1, 1996 and following the close of each calendar year thereafter, on a date set by the Commissioner:1. Every insurer and HMO in this State shall file with the Commissioner its net earned premium in the preceding calendar year; 2. The contracting carrier shall file wi…

(a) Net losses of the Under 50 Plan shall be apportioned among insurers and HMOs as set forth in the plan of operation of the Under 50 Plan. (b) Assessments for net losses of the Under 50 Plan may be determined or apportioned, and may include calculations based upon the informati…

(a) Every insurer issuing or renewing standardized Medicare supplement insurance policies or contracts in this State shall offer, at a minimum, Medicare Supplement Plan C policies or contracts to New Jersey residents 50 years of age or older who are enrolled in Medicare due to di…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Applicant" means an individual who, at the time of application to an insurer, has attained the age of 50 years but not attained the age o…

(a) No insurer shall deny or condition the issuance or renewal, or discriminate in the pricing of Medicare supplement policies or contracts available pursuant to section 2 of P.L. 1995, c.229 because of the health status, claims experience, receipt of health care or medical condi…

Rates for Medicare supplement insurance policies or contracts issued pursuant to section 2 of P.L. 1995, c.229 shall be no greater than the lowest rate charged by the insurer for the same type of policies or contracts issued to persons 65 years of age or older and shall be calcul…

The purpose of this subchapter is to authorize the use of mortality tables adopted after September 11, 1981 by the National Association of Insurance Commissioners in determining minimum nonforfeiture standards and minimum valuation standards. Notes N.J. Admin. Code § 11:4-24.1…

The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise. "1980 CSO Table" means that mortality table, consisting of separate rates of mortality for male and female lives, prescribed by N.J.S.A. 17B:19…

(a) In determining minimum cash surrender values, minimum amounts and minimum periods of nonforfeiture benefits for any policy of insurance delivered or issued for delivery in this State after the operative date of N.J.S.A. 17B:25-19h(xi) for that policy form and before January 1…

(a) Because the smoker and nonsmoker mortality tables do not extend below age 15, the Department shall permit the following uses of the composite and smoker and nonsmoker mortality tables for juvenile insureds, as hereafter provided: 1. Insurers may use the composite mortality ta…

If any provision of this subchapter or the application thereof to any person or circumstances is for any reason held to be 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. Ad…

(a) The purpose of this subchapter is to establish rules for the filing and review of funeral insurance policies pursuant to N.J.S.A. 17B:17-5.1. (b) This subchapter shall apply to all life insurance policy or annuity contract forms delivered or issued for delivery, marketed, use…

The following words and terms, where used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. "Funeral insurance policy" means any insurance policy or annuity contract (other than "credit life insurance" as defined at N.J.S.A. 45:…

(a) No insurer shall deliver or issue for delivery any funeral insurance policy in this State that has not been filed pursuant to law on or after December 21, 1993, or as otherwise permitted under this subchapter. (b) The requirements of this subchapter apply to all previously fi…

(a) The submission for the filing of any funeral insurance policy shall be accompanied by a copy of the prepaid funeral agreement to which the policy is related. The prepaid funeral agreement shall provide that: 1. Cancellation of the funeral arrangements will not cancel or other…

(a) A funeral insurance policy shall be identified in the policy form as a life insurance policy or annuity contract. (b) Funeral insurance policies identified as life insurance shall provide, at a minimum, the following benefits in relation to premiums: 1. The guaranteed death b…

If any provision of this subchapter, or its application to any person or circumstances, is held invalid, the remainder of this subchapter and its application to other persons or circumstances shall not be affected. Notes N.J. Admin. Code § 11:4-25.6

If after notice and an opportunity for hearing, the Commissioner of Insurance finds that a person has violated this regulation or the enabling legislation, a penalty, in addition to any other penalty, not exceeding $ 2,000 for each violation, may be imposed and shall be collected…

The purpose of this subchapter is to recognize the following mortality tables: the 1983 Table "a", the 1983 GAM Table, the Annuity 2000 Mortality Table, the 2012 IAR Table, and the 1994 GAR Table, for use in determining the minimum standard of valuation for annuity and pure endow…

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise. "Annuity 2000 Mortality Table" means that mortality table developed by the Society of Actuaries Committee on Life Insurance Research and shown…

(a) Except as provided in (b) and (c) below, the 1983 Table "a" is recognized and approved as an individual annuity mortality table for valuation and, at the option of the company, may be used for purposes of determining the minimum standard of valuation for any individual annuit…

(a) In using the 2012 IAR Mortality Table, the mortality rate for a person age x in year (2012 + n) is calculated as follows: q[x]<2012+n> = q[x]<2012> (1 - G2[x]). The resulting q[x]<2012+n> shall be rounded to three decimal places per 1,000 (for example, 0.741 deaths per 1,000)…

(a) Except as provided in (b) and (c) below, the 1983 GAM Table, the 1983 Table "a" and the 1994 GAR Table are recognized and approved as group annuity mortality tables for valuation and, at the option of the company, any one of these tables may be used for purposes of valuation …

(a) In using the 1994 GAR Table, the mortality rate for a person age x in year (1994+n) is calculated as follows: q[x]<1994> + n = q[x]<1994> (1 - AA[x]) where the q[x]<1994> and AA[x]s are as specified in the 1994 GAR Table. Notes N.J. Admin. Code § 11:4-26.6 Renumbered from N.J…

If any provision of this subchapter or the application thereof to any person or circumstances is for any reason held to be 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. Ad…