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

(a) The general order of benefit determination shall be as follows: 1. The primary plan shall pay or provide its benefits as if the secondary plan or plans did not exist. 2. A secondary plan shall take the benefits of another plan into account only when, under this subchapter, it…

(a) A plan determined to be a secondary plan pursuant to N.J.A.C. 11:4-28.6 may reduce its benefits so that the total benefits paid or provided by all plans during a claim determination period are not more than the total allowable expenses. Where a benefit is payable by both the …

An explanation of benefits provided to covered persons under a plan shall include the following language: "If you are covered by more than one health benefit plan, you should file all your claims with each plan and provide each plan with information regarding the other plans unde…

(a) A plan with order of benefit determination rules which comply with this subchapter (complying plan) shall coordinate its benefits with a plan that declares itself "excess" or "always secondary" or which uses order of benefit determination rules which are inconsistent with tho…

Payment of guaranteed annual endowment benefits in a policy shall not be made contingent on the payment of a premium falling due at the time such benefit would otherwise be payable or credited to the insured. Notes N.J. Admin. Code § 11:4-3.1

The gross premium for the guaranteed annual endowments shall be shown prominently and separately in the policy as distinct from the regular insurance gross premium. Notes N.J. Admin. Code § 11:4-3.2

The gross premium for any additional insurance effective after the first policy year, other than return of premiums, shall also be shown prominently and separately in the policy. Notes N.J. Admin. Code § 11:4-3.3

Annual coupons for the guaranteed annual endowments shall not be included as a part of policies containing guaranteed annual endowments. Notes N.J. Admin. Code § 11:4-3.4

Guaranteed annual endowments shall not be included as benefits in policies entitled to participate in dividends. Notes N.J. Admin. Code § 11:4-3.5

If any provision of this regulation or the application thereof to any person or circumstance is held invalid, the remainder of the regulation and the application of such provision to other persons or circumstances shall not be affected thereby. Notes N.J. Admin. Code § 11:4-3.6…

The effective date of this regulation shall be August 1, 1963. Notes N.J. Admin. Code § 11:4-3.7

The purpose of these rules is to regulate the content, filing and disclosure of information to individual policy owners and group certificate holders with respect to accelerated death benefit provisions of life insurance policies. Notes N.J. Admin. Code § 11:4-30.1

(a) Pursuant to N.J.S.A. 17B:25-18 and 17B:27-25, individual and group policies, riders and endorsements and group certificates with accelerated death benefit provisions must be filed by the Commissioner before they are delivered or issued for delivery in this State. (b) The foll…

(a) Prior to or concurrent with the election of the option to accelerate the payment of death benefits, the owner shall be given an illustration demonstrating the effect of the acceleration of the payment of death benefits on the cash value, death benefit, premium and policy or c…

(a) Insurers shall not discriminate among insureds on the basis of qualifying events covered under the policy. (b) Conditions for payment of accelerated death benefits may not be based on type of disease or the fact of institutionalization. However, it is not discriminatory to pr…

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 § 11:4-30.13

Notes N.J. Admin. Code § 11:4-30.14 Repealed by R.2000 d.170, effective 4/17/2000. See: 32 New Jersey Register 167(a), 32 New Jersey Register 1396(a). Section was "Effect on previously filed forms".

These rules shall apply to all accelerated death benefit provisions of individual and group life insurance policies delivered or issued for delivery in this State. Notes N.J. Admin. Code § 11:4-30.2 Amended by R.2012 d.096, effective 5/7/2012. See: 43 N.J.R. 3119(a), 44 N.J.R. 15…

The following terms, when used in this subchapter, shall have the following meanings: "Accelerated death benefits" means the advance payment of some or all of the death proceeds payable under a life insurance policy or group certificate: 1. To the owner or certificate holder, dur…

Accelerated death benefit provisions will be permitted in the form of either a surrender of the policy or a lien on the death benefits. Notes N.J. Admin. Code § 11:4-30.4 Amended by R.2012 d.096, effective 5/7/2012. See: 43 N.J.R. 3119(a), 44 N.J.R. 1531(a). Deleted "total or par…

(a) Under the surrender approach, the owner of a policy or certificate is permitted to accelerate the payment of all or part of the death benefit, as specified in the policy or certificate, through the acceleration of (all or part) of the death benefit. Under this approach, the c…

(a) Under the lien approach, the payment to the owner of the accelerated death benefit is treated as a lien on the death benefits of the policy. Expense charges may be added to the lien. Due and unpaid premiums may be included in the lien after the automatic premium loan, if avai…

(a) Payment options available to the owner shall include the right to receive the accelerated death benefit in lump sum and may include an option to receive the benefit in periodic payments for a term certain period (that is, without life contingencies). 1. In no event shall the …

(a) The following are required terms:1. Accelerated death benefit provisions shall specify the procedure to be followed to accelerate the payment of death benefits. Insurers are subject to N.J.S.A. 17B:25-11 with respect to any delay in processing requests to accelerate the payme…

(a) When a partial amount of the death benefit is accelerated: 1. The policy or group certificate shall be modified by an endorsement which includes a statement of cash values, policy loans, premiums and death benefits following acceleration. 2. The dividends or non-guaranteed el…

(a) The purpose of this subchapter is to provide: 1. Tables of select mortality factors and rules for their use; 2. Rules concerning a minimum standard for the valuation of plans with non-level premiums or benefits; and 3. Rules concerning a minimum standard for the valuation of …

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Appointed actuary" means any individual who is appointed or retained in accordance with the requirements set forth at N.J.A.C. 11:1-21A.3…

(a) At the election of the insurer for any one or more specified plans of life insurance, the minimum mortality standard for basic reserves may be calculated using the 1980 CSO valuation tables with select mortality factors (or any other valuation mortality table adopted by the N…

(a) Basic reserves shall be calculated as the greater of the segmented reserves and the unitary reserves. Both the segmented reserves and the unitary reserves for any policy shall use the same valuation mortality table and selection factors. At the option of the insurer, in calcu…

(a) Policies with a secondary guarantee include: 1. A policy with a guarantee that the policy will remain in force at the original schedule of benefits, subject only to the payment of specified premiums; 2. A policy in which the minimum premium at any duration is less than the co…

This subchapter shall become operative January 1, 2000, except that insurers meeting the requirements of N.J.A.C. 11:4-32.1(c)6 and obtaining the approval of the Commissioner to calculate reserves for policies issued prior to January 1, 2000 using the methods and assumptions desc…

This subchapter establishes procedures for modifying the calculation of excess interest reserves when a life insurer guarantees to credit policy values with interest which exceeds the maximum valuation rate prescribed in N.J.S.A. 17B:19-8. This subchapter does not limit or restri…

This subchapter applies to all life insurance policies, pure endowment and annuity contracts issued by an insurer transacting business in this State in which the insurer has committed to crediting interest to policy values for any period that extends beyond the valuation date at …

(a) In addition to the basic policy reserve required under N.J.S.A. 17B:19-8, a life insurer is also required by N.J.S.A. 17B:19-8 to establish an excess interest reserve whenever the insurer has committed to crediting interest to policy values for any period of time that extends…

If any provision of this subchapter or the application thereof to any person or circumstance 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. Adm…

(a) The purpose of this subchapter is to implement the New Jersey Long-Term Care Insurance Act, P.L. 2003, c. 207, codified at N.J.S.A. 17B:27E-1 et seq., and to promote the public interest and the availability of long-term care insurance coverage, to protect applicants for long-…

(a) A long-term care insurance policy or certificate, if it provides benefits for home health care or community care services, shall not limit or exclude benefits: 1. By requiring that the insured would need care in a skilled nursing facility if home health care services were not…

(a) No carrier may offer a long-term care insurance policy unless the carrier also offers to the policyholder, in addition to any other inflation protection, the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations…

(a) Application forms shall not include provisions, statements or questions that: 1. Pertain to race, creed, color, national origin or ancestry of the proposed insured; 2. Change the terms of the policy to which it is attached; 3. State that the applicant has not withheld any inf…

(a) Every carrier shall maintain records for each agent of that agent's amount of replacement sales as a percent of the agent's total annual sales and the amount of long-term care insurance policies sold by the agent that lapsed as a percent of the agent's total annual sales. (b)…

A producer is not authorized to sell, solicit or negotiate with respect to long-term care insurance except as authorized by the New Jersey Insurance Producer Licensing Act of 2001, N.J.S.A. 17:22A-26 et seq. Notes N.J. Admin. Code § 11:4-34.14

(a) The Commissioner may, upon written request and after an administrative hearing, issue an order to modify or suspend a specific provision or provisions of this subchapter with respect to a specific long-term care insurance policy or certificate upon a written finding that: 1. …

(a) When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves for the benefits shall be determined in accordance with N.J.S.A. 17B:19-8a.vii. Claim reserves shall also be esta…

(a) This section applies to all rates for individual long-term care policies except those covered pursuant to N.J.A.C. 11:4-34.8 and 34.18. (b) Premiums and benefits under long-term care insurance policies whose rates are subject to this section shall meet the loss ratio requirem…

(a) This section applies to any individual long-term care policy issued in this State on or after January 18, 2006 and for which initial rates were filed pursuant to N.J.A.C. 11:4-34.8. (b) A carrier shall request approval of a revised premium rate schedule, including an exceptio…

(a) Prior to a carrier offering or placing in force group long-term care insurance coverage to or on a resident of this State under a group policy issued in another state pursuant to N.J.S.A. 17B:27E-5b, it shall file with the Commissioner evidence that the group policy or certif…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Applicant" means: 1. In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and 2. …

Notes N.J. Admin. Code § 11:4-34.20 Repealed by R.2010 d.114, effective 6/21/2010. See: 41 N.J.R. 4054(a), 42 N.J.R. 1208(a). Section was "Filing requirements for advertising".

(a) Every carrier marketing long-term care insurance coverage in this State, directly or through its producers, shall:1. Establish marketing procedures and agent training requirements to assure that: i. Any marketing activities, including any comparison of policies, by its agents…

(a) This section shall not apply to life insurance policies and annuities that only accelerate benefits for long-term care, but shall apply to any other life insurance policy and annuity contract providing long-term care benefits. (b) Every carrier marketing long-term care insura…