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

(a) The following shall apply to license renewal: 1. Where a current licensee seeks to renew a license, the licensee shall, at least 15 days before June 30, submit a properly completed renewal application signed, dated and certified to be correct by the licensee or a licensed off…

(a) Where it appears from an application, the attached documents or Department records that an applicant has not demonstrated the qualifications prescribed in the Act or this subchapter, the Department shall advise the applicant in writing that the license request is denied; shal…

(a) A person shall not act as a viatical settlement representative without first obtaining an appointment from a licensed viatical settlement provider or licensed viatical settlement broker. 1. The appointment shall be made on a form required by the Commissioner and accompanied b…

(a) A person shall not use a viatical settlement contract or provide to a viator a disclosure statement form in this State unless filed with and approved by the Commissioner. Contract filings shall include the methodology for determining the viatical settlement proceeds. A viatic…

(a) The purpose of this subchapter is to set forth standards and procedures whereby a carrier shall obtain approval from the Commissioner of its offering of health benefits plans utilizing selective contracting arrangements that promote health care cost containment while adequate…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Allowable expense" means the usual, customary and reasonable item of expense for a covered service when the item of expense is covered at…

(a) A selective contracting arrangement that involves direct contracting between the carrier and network providers or that involves a contract between the carrier and a PPO shall contain an adequate number of network providers by specialty to render the particular covered service…

(a) No carrier shall issue health benefits plans utilizing selective contracting arrangements unless the carrier has entered into such arrangements directly with network providers or has contracted with a licensed or certified ODS, an HMO, or a PPO for prescription drug benefits.…

(a) The approval of a selective contracting arrangement issued by the Department under this subchapter may be denied, suspended or revoked if the Commissioner determines that: 1. The selective contracting arrangement criteria set forth in this subchapter are not being met; 2. Pay…

Notes N.J. Admin. Code § 11:4-37.6 Recodified by R.2006 d.189, effective 5/15/2006. See: 37 N.J.R. 4510(a), 38 N.J.R. 2159(a). Former N.J.A.C. 11:4-37.6 recodified as N.J.A.C. 11:4-37.5; section was "Denial, suspension and revocation".

Notes N.J. Admin. Code § 11:4-37.7 Repealed by R.2006 d.189, effective 5/15/2006. See: 37 N.J.R. 4510(a), 38 N.J.R. 2159(a). Section was "Monitoring; auditing."

(a) Every carrier shall pay a $ 1,500 filing fee for filing each of the following with the Department: 1. A selective contracting arrangement approval application pursuant to N.J.A.C. 11:4-37.4; and 2. A triennial renewal application of a selective contracting arrangement pursuan…

Carriers failing to comply with the requirements of this subchapter may be subject to penalties authorized by law. Notes N.J. Admin. Code § 11:4-37.9 New Rule, R.1998 d.302, effective 6/15/1998. See: 30 New Jersey Register 267(a), 30 New Jersey Register 2214(a).

(a) Passbooks resembling those used for savings deposits in banks shall not be used in connection with policies to which this regulation applies which contain guaranteed annual endowment benefits. (b) No reference shall be made in any material used in connection with such policie…

The use of such books as described at N.J.A.C. 11:4-4.1(a) is determined to be an unfair method of competition and unfair or deceptive act or practice pursuant to N.J.S.A. 17B:30-18, and such books shall not be used in connection with policies to which this regulation applies. No…

(a) This practice shall be discontinued with respect to policies to which this regulation applies because it conflicts with N.J.S.A. 17B:25-5 which requires "that the policy constitute the entire contract between the parties". (b) The reference to such language as "deposits" in s…

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 § 11:4-4.4…

The effective date of this regulation shall be August 1, 1963. Notes N.J. Admin. Code § 11:4-4.5

(a) The purpose of this subchapter is to implement P.L. 1995, c.73 (the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act) by setting forth standards and procedures whereby all life insurance, health insurance, and annuity forms, and rates whe…

(a) An insurer seeking to file and use a form specified at N.J.A.C. 11:4-40.9 to be eligible for file and use shall, in addition to the items set forth at N.J.A.C. 11:4-40.5(b), submit the following to the Department: 1. A certification memorandum signed and acknowledged by a res…

A form submitted by an insurer to the Commissioner for either prior approval or file and use pursuant to this subchapter shall be accompanied by the service fee(s) set forth at N.J.A.C. 11:1-32 unless the insurer is exempt from the payment of such fees pursuant to section 13 of P…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Annuity" means a contract not included within the definitions of life insurance or health insurance as set forth in this section, under w…

(a) All life, health and annuity forms shall comply with the standards set forth in this subchapter and in any other applicable statutes, rules and published guidelines before being delivered or issued for delivery in this State. (b) No form delivered or issued for delivery in th…

(a) All insurers submitting forms or other correspondence to the Department pursuant to this subchapter shall comply with the following general procedures: 1. All individual health, group health, blanket, prepaid legal contracts, group life and service corporation forms, individu…

(a) No insurer shall deliver or issue for delivery in this State any form unless the form has been approved by the Commissioner pursuant to the procedures set forth in this subchapter, except for those forms eligible for submission to the Commissioner pursuant to the file and use…

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of individual life and annuities variable forms shall include, if applicable, the following items in the submission to the Department: 1. A prospectus; and 2. An actuarial memorandum which d…

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of valuation and non-forfeiture interest rate changes to previously filed forms shall include, if applicable, the following items in the submission to the Department: 1. If the interest rate…

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of certificates of assumption shall include, if applicable, the following items in the submission to the Department: 1. A clear indication whether the assuming and ceding insurers are author…

(a) An insurer may deliver or issue for delivery in this State a form providing life, health or annuity benefits, and accompanying rates if applicable, without obtaining prior approval from the Commissioner pursuant to this subchapter provided the form is set forth in this sectio…

(a) The purpose of this subchapter is to implement P.L. 2001, c. 237 (N.J.S.A. 17B:25-18.4), which establishes a special procedure whereby insurers may forego prior approval of certain life insurance, annuity and variable contract forms. (b) This subchapter shall apply to all ind…

The following words and terms, as used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise: "Annuity" means all contracts meeting the definition set forth at N.J.S.A. 17B:17-5. "Available for sale or use" means that the insurer has…

(a) Forms submitted to the Commissioner on the basis that they have been made available for sale or use in 40 states, subject to state variations that do not alter the unique features or design of the product, shall be eligible for sale or use pursuant to the requirements of this…

(a) Filings pursuant to N.J.A.C. 11:4-40A.3(a) shall include the following: 1. For each form submitted, a separate certification memorandum, signed by a responsible officer of the insurer, which shall include: a statement that the form has been made available for sale or use in 4…

(a) If the Commissioner determines that a certification submitted to the Department by an insurer pursuant to this subchapter is an improper certification, the insurer shall be subject to the following penalties specifically determined by the Commissioner in consideration of the …

(a) Any form and certification submitted pursuant to P.L. 2001, c. 237 prior to April 7, 2003, which was acknowledged by the Commissioner but does not meet the requirements of this subchapter, shall be deemed withdrawn July 6, 2003, and the form may not be available for sale or u…

(a) The purpose of these rules is to implement P.L. 1995, c.73 (the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act) by setting forth the Department's standards for approval of all individual life insurance forms delivered or issued for deli…

(a) The following requirements shall apply to survivorship forms, which provide that the death benefit is payable on the last surviving insured: 1. For any survivorship form with cash values, the values shall be calculated using exact ages, sexes and underwriting classifications.…

(a) The following standards shall apply to coverage which provides a re-entry or requalification feature:1. The Department shall require a certification that the insurer will not attempt to defeat the requalification provision by markedly altering its underwriting standards betwe…

(a) Pursuant to (b) below, the Department shall permit the use of a single policy form to provide more than one product where there are alternative plans. The submission shall include specimen issues of the schedule pages and any related tables of values for each alternative plan…

Forms which have been filed by the Commissioner pursuant to N.J.S.A. 17B:25-18 containing provisions not in compliance with these rules shall be deemed withdrawn as of December 31, 1996. Notes N.J. Admin. Code § 11:4-41.13 Amended by R.1997 d.60, effective 2/3/1997. See: 28 New J…

(a) The standards set forth in this section shall apply to individual life insurance policies that: 1. Classify insureds explicitly by smoking and/or tobacco use habits, resulting in premium, cost or benefit differences; and 2. Permit a reclassification resulting in a change in p…

Notes N.J. Admin. Code § 11:4-41.15 Recodified to N.J.A.C. 11:4-41.12 by R.2000 d.130, effective 3/20/2000. See: 31 New Jersey Register 3910(a), 32 New Jersey Register 1024(a).

Notes N.J. Admin. Code § 11:4-41.16 Recodified to N.J.A.C. 11:4-41.13 by R.2000 d.130, effective 3/20/2000. See: 31 New Jersey Register 3910(a), 32 New Jersey Register 1024(a).

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Account value policy" means any policy, including, but not limited to, true universal life (flexible premium universal life) and interest…

(a) No individual life insurance policy, rider, application or endorsement shall contain provisions which are unjust, unfair, inequitable, misleading, contrary to law or to the public policy of this State. (b) The following approval standards shall apply to all individual life in…

(a) The Department shall permit the following exclusions for coverage: 1. Aviation exclusions; 2. Avocation exclusions; 3. War risk exclusions, which may include military, non-combatant civilian and civilian exclusions. i. Regarding military exclusions, risk of death may be exclu…

Bail-out features shall not be permitted. Notes N.J. Admin. Code § 11:4-41.5