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

(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 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

Any form which describes death benefits or credited interest in terms of a published index shall state how death benefits and interest shall be determined upon the discontinuance of the index, and that any substitute index is subject to Department approval. Notes N.J. Admin. Code…

(a) Pre-existing condition exclusions shall only be permitted in the case of benefits for disability, as follows:1. The insurer shall not be liable for a disability resulting from any pre-existing condition which is disclosed in the application and excluded by rider. 2. The insur…

(a) Use of the same form for field issue and home office issue contract shall be permitted when the contract terms are written so as to make the difference in the administrative aspect of the issuance and delivery process negligible. (b) The following requirements shall apply to …

(a) The following standards shall apply to other insured coverage, which provides coverage to an insured other than the policy's primary insured: 1. The form shall clearly describe what happens to the insurance on the other insured upon the death of the primary insured. 2. If cov…

(a) This subchapter sets forth standards for provisions contained in group life, group health and blanket insurance contract, policy and certificate forms to assure that the provisions are not unjust, unfair, inequitable, misleading, confusing or unreasonably restrictive and that…

(a) No policy or certificate providing group health insurance shall limit or exclude health benefits as the result of the covered person's sustaining a loss attributable to the actions of a third party. (b) Insurers shall file with the Commissioner no later than December 31, 2002…

(a) A blanket insurance policy or certificate or other group policy or certificate providing health insurance, other than a group health benefits plan, may include an exclusion for losses resulting from the covered person's use of alcohol or drugs, but such exclusion shall be wor…

(a) A group policy or certificate providing health insurance benefits shall not include any provision that restricts, limits, or excludes coverage of services or expenses, directly or indirectly, that otherwise are eligible under the policy or certificate on the grounds that such…

(a) An insurer, in providing the conversion right required by N.J.S.A. 17B:27-19, shall treat the retirement of a covered person under a policy providing group life insurance as a termination of employment and shall permit the covered person to obtain, without evidence of insurab…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Blanket insurance" means a policy or contract of insurance against death or injury resulting from an accident or from accidental means …

(a) The standards contained in this subchapter shall be in addition to any other rules and statutes applicable to group health insurance, group life insurance and blanket insurance contracts, policies and certificates. (b) If a group insurance contract, policy or certificate cont…

(a) The face page of every certificate issued under a blanket insurance policy or a group policy providing health insurance or life insurance delivered or issued for delivery in New Jersey shall state that it is subject to the laws of the State of New Jersey. (b) Group policies a…

(a) Group policies and certificates providing health, life, or blanket insurance shall not limit or exclude benefits because a covered person suffers a loss due to domestic violence. 1. No application or evidence of coverage form shall include questions regarding domestic violenc…

(a) Group health, group life insurance and blanket insurance policies and certificates that provide accident coverage and which include an aggregate limit on the benefits payable in connection with any single accident shall provide that the aggregate limit shall apply on a per co…

(a) Group policies and certificates providing disability income insurance may provide that benefits shall be offset by other income received by the covered person under the following conditions:1. Offsets to group disability benefits may not result in a monthly benefit of less th…

(a) Group policies and certificates providing health insurance in which some portion of the benefits are subject to pre-authorization provisions shall comply with the following: 1. There shall be a caption for the pre-authorization provision in both the policies and certificates …

(a) Blanket and group policies and certificates providing life insurance or accidental death and dismemberment insurance benefits shall not subject such benefits to pre-existing condition exclusions and limitations. (b) Group policies and certificates providing health insurance b…

(a) The subchapter implements P.L. 1995, c.73, by setting forth standards and requirements that individual annuity contract forms delivered or issued for delivery in this State are required to satisfy in order to obtain approval from the Commissioner. (b) This subchapter shall ap…

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 definition of life insurance as set forth in N.J.S.A. 17B:17-3, or health insurance as …

(a) All individual annuities shall be filed with the Commissioner pursuant to N.J.S.A. 17B:25-18; P.L. 1995, c.73, sections 16 and 17; and N.J.A.C. 11:4-40 prior to being delivered or issued for delivery in this State. (b) Individual annuity contract forms shall not contain any p…

(a) Individual immediate annuity contracts which include surrender benefits, partial withdrawals or indeterminate annuity payments other than commutation rights shall meet or exceed the requirements of the Standard Nonforfeiture Law for Individual Deferred Annuities at N.J.S.A. 1…

(a) Insurers shall include a provision in all individual flexible premium annuity forms specifying any upper and/or lower dollar limits on premium payments, which the insurer may waive in a uniform and nondiscriminatory manner upon written notice of any new limits to the owner. F…

(a) An individual annuity form which includes a waiver of surrender charges upon confinement to a nursing home or similar institution shall comply with the following requirements: 1. The benefit shall be limited to the confinement of the owner, the annuitant, the owner's spouse o…

Submissions of all individual deferred annuity contracts having a separate surrender charge associated with each premium payment shall include an actuarial certification that surrender charges in later years comply with N.J.S.A. 17B:25-20. Notes N.J. Admin. Code § 11:4-43.7 Amend…

(a) The purpose of this subchapter is to implement the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act, P.L. 1995, c.73, by setting forth the Department's standards for approval of life insurance and annuity contracts issued on a variable ba…

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 New Jersey Department of Banking and Insurance. "Contract on a variable basis" or "variable…

(a) All individual life insurance and annuities contracts on a variable basis shall include the following: 1. A provision describing the periodic reports; 2. A provision specifying any rights for deferral. Any deferral of a minimum guaranteed death benefit for an individual varia…

(a) The following restrictions shall apply to all individual life insurance and annuities contracts on a variable basis: 1. The insurer shall not reserve the right to unilaterally terminate or discontinue transfer privileges. Suspension of such privilege for a reasonable period i…