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

(a) No form to which this subchapter applies may be delivered or issued for delivery in this State unless submitted to the Commissioner for review and filed by the Commissioner pursuant to all applicable law, including, but not limited to, N.J.A.C. 11:4-40. (b) For any form to wh…

(a) For any flexible factor form where cash values and/or death benefits are subject to variation on the basis of interest, mortality, or expense factors that may be adjusted by the insurer, or on the basis of premium amounts which the policyholder may unilaterally change or choo…

(a) Any periodic report for use with an individual variable annuity shall satisfy, at a minimum, the following requirements: 1. The report shall be provided at least annually, and shall show the values by fund, sub-account and division (including, but not limited to, dollar and u…

(a) Any periodic report for use with a variable life form shall satisfy, at a minimum, the following requirements: 1. The report shall be provided at least annually, and shall show values by fund, sub-account and division (including, but not limited to, dollar and unit values, if…

(a) In the case of a policy for which illustrations shall be used pursuant to N.J.A.C. 11:4-52, the insurer shall provide each policyholder or contractholder with a periodic report on the status of the policy, which shall satisfy the following requirements: 1. The report shall be…

Failure to comply with this subchapter shall result in the imposition of penalties as may be authorized by law. Notes N.J. Admin. Code § 11:4-45.8 Recodified from N.J.A.C. 11:4-45.7 and amended by R.1998 d.337, effective 7/6/1998. See: 30 New Jersey Register 275(a), 30 New Jersey…

(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 the terms and conditions under which life insurance companies may issue synthetic guaranteed investment…

The following words and terms, as 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 value record" means an accounting r…

(a) In addition to complying with the requirements set forth in these rules, all synthetic guaranteed investment contract form submissions shall comply with all applicable requirements of N.J.A.C. 11:4-40. (b) All synthetic guaranteed investment contract form submissions shall co…

(a) An acceptable plan of operation submitted in support of the Department's review of the contract shall include at least the following: 1. A description of all contingencies and circumstances under the contract that would require the insurer to make payments or perform any othe…

(a) The contract shall include at least the following: 1. The permissible levels and timing of any new deposits to the segregated portfolio; 2. If the contract does not have a set maturity, settlement options at termination permitting the contractholder to receive the contract va…

(a) The insurer shall monitor the market value record for each contract. Upon each recalculation of the crediting rate, but no less frequently than quarterly, the insurer shall update the market value record to reflect the market value of the segregated portfolio. (b) No contract…

(a) Reserves shall be held by the insurer in the general account and shown on Exhibit 10 of the Annual Statement. The assets supporting those reserves, together with the assets in the segregated portfolio, shall be sufficient to mature the liabilities under moderately adverse con…

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(s) to other persons or circumstances shall not be affected thereby. Notes N.J. …

(a) These rules set forth requirements regarding actuarial reports and memorandum which are to be developed in connection with flexible-factor life insurance forms for such forms to be filed by the Commissioner for use and delivery for use in this State pursuant to N.J.S.A. 17B:2…

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. "Department" means the New Jersey Departmen…

(a) All forms with any flexible factors shall include a flexible-factor guarantee. (b) All forms to which this subchapter applies shall specify the experience factors upon which changes to flexible factors could be based. Notes N.J. Admin. Code § 11:4-47.3 Amended by R.2001 d.411…

(a) Any modification to flexible factors on an in-force policy made by an insurer shall be subject to the following requirements: 1. The modification shall be made only to flexible factors identified as such in the contract; 2. The modification shall be based upon future anticipa…

(a) Each form submitted for filing shall be accompanied by a certification by a qualified actuary that the nonforfeiture benefits provided are in compliance with N.J.S.A. 17B:25-19 or are exempt from providing guaranteed nonforfeiture benefits as described in N.J.S.A. 17B:25-19. …

Failure to comply with this subchapter shall result in the imposition of any penalties as may be authorized by law. Notes N.J. Admin. Code § 11:4-47.6 Recodified from N.J.A.C. 11:4-47.7 and amended by R.2003 d.278, effective 7/7/2003. See: 35 New Jersey Register 497(a), 35 New Je…

(a) This subchapter sets forth standards and requirements that all life and health insurance policy forms and annuity contract forms are required to meet in order to comply with the prohibition against unfair discrimination as provided at N.J.S.A. 17B:30-12. (b) These rules shall…

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

(a) No insurer shall make or permit any unfair discrimination between individuals of the same class and equal expectation of life in the rates charged, dividends or other benefits payable thereon, or in any other of the terms and conditions for any policy of life insurance or con…

The Department shall approve life insurance policy forms that provide conversion credits pursuant to N.J.S.A. 17B:30-14e. Notes N.J. Admin. Code § 11:4-48.4 Recodified from N.J.A.C. 11:4-48.6 and amended by R.2000 d.130, effective 3/20/2000. See: 31 New Jersey Register 3910(a), 3…

The Department shall not approve life insurance policy forms intended for sale to non-smokers. Insurers may decline or not offer insurance to smokers if underwriting considerations based on mortality risk exposure would result in such smokers being ineligible. Insurers shall not …

The Department shall not approve provisions in life insurance policy forms under which the level of premiums or benefits varies depending solely upon who retains the ownership rights of the policy. Notes N.J. Admin. Code § 11:4-48.6 Recodified from N.J.A.C. 11:4-48.8 by R.2000 d.…

A policy shall not provide credits for a surrender charge imposed under another contract for the reason that such credits unfairly discriminate among contractholders based on the source of funding. Notes N.J. Admin. Code § 11:4-48.7 Recodified from N.J.A.C. 11:4-48.9 by R.2000 d.…

(a) In addition to the discounts based solely on savings in expenses due to the method of premium collection as permitted by N.J.S.A. 17B:30-14d and the discounts based solely on the amount of insurance issued to a particular insured as permitted by N.J.S.A. 17B:30-14e, reduction…

Notes N.J. Admin. Code § 11:4-48.9 Recodified to N.J.A.C. 11:4-48.9 by R.2000 d.130, effective 3/20/2000. See: 31 New Jersey Register 3910(a), 32 New Jersey Register 1024(a). Recodified from N.J.A.C. 11:4-48.10 by R.2003 d.54, effective 2/3/2003. See: 34 New Jersey Register 3194(…

(a) The purpose of this subchapter is to implement P.L. 1995, c.331 by specifically setting forth the benefits required to be provided pursuant to P.L. 1995, c.331, and by identifying the particular health insurance policy or contract responsible for payment of such benefits. (b)…

The following words and terms, as 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. "Dental only policy or contract" means a policy or contra…

(a) The diabetes benefits set forth in this subsection shall be included in all health benefits plans. 1. All equipment and supplies for the treatment of diabetes if recommended or prescribed by a physician or nurse practitioner/clinical nurse specialist as follows: i. Blood gluc…

All group health insurance policies or contracts providing hospital or medical expense benefits, except for policies or contracts providing prescription drug benefits, may provide that the benefits required to be provided pursuant to this subchapter are excluded if the benefits a…

(a) In conformance with N.J.S.A. 30:7E-1 et seq., the purpose of this subchapter is to establish rules for the reimbursement of costs incurred in the provision of medical care, hospitalization, surgery, dental care and vision care to inmates that are covered by a health coverage …

The following words and terms, as used in this subchapter, shall have the following meanings, unless the text clearly indicates otherwise: "Confinement" means incarceration, detention or commitment to any institution. "Correctional medical services subcontractor" and "correctiona…

Inmates are liable for the cost of any medical care, surgery, medical service, nursing care, prescription drugs, nonprescription drugs, durable medical equipment, hospitalization, therapy treatment, dental care, vision care provided to them while in confinement. Notes N.J. Admin.…

Pursuant to N.J.S.A. 30:7E-2, the amount of inmate liability for medical care shall be the usual, customary and reasonable charges incurred for the inmate's medical care as determined by the State and county treasurers in accordance with the guidelines promulgated by the Commissi…

(a) In accordance with N.J.S.A. 30:7E-3, State and County Treasurers shall file a claim for reimbursement of the value of the usual, customary and reasonable charges incurred for an inmate's medical care upon any health coverage plan providing benefits to an inmate as an enrollee…

(a) Where the inmate is an enrollee, he or she shall provide a signed and completed assignment of benefits form in favor of the treasurer of the State or county institution, a claims form and a medical release. These forms shall be obtained from the inmate's plan. The assignment …

(a) The determination of primary coverage responsibility shall be governed by N.J.A.C. 11:4-28 to determine the priority of reimbursement in the event of multiple coverages of an inmate. (b) For the purpose of the coordination of benefits, the medical services provided by the ins…

Health coverage plans shall not contain any provision which would limit or restrict the ability of the State or county treasurers to seek reimbursement for the cost of medical services provided to inmates under N.J.S.A. 30:7E-1 et seq. Notes N.J. Admin. Code § 11:4-50.8

(a) The purpose of these rules is to provide life insurance policy illustrations that shall protect consumers and foster consumer education. These rules provide illustration formats, prescribe standards to be followed when illustrations are used, and specify the disclosures that …

In addition to any other penalties provided by the laws of this State, an insurer or producer that violates a requirement of these rules shall be guilty of a violation of N.J.A.C. 11:2-17. Notes N.J. Admin. Code § 11:4-52.10

(a) Until January 1, 1999, insurers may use the following language instead of the statement required by N.J.A.C. 11:4-52.5(d)1: "I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either highe…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Actuarial Standards Board" means the board established by the American Academy of Actuaries to develop and promulgate standards of actu…

(a) Each insurer marketing policies to which these rules are applicable shall notify the Commissioner whether a policy form is to be marketed with or without an illustration. 1. For policy forms filed after July 6, 1998, the identification shall be made at the time of filing. Any…

(a) An illustration used in the sale of a life insurance policy shall satisfy the applicable requirements of these rules, be clearly labeled "life insurance illustration" and contain the following basic information: 1. The name of the insurer; 2. The name and business address of …