New Jersey Administrative Code

(a) Whenever the risk management plan of a joint insurance fund requires the fund's members to individually retain a specific amount of risk, potential liability, or incurred losses, the participant shall provide for such liability, or incurred loss: 1. As a deductible to be char…

Prior to any commitment or agreement requiring the expenditures of funds by the fund, the custodian of the fund's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted. Notes N.J. Admin. Code §…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Actuary" means a person who is a Fellow in good standing of the Casualty Actuarial Society with three years recent experience in loss r…

(a) The free balance of any account maintained by a fund, whether for claim or loss retention, administrative, contingency, or, in the case of an environmental impairment liability fund, the contingency account to be funded by bond proceeds pursuant to N.J.A.C. 11:15-2.1 3(b), sh…

(a) Any monies for a fund year in excess of the amount necessary to fund all obligations for that fiscal year as certified by an actuary may be declared to be refundable by the fund not sooner than the time periods after the end of the fiscal year as set forth in (b) and (c) belo…

(a) All disbursements, payments of claims settlements or other expenditures of funds of the fund whether for administrative expenses or for claims purposes must be approved by a majority of the fund commissioners or the executive committee thereof, unless approved pursuant to (b)…

(a) Consistent with N.J.A.C. 11:15-2.6(a)6, each fund providing primary or underlying coverage on a self-insured or commercially insured basis shall secure excess insurance or reinsurance in a form, in an amount and by an insurer, or other entity authorized to provide such covera…

(a) An annual certified report in a form acceptable to the Commissioner shall be prepared by each fund, filed concurrently with the Department and Department of Community Affairs and made available to each fund member on or before June 30 of each year. The report shall include:1.…

(a) In addition to any examination conducted pursuant to N.J.A.C. 11:15-2.6(f), the Commissioner may conduct an examination of any fund as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the fund may be insolvent or in a financial condit…

(a) No servicing organization of a fund, or producer that may be appointed pursuant to N.J.A.C. 11:15-2.6(c)10, or their employees, officers or directors shall have either a direct or indirect financial interest in the administrator of that fund or be an employee, officer or dire…

All officials or employees of a participating local unit or any members of the family of such officials or employees shall comply with N.J.S.A. 40A:9-22.1 et seq. (the "Local Government Ethics Law"). Notes N.J. Admin. Code § 11:15-2.27 Amended by R.1995 d.408, effective 8/7/1995.…

(a) The Commissioner shall give prior written notice of any proposed suspension or revocation of authority, cease and desist order, or other enforcement action to the fund commissioners, executive committee, or member local unit as the case may be, or to any person to whom the pr…

(a) After notice and opportunity for a hearing, as provided in N.J.A.C. 11:15-2.2 8, the Commissioner may issue an order revoking or suspending a fund's authority or requiring a person or fund to cease and desist from engaging in an act or practice to be in violation of any provi…

(a) Pursuant to N.J.S.A. 40A:10-36, the governing body of any local unit of government may by resolution agree to join together with any other local unit or units to establish a joint insurance fund as defined in this subchapter. The resolution shall provide for execution of a wr…

The rules contained in this subchapter and any of the provisions thereof shall be severable, and if any of its provisions shall be held to be unconstitutional or otherwise invalid, the decision of the court shall not affect the validity of the remaining rules and regulations or a…

(a) Every joint insurance fund shall be subject to and operate in compliance with the provisions of the "Local Fiscal Affairs Law" (N.J.S.A. 40A:5-1 et seq.), the "Local Public Contracts Law" (N.J.S.A. 40A:11-1 et seq.), regulations (including, but not limited to, N.J.A.C. 5:34),…

(a) Each joint insurance fund shall file with the Department for approval by the Commissioner and the Commissioner of the Department of Community Affairs, as provided in N.J.S.A. 40A:10-41, its bylaws and plan of risk management and any amendments thereto. In addition, the initia…

(a) The commissioners of a joint insurance fund shall prepare and, after the approval, by resolution, of the governing body of each participating local governmental unit, shall adopt bylaws for the joint insurance fund. The bylaws shall include, but not be limited to: 1. Procedur…

If the Commissioner determines that the bylaws or plan of risk management of the fund or any subsequent amendments thereto do not contain all of the information set forth in N.J.A.C. 11:15-2.6, are not submitted in the proper format set forth in N.J.A.C. 11:15-2.5, or otherwise d…

(a) After notice and opportunity for a hearing, the Commissioner may suspend or terminate the authority of any fund, or direct or take any action deemed necessary for good cause, to enable a fund to meet its obligations, cover its expected losses, or to liquidate, rehabilitate or…

(a) Prospective new members of the fund shall submit an application for membership to the fund's commissioners, or executive committee, as applicable, on a form acceptable to the Commissioner. Such application shall include a copy of the resolution of participation and executed i…

(a) This subchapter sets forth the requirements for the establishment, operation, oversight, modification and dissolution of joint insurance funds formed by two or more local units for the purpose of providing contributory or non-contributory group health insurance or group term …

(a) A member of the fund may remain a member for the full term of membership, as provided in the fund's bylaws, unless terminated by the fund for nonpayment of assessments, noncompliance with risk management or underwriting standards, or for other reasons subject to the prior app…

The insolvency or bankruptcy of a member does not relieve the fund or any other member of joint and several liability for the payment of any liability incurred by the member during the period of its membership, including, but not limited to, being subject to and liable for supple…

(a) A fund may not voluntarily dissolve, or otherwise cease to do business and distribute its assets to its members, unless and until it satisfies the following requirements: 1. A majority of the fund's members must have voted in favor of a resolution to dissolve the fund, pursua…

(a) Pursuant to the terms of the indemnity and trust agreement, each fund shall establish a separate trust fund account in accordance with N.J.A.C. 11:15-3.6(b)6 from which monies shall be disbursed solely for the payment of claims, allocated claim expenses and stop-loss insuranc…

Each fund shall establish an administrative account for each fund year which shall be utilized for payment of the fund's general operating expenses, including, but not limited to, cost containment activities, data processing services and general legal expenses. A fund shall not b…

(a) Each participating member of a joint insurance fund shall appropriate and pay to the fund its assessments as required by the joint insurance fund. Assessments for contributory or non-contributory group health insurance and term life insurance may be paid in monthly installmen…

(a) Each fund shall levy upon its members an additional assessment whenever needed or so ordered by the Commissioner, to supplement the fund's claim or loss retention accounts or administrative accounts to assure payment of the fund's obligations. 1. The fund shall assess each pa…

Should any member of a joint insurance fund fail or refuse to pay as directed its assessment(s) to the fund or to pay as directed any supplemental assessment(s), or should the fund commissioners fail to assess funds required to meet the obligations of the fund, the chairman of th…

Prior to any commitment or agreement requiring the expenditures of funds by the joint insurance fund, the custodian of the fund's assets shall certify the availability of sufficient unencumbered funds in the account to fully pay all charges or commitments to be accepted. Notes N.…

(a) The free balance of any account maintained by a joint insurance fund, whether for administrative, contingency or claims or loss purposes, shall be invested to obtain the maximum interest return practicable. All investments shall be in accordance with the fund's cash managemen…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Actuary" in the case of health insurance means a fellow in good standing of the Society of Actuaries or the Casualty Actuarial Society …

(a) A fund may seek to make refund payments from a claims or loss retention account remaining from any year which has been completed for at least 12 months by filing a notification of its intent to do so with the Department with appropriate documentation, including, but not limit…

(a) All disbursements, payments of claims settlements or other expenditure of funds of the joint insurance fund whether for administrative expenses or for claims purposes must be approved by a majority of the joint insurance fund commissioners or the executive committee thereof, …

(a) Employee claims information is privileged and confidential and shall not be included as a part of any open public record. (b) Fund commissioners and the officials of the member shall not have access to any employee claim information which reveals the identity of any individua…

(a) Each fund providing primary or underlying coverage on a self-insured basis shall secure stop-loss insurance or reinsurance in a form and amount acceptable to the Commissioner from an insurer authorized or admitted to transact life or health insurance, as applicable, in the St…

(a) A sworn annual report in a form acceptable to the Commissioner shall be prepared by each fund, filed currently with the Department and Department of Community Affairs and made available to each fund member not later than 120 days after the end of the immediately preceding fis…

(a) The Commissioner may conduct an examination of any fund as he or she deems necessary, or at any time the Commissioner has reasonable cause to believe the fund may be insolvent or in a financial condition detrimental to its members or to the public. It shall be the duty of the…

(a) No servicing organization or program manager of a fund, or producer appointed by a fund pursuant to N.J.A.C. 11:15-3.6(e)15, or their employees, officers or directors shall have either a direct or indirect financial interest in the administrator of that fund, or be an employe…

All officials or employees of a participating local unit or any members of the family of such officials or employees shall comply with N.J.S.A. 40A:9-22.1 et seq., (the "Local Government Ethics Law"). Notes N.J. Admin. Code § 11:15-3.27

(a) The Commissioner shall give prior written notice of any proposed suspension of authority, revocation, cease and desist order, or other enforcement action to the fund commissioners, its executive committee or member local unit as the case may be, or to any person to whom the p…

(a) After notice and opportunity for a hearing, as provided in N.J.A.C. 11:15-3.2 8, the Commissioner may issue an order revoking or suspending a fund's authority or requiring a person or fund to cease and desist from engaging in an act or practice found to be in violation of any…

(a) Pursuant to N.J.S.A. 40A:10-36, the governing body of any local unit of government may by resolution agree to join together with any other local unit or units to establish a joint insurance fund as defined in this subchapter. The resolution shall provide for execution of a wr…

The rules contained in this subchapter and any of the provisions thereof shall be severable, and if any of its provisions shall be held to be unconstitutional or otherwise invalid, the decision of the court shall not affect the validity of the remaining rules and regulations or a…

(a) Every joint insurance fund shall be subject to and operate in compliance with the provisions of the "Local Fiscal Affairs Law" (N.J.S.A. 40A:5-1 et seq.), the "Local Public Contracts Law" (N.J.S.A. 40A:11-1 et seq.), regulations (N.J.A.C. 5:34), and the various statutes autho…

(a) Each joint insurance fund shall file with the Department for approval by the Commissioners of Banking and Insurance and Community Affairs, as provided in N.J.S.A. 40A:10-41, its bylaws and plan of risk management and any subsequent amendments thereto. In addition, the initial…