New Jersey Administrative Code

Every insurer, agent or broker selling insurance pursuant to a mass marketing plan shall, prior to sale, make full and fair disclosure to prospective employee and member insureds of all features of such plan, whether favorable or unfavorable, including, but not limited to, premiu…

(a) No insurer shall use underwriting standards for individual risk selection in a mass marketing plan which are, on the whole, either less restrictive, unless written with an appropriate charge as contemplated by the insurer's filed rates, or more restrictive than the standards …

(a) The failure of an employer, association, organization or other group to remit premiums when due for any reason (including but not limited to interruption or termination of employment or membership) shall not be regarded as "nonpayment of premium" by any employee or member ins…

An insurer, agent or broker selling insurance pursuant to a mass marketing plan shall, with respect to any employees or members who apply for but are denied insurance under such plan and are not otherwise insured, assist such persons in their efforts to obtain insurance through a…

(a) Any employer, association, or organization domiciled or principally located in New Jersey may be eligible for a mass marketed insurance plan if 25 or more employees or members are enrolled to participate upon inception of the plan. (b) Size of group and number of participant …

If any provision of this regulation or the application thereof to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this regulation, and to this end each Section of this regulation is declared to be severable. Notes N.…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Mass marketing plan" means a method of selling personal property-liability insurance wherein: 1. Such insurance is offered to employees…

This regulation shall be applicable only to insurance policies issued or renewed in this State and is in addition to, and not in substitution for, other applicable requirements of the insurance law and Department regulations. The requirements of this regulation are not applicable…

No insurer shall sell insurance pursuant to a mass marketing plan to members of any association or organization formed principally for the purpose of obtaining such insurance. Notes N.J. Admin. Code § 11:2-12.4

(a) Premiums under a mass market plan shall comply with the filing requirements and with the standards in the insurance law, including the standards that rates not be excessive, inadequate, or unfairly discriminatory. Rates shall not be deemed to be unfairly discriminatory becaus…

An insurer selling insurance pursuant to mass marketing plans shall maintain separate statistics as to loss and expense experience pertinent to each individual plan only if such individual plan provides some rate or coverage advantage not available from the same insurer on a nonp…

No person shall act as an insurance agent or an insurance broker in connection with a mass marketing plan for any kind of insurance unless such person is duly licensed, under N.J.S.A. 17:22A-26 et seq. as an insurance agent or broker for such kind of insurance in such insurance p…

No insurer shall sell insurance pursuant to a mass marketing plan if it is a condition of employment or of membership in an association, organization or other group that any employee or member purchase insurance pursuant to such plan, or if any employee or member shall be subject…

(a) No insurer shall sell insurance pursuant to a mass marketing plan if: 1. The purchase of insurance available under such plan is contingent upon the purchase of any other insurance, product or service; or 2. The purchase or price of any other insurance, product, or service is …

(a) The purpose of this subchapter is to set forth requirements regarding the discontinuance and replacement of all group life, accident and health insurance policies and contracts, group dental plan organization contracts, group dental service corporation contracts and group hea…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Carrier" means a life insurance company or any entity subject to the insurance laws and rules of this State, or subject to the jurisdic…

(a) If a policy or contract provides for automatic discontinuance after a premium or subscription charge has remained unpaid through the grace period allowed for such payment, the carrier shall be liable for valid claims for covered losses incurred and services or supplies provid…

(a) Any written notice of discontinuance provided pursuant to N.J.A.C. 11:2-13.3 by the carrier to the group policy holder or contractholder shall include a statement that, unless otherwise provided in the policy or contract, the carrier shall not be liable for claims for losses …

(a) Every group policy or other contract subject to these rules hereafter issued, or under which the level of benefits is hereafter altered, modified or amended, shall provide a reasonable provision for extension of benefits in the event of total disability which exists as of the…

(a) This section shall determine carrier liability where one carrier's policy or contract replaces another carrier's plan providing similar types of coverage. (b) The prior carrier remains liable only to the extent of its accrued liabilities and extensions of benefits. The positi…

Noncomplying policy forms shall be deemed withdrawn on October 19, 1999. Notes N.J. Admin. Code § 11:2-13.7 Recodified from N.J.A.C. 11:2-13.9 and amended by R.1999 d.134, effective 4/19/1999. See: 30 New Jersey Register 3356(a), 31 New Jersey Register 1101(a). Rewrote the sectio…

Notes N.J. Admin. Code § 11:2-13.8 Repealed by R.1999 d.134, effective 4/19/1999. See: 30 New Jersey Register 3356(a), 31 New Jersey Register 1101(a). Section was "Separability of provisions".

Notes N.J. Admin. Code § 11:2-13.9 Recodified to N.J.A.C. 11:2-13.7 by R.1999 d.134, effective 4/19/1999. See: 30 New Jersey Register 3356(a), 31 New Jersey Register 1101(a).

(a) This subchapter establishes procedures pursuant to N.J.S.A. 17:17C-5a for the conduct of the vote of the policyholders of a domestic mutual life insurer on a proposal to approve a plan of reorganization to convert from a domestic mutual life insurance company to a domestic st…

In performing any duty set forth in this subchapter or any duty incidental to such tasks, the insurer may utilize the services of a firm that is professionally engaged in the business of mailing materials to shareholders or policyholders and/or soliciting and tabulating sharehold…

Failure to comply with the provisions of this subchapter shall result in the imposition of penalties as authorized by law. Notes N.J. Admin. Code § 11:2-14.11

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Ballot" means the instrument by which a policyholder indicates his approval or disapproval of the plan of reorganization, including, but …

The insurer shall prepare, in electronic format, a list of policyholders eligible to vote on the plan of reorganization, which list shall be subject to review by the Department. The insurer, acting directly or through one or more agents (as specified in N.J.A.C. 11:2-14.1 0), sha…

The insurer shall operate a toll free telephone center ("Demutualization Call Center") to answer questions from policyholders on the plan, including, but not limited to, questions on the method of voting. The insurer shall submit to the Department for its approval, in advance of …

The insurer shall file with the Department its procedures for the printing, mailing, receipt, custody, safeguarding, verification and tabulation of ballots, and measures to prevent ballot tampering. The insurer shall also file with the Department its procedures for IVR and intern…

(a) In order to be counted as a vote cast, a paper ballot shall have, among other things, a valid signature. Absent challenge to any particular paper ballot, a ballot shall be presumed to have been executed by a person over the age of 18 at the time of execution and all signature…

(a) Voting on the plan shall be in accordance with N.J.S.A. 17:17C-5 under the supervision of the Department or its designee(s). At the conclusion of the policyholder meeting, the insurer shall verify and tabulate such votes separately from those received other than in person and…

The Demutualization Call Center shall be equipped to respond to questions from policyholders concerning the voting procedures, but shall not advise policyholders whether to vote in favor of or against the plan. Notes N.J. Admin. Code § 11:2-14.8

The insurer shall establish a mechanism to be filed with the Department which permits policyholders to verify by telephone whether their votes have been received. Notes N.J. Admin. Code § 11:2-14.9

Whenever an insurer is declared insolvent by a court of competent jurisdiction, or its business is suspended under the laws of its state of incorporation, or its certificate of authority is revoked by this State, the company's insurance policies shall be deemed cancelled by said …

(a) Whenever a domestic or foreign surety company which has qualified to transact surety business in this State, in any year, becomes surety in an amount not to exceed $500.00 with respect to any guaranteed arrest bond certificates issued in such year by an automobile club or ass…

N.J.S.A. 17:29B-4(9) and 17B:30-13.1 prohibit insurers from engaging in unfair claims settlement practices. The purpose of this subchapter is to promote the fair and equitable treatment of claimants by defining certain minimum standards for the settlement of claims which, if viol…

(a) This section, unless otherwise noted in this subchapter, is applicable to claims arising under all property/liability coverages. This section is organized so that the requirements for all lines of property/liability insurance are found in (a)1 through 6 below; for automobile …

(a) Upon payment of $ 5,000 or more in settlement of any third-party liability claim, where the claimant is a natural person, the insurer or its representative (including the insurer's attorney) shall mail to the third-party claimant written notice of payment at the same time pay…

(a) Each insurer's claim files are subject to examination and inspection by the Commissioner or by his duly appointed designees pursuant to N.J.S.A. 17:23-20 et seq., 17:29B-5, and 17B:30-16. (b) Detailed documentation and/or evidence shall be contained in each claim file in orde…

(a) If the Department observes that an insurer's claims settlement practices are not meeting the standards established by statute or by this subchapter, the Department may require such insurer to file periodic reports. Depending on the nature and extent of an insurer's deviations…

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) If, after notice and hearing, the Commissioner finds that a person has violated this subchapter, he shall make his findings in writing and shall issue and cause to be served upon the person charged with the violation an order requiring such person to cease and desist from eng…

This subchapter applies to all persons and all policies except the following: ocean marine, fidelity and surety, boiler and machinery and workers' compensation. It shall also not apply to commercial property and liability policies for which the annual premium is more than $ 10,00…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "After market part" means sheet metal or plastic parts which constitute the exterior of an automobile, including inner and outer panels,…

(a) Every insurer shall distribute copies of this subchapter to every person directly responsible for the handling and settlement of claims subject to this subchapter. Every insurer shall satisfy itself that all such responsible persons are thoroughly conversant with and are comp…

(a) No insurer shall fail to fully disclose to first party claimants all pertinent benefits, coverages or other provisions of an insurance policy or insurance contract under which a claim is presented. (b) No agent, broker, or insurer shall conceal from first party claimants bene…