New Jersey Administrative Code

(a) The purpose of this subchapter is to provide: 1. Tables of select mortality factors and rules for their use; 2. Rules concerning a minimum standard for the valuation of plans with non-level premiums or benefits; and 3. Rules concerning a minimum standard for the valuation of …

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Appointed actuary" means any individual who is appointed or retained in accordance with the requirements set forth at N.J.A.C. 11:1-21A.3…

(a) At the election of the insurer for any one or more specified plans of life insurance, the minimum mortality standard for basic reserves may be calculated using the 1980 CSO valuation tables with select mortality factors (or any other valuation mortality table adopted by the N…

(a) Basic reserves shall be calculated as the greater of the segmented reserves and the unitary reserves. Both the segmented reserves and the unitary reserves for any policy shall use the same valuation mortality table and selection factors. At the option of the insurer, in calcu…

(a) Policies with a secondary guarantee include: 1. A policy with a guarantee that the policy will remain in force at the original schedule of benefits, subject only to the payment of specified premiums; 2. A policy in which the minimum premium at any duration is less than the co…

This subchapter shall become operative January 1, 2000, except that insurers meeting the requirements of N.J.A.C. 11:4-32.1(c)6 and obtaining the approval of the Commissioner to calculate reserves for policies issued prior to January 1, 2000 using the methods and assumptions desc…

This subchapter establishes procedures for modifying the calculation of excess interest reserves when a life insurer guarantees to credit policy values with interest which exceeds the maximum valuation rate prescribed in N.J.S.A. 17B:19-8. This subchapter does not limit or restri…

This subchapter applies to all life insurance policies, pure endowment and annuity contracts issued by an insurer transacting business in this State in which the insurer has committed to crediting interest to policy values for any period that extends beyond the valuation date at …

(a) In addition to the basic policy reserve required under N.J.S.A. 17B:19-8, a life insurer is also required by N.J.S.A. 17B:19-8 to establish an excess interest reserve whenever the insurer has committed to crediting interest to policy values for any period of time that extends…

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) The purpose of this subchapter is to implement the New Jersey Long-Term Care Insurance Act, P.L. 2003, c. 207, codified at N.J.S.A. 17B:27E-1 et seq., and to promote the public interest and the availability of long-term care insurance coverage, to protect applicants for long-…

(a) A long-term care insurance policy or certificate, if it provides benefits for home health care or community care services, shall not limit or exclude benefits: 1. By requiring that the insured would need care in a skilled nursing facility if home health care services were not…

(a) No carrier may offer a long-term care insurance policy unless the carrier also offers to the policyholder, in addition to any other inflation protection, the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations…

(a) Application forms shall not include provisions, statements or questions that: 1. Pertain to race, creed, color, national origin or ancestry of the proposed insured; 2. Change the terms of the policy to which it is attached; 3. State that the applicant has not withheld any inf…

(a) Every carrier shall maintain records for each agent of that agent's amount of replacement sales as a percent of the agent's total annual sales and the amount of long-term care insurance policies sold by the agent that lapsed as a percent of the agent's total annual sales. (b)…

A producer is not authorized to sell, solicit or negotiate with respect to long-term care insurance except as authorized by the New Jersey Insurance Producer Licensing Act of 2001, N.J.S.A. 17:22A-26 et seq. Notes N.J. Admin. Code § 11:4-34.14

(a) The Commissioner may, upon written request and after an administrative hearing, issue an order to modify or suspend a specific provision or provisions of this subchapter with respect to a specific long-term care insurance policy or certificate upon a written finding that: 1. …

(a) When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves for the benefits shall be determined in accordance with N.J.S.A. 17B:19-8a.vii. Claim reserves shall also be esta…

(a) This section applies to all rates for individual long-term care policies except those covered pursuant to N.J.A.C. 11:4-34.8 and 34.18. (b) Premiums and benefits under long-term care insurance policies whose rates are subject to this section shall meet the loss ratio requirem…

(a) This section applies to any individual long-term care policy issued in this State on or after January 18, 2006 and for which initial rates were filed pursuant to N.J.A.C. 11:4-34.8. (b) A carrier shall request approval of a revised premium rate schedule, including an exceptio…

(a) Prior to a carrier offering or placing in force group long-term care insurance coverage to or on a resident of this State under a group policy issued in another state pursuant to N.J.S.A. 17B:27E-5b, it shall file with the Commissioner evidence that the group policy or certif…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Applicant" means: 1. In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and 2. …

Notes N.J. Admin. Code § 11:4-34.20 Repealed by R.2010 d.114, effective 6/21/2010. See: 41 N.J.R. 4054(a), 42 N.J.R. 1208(a). Section was "Filing requirements for advertising".

(a) Every carrier marketing long-term care insurance coverage in this State, directly or through its producers, shall:1. Establish marketing procedures and agent training requirements to assure that: i. Any marketing activities, including any comparison of policies, by its agents…

(a) This section shall not apply to life insurance policies and annuities that only accelerate benefits for long-term care, but shall apply to any other life insurance policy and annuity contract providing long-term care benefits. (b) Every carrier marketing long-term care insura…

If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing carrier shall waive any time periods applicable to preexisting conditions and probationary periods in the new long-term care policy or certificate for similar …

(a) This section does not apply to life insurance policies, annuity contracts, or riders providing long-term care benefits only through acceleration of life or annuity benefits. Such life insurance policies, annuity contracts, or riders must have nonforfeiture benefits that compl…

(a) A long-term care insurance policy or certificate shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits shall not be more restrictive than r…

(a) For purposes of this section, the following definitions apply: 1. "Qualified long-term care services" means services that meet the requirements of Section 7702(c)(1) of the Internal Revenue Code of 1986, as amended, as follows: necessary diagnostic, preventive, therapeutic, c…

(a) This section implements, interprets and makes specific the provisions of N.J.S.A. 17B:27E-6e in prescribing a standard format and the content of an outline of coverage. 1. The outline of coverage shall be a freestanding document, using no smaller than 10-point type. 2. The ou…

(a) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the Commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate…

(a) No individual producer licensed on or after February 17, 2009 may sell, solicit or negotiate long-term care insurance unless the individual is licensed as an insurance producer for accident and health or sickness or life insurance pursuant to N.J.S.A. 17:22A-26 et seq. and ha…

(a) No long-term care insurance policy delivered or issued for delivery in this State shall use the terms set forth below, unless the terms are defined in the policy and the definitions are consistent with the following: 1. "Activities of daily living" means at least bathing, con…

(a) In order to qualify for New Jersey's Long-Term Care Partnership Program, a long-term care insurance policy shall satisfy the following requirements: 1. The policy shall cover an insured who was a New Jersey resident at the time coverage first became effective under that polic…

Long-term care insurance policies that are to be delivered or issued for delivery in this State, and certificates and riders for use with such policies, shall be submitted to the Department for review and approval prior to use pursuant to the procedures in N.J.A.C. 11:4-40. Notes…

In addition to any other penalties provided by the laws of this State, any carrier and any agent found to have violated any requirement of this State relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to thre…

(a) Renewability: The terms "guaranteed renewable" and "noncancellable" shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of N.J.A.C. 11:4-34.6 and 34.7. 1. A policy issued to an…

(a) Each carrier offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following: 1. Notice before lapse or termination. i. No individual long-term care policy or group certificate shall be issued until the carrier has received from…

(a) Renewability: Individual long-term care insurance policies shall contain a renewability provision. 1. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state that the coverage is guaranteed renewable or noncancella…

(a) This section applies to any long-term care policy or certificate issued on or after December 19, 2005. (b) Other than policies for which no applicable premium rate or rate schedule increases can be made, carriers shall provide all of the information listed in this subsection …

(a) This section applies to any long-term care insurance policy or certificate issued in this State on or after June 19, 2006. Carriers may opt to comply with this section prior to June 19, 2006. (b) A carrier shall provide the information listed below to the Commissioner at leas…

(a) Carriers must complete underwriting prior to issuing a policy or certificate and are prohibited from reunderwriting at the time of claim. (b) All applications for long-term care insurance policies or certificates except those that are guaranteed issue, that is, that are issue…

(a) The purpose of this subchapter is to implement N.J.S.A. 17B:30B-1 et seq., governing viatical settlements. (b) This subchapter applies to persons who enter into agreements with New Jersey residents to purchase their life insurance policies for less than the current death bene…

(a) Viatical settlement providers and viatical settlement brokers are prohibited from entering into viatical settlements with viators who are insured policyowners or certificateholders of individual or group life insurance policies containing accelerated death benefit provisions …

(a) On or before March 1 of each year, each viatical settlement provider licensed in this State shall make and file with the Commissioner a report of all viatical settlement transactions where the viator is a resident of this State and for all states in the aggregate containing t…

(a) With respect to policies containing a provision for double or additional indemnity for accidental death, the additional payment shall remain payable to the beneficiary last named by the viator prior to entering into the viatical settlement contract, or to such other beneficia…

(a) A viatical settlement provider, viatical settlement broker or viatical settlement representative shall not discriminate in the making or solicitation of viatical settlements on the basis of race, age, sex, national origin, creed, religion, occupation, marital or family status…

(a) If a viatical settlement provider enters into a viatical settlement that allows the viator to retain an interest in the policy, the viatical settlement contract shall contain the following provisions: 1. A provision that the viatical settlement provider will effect the transf…

Advertising related to the viatical settlement shall be truthful and not misleading by fact or implication. If the advertiser emphasizes the speed with which the viatication will occur, the advertising shall disclose the average time frame from completed application to the date o…

(a) A disclosure document containing the disclosures required in N.J.S.A. 17B:30B-8 and this subchapter shall be provided to the viator before or concurrent with taking an application for a viatical settlement contract. (b) The disclosure document shall contain the following lang…