New Jersey Administrative Code

(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…

Notes N.J. Admin. Code § 11:4-44.5 Repealed by R.2003 d.54, effective 2/3/2003. See: 34 New Jersey Register 3194(a), 35 New Jersey Register 618(a). Section was "Standards for individual market value adjusted annuities".

(a) These rules set forth the standards and requirements for periodic reports required to be provided to policyholders or contract holders in connection with flexible-factor life insurance forms, individual variable annuity forms, and variable life insurance forms to be filed by …

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 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…