New Jersey Administrative Code

Failure to comply with the provisions of this subchapter may result in the imposition of penalties as authorized by law, including, but not limited to, penalties set forth in N.J.S.A. 17:33-2. Notes N.J. Admin. Code § 11:1-6.5

(a) The purpose of these rules is to implement N.J.S.A. 17:30D-17(a), (b), and (h). These statutory provisions require insurers, insurance associations and licensed medical practitioners to notify the Commissioner and the Medical Practitioner Review Panel of any medical malpracti…

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. "Medical malpractice liability insurance" mea…

(a) Any insurer or insurance association authorized to issue medical malpractice liability insurance in the State shall notify the Medical Practitioner Review Panel in writing of the following: 1. Any medical malpractice claim settlement, judgment or arbitration award involving a…

All information or documentation submitted to the Panel pursuant to this subchapter is confidential, except for release to a government agency under certain circumstances and conditions as set forth at N.J.S.A. 45:9- 19.10. Notes N.J. Admin. Code § 11:1-7.4 Amended by 51 N.J.R. 7…

(a) Any insurer, insurance association or practitioner failing to notify the Medical Malpractice Review Panel pursuant to the requirements of this subchapter shall be subject to such penalties as the Commissioner may determine in accordance with N.J.S.A. 17:30D-12. Additionally, …

(a) The Dental Plan Organization Act (N.J.S.A. 17:48D-1 et seq.) regulates persons and corporations which offer plans for the provision of dental services on other than a pure fee-for-service basis. The Act provides for the licensing and supervision of dental plan organizations t…

(a) Complaint systems required of every DPO (see N.J.S.A. 17:48D-12) shall provide that a written response shall be furnished to the covered person within 30 days after its receipt of a written complaint. The DPO's response shall, based on the information available to it at the t…

(a) The minimum amount of the fidelity bond, or crime insurance or its equivalent, on each director, officer, partner or employee of the DPO who receives, collects, reimburses or invests moneys in connection with the activities of the organization shall be $ 50,000. 1. Every DPO …

(a) A DPO shall file a schedule of premiums at least annually. Every new or revised schedule of premiums shall be filed with the Commissioner at least 60 days prior to the effective date of coverage using that schedule of premiums. The Commissioner may disapprove a schedule of pr…

(a) Any DPO which violates any provision of this subchapter shall be subject to the appropriate penalty for violations of N.J.S.A. 17:48D-1 et seq., including suspension, nonrenewal or revocation of its certificate of authority. (b) Any DPO that fails to reply to any inquiry of t…

If any provision of this subchapter, or its application to any person or circumstances, is held invalid, the remainder of this subchapter and its application to other persons or circumstances shall not be affected. Notes N.J. Admin. Code § 11:10-1.14 Recodified from 11:10-1.14 by…

Notes N.J. Admin. Code § 11:10-1.15 Recodified to N.J.A.C. 11:10-1.14 by R.2011 d.227, effective 9/6/2011. See: 43 N.J.R. 124(a), 43 N.J.R. 2347(a). Section was "Separability".

(a) This subchapter applies to dental plan organizations as defined in N.J.S.A. 17:48D-2c and N.J.A.C. 11:10-1.3. Such organizations may offer group and individual dental plans on other than a pure fee-for-service basis. (b) If the dental plan organization utilizes more than one …

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Alternative payment" means a type of payment to a DPO contracted dentist based upon a payment methodology approved by the Department. "…

(a) Any person desiring to establish, operate or administer a dental plan organization shall apply to the Commissioner for a certificate of authority. An application for a certificate of authority as a dental plan organization is available on the Department's website at www.state…

(a) Every DPO shall enter into a written agreement with each dentist who will be providing dental services for plan covered persons, unless the dentist is employed by the DPO. (b) DPOs shall file with the Commissioner at least 60 days prior to the planned date of use a copy of th…

(a) The DPO shall prepare and issue the evidence of coverage to each enrollee within 60 days of the effective date of coverage or of a change in coverage. Covered groups may distribute the forms to covered persons on behalf of the DPO. (b) The evidence of coverage must contain al…

(a) Every DPO shall submit a quarterly report and the DPO Supplement to the Quarterly Report for each of the first three calendar quarters ending March, June and September within 45 days of the end of each quarter. Every DPO shall also submit the DPO Supplement to the Annual Repo…

(a) Every DPO shall accumulate and maintain a minimum general surplus as set forth in this subsection, of which $ 50,000 shall be deposited with the Commissioner pursuant to N.J.A.C. 11:2-32 either within 90 days of the approval of the certificate of authority or by December 31, …

(a) To achieve compliance with the expense limits set forth in N.J.S.A. 17:48D-14, every DPO shall: 1. Use at least 70 percent of its New Jersey premium in the first calendar year of operation, 75 percent in the second calendar year, and 80 percent in all subsequent calendar year…

P.L. 1983, Chapters 142 through 145, require that each employer or other organization subject thereto offer its employees or members the option of selecting alternate coverage which permits covered persons to obtain dental services from any dentist of their choice whenever the em…

(a) This subchapter applies to each employer or other organization which: 1. Employs or has 25 or more employees or members during the full preceding calendar year; and 2. Contributes to a dental plan contract. (b) Insurers, dental plan organizations, and dental service corporati…

The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise: "Alternative coverage" means a plan that permits covered persons to obtain dental services from any licensed dentist. "Dental plan contract" me…

(a) An insurer, dental plan organization and dental service corporation shall provide to each employer or other organization to which this subchapter applies a copy of N.J.S.A. 17:48D-9.1 and 9.2 (as appropriate) and this subchapter at the time of offering a dental plan contract …

(a) Each health insurer, dental service corporation, or dental plan organization shall, at the time a dental plan contract is offered or at the time of renewal, obtain written verification from each employer or other organization of compliance with P.L. 1983, c. 142 through 145, …

If any provision of this subchapter, or its application to any person or circumstances, is held invalid, the remainder of this subchapter and its application to other persons or circumstances shall not be affected. Notes N.J. Admin. Code § 11:10-2.6 Amended by R.1985 d.220, effec…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Commissioner" means the New Jersey Commissioner of Banking and Insurance. "Insurer" means any person who obtains a certificate of autho…

(a) An insurer defined in N.J.S.A. 17:46C-3.b may transact the business of legal insurance in New Jersey after satisfying the following conditions: 1. Notify the Commissioner of the intent to write legal insurance, submit satisfactory evidence of authorization to transact the bus…

An insurer transacting legal insurance in New Jersey shall submit experience reports on or before the first day of March which will be based on activities up through the prior December 31 on a form to be prescribed by the Commissioner. Notes N.J. Admin. Code § 11:12-1.3 Repealed …

An insurer who obtains a certificate of authority under N.J.S.A. 17:46C-4 shall submit an annual report on or before the first day of March on a form to be prescribed by the Commissioner. Notes N.J. Admin. Code § 11:12-1.4 Amended by 46 N.J.R. 1884(a), effective 9/2/2014.

The Commercial Insurance Deregulation Act of 1982 (N.J.S.A. 17:29AA-1 et seq.) establishes a separate rating law for commercial lines insurance and exempts such lines from the provisions of N.J.S.A. 17:29AA-1 et seq. except as provided by the Act. This chapter provides rules for …

(a) This chapter applies to all policies or contracts of insurance issued by a licensed insurer pursuant to Title 17 of the Revised Statutes except: 1. Ocean marine, title, mortgage guaranty, workers' compensation and employers' liability, and policy or contract of reinsurance, o…

The following words and terms, when used in this chapter, have the following meanings unless the context clearly indicates otherwise. "Advisory organizations" means any group, association or other organization of insurers, whether located within or outside this State, that assist…

(a) Pursuant to N.J.S.A. 17:29AA-10, rates shall not be made or used which are excessive, inadequate or unfairly discriminatory. (b) Pursuant to N.J.S.A. 17:29AA-11 policy forms shall not be unfair, inequitable, misleading or contrary to law, nor shall they produce rates, which a…

If any provision of this chapter, or its application to any person or circumstances is held to be invalid, the remainder of this chapter and its application to the other persons or circumstances shall not be affected. Notes N.J. Admin. Code § 11:13-1.5

(a) This subchapter sets forth procedures and requirements for the filing of commercial lines rates, supplementary rate information and policies. The requirements of this subchapter shall not be applicable to: 1. Policy forms exempted by order of the Commissioner; or 2. Rates, su…

(a) Filings containing changes in rates, supplementary rate information, including any manual rules or plans, or in policy forms or endorsement required to be filed with the Department shall be presented in the following fashion: 1. A copy of the page or pages containing the pass…

(a) If a filer adopts rates or supplementary rate information used by other filers or proposes to adopt policy forms or endorsements previously approved (or deemed approved) for other filers in New Jersey, the filing shall clearly identify such reference including the name of the…

Policy forms and supplementary rate information such as manual rules or rating plans are rarely entirely new. Most such filings are built upon something previously or currently in use. Any required action with respect to such filings will be expedited if they are identified as to…

Notes N.J. Admin. Code § 11:13-2.5 Amended by R.2002 d.101, effective 4/1/2002. See: 33 N.J.R. 1875(a), 34 N.J.R. 1431(b). Rewrote the section. Amended by R.2003 d.21, effective 1/6/2003. See: 34 N.J.R. 2947(a), 35 N.J.R. 252(a). In (a) and (b), added "or advisory organizations" …

(a) This subchapter sets forth procedures and requirements which are applicable to various categories of commercial lines risks herein designated as special risks pursuant to section 3.k of Commercial Insurance Deregulation Act of 1982. Such special risks are: 1. Commercial lines…

The Commissioner may require the filing of such additional reports, including expense statistics with respect to special risks written by insurers, as he deems necessary to implement the provisions of the Commercial Insurance Deregulation Act of 1982 and this chapter. Notes N.J. …

The underwriting files, premium, loss and expense statistics, financial and other records with respect to special risks written by an insurer shall be maintained in such detail as may be required by the Commissioner and shall be subject to examination by the Commissioner or his d…

(a)N.J.A.C. 11:4-7 including all subsequent amendments and supplements is hereby adopted as a rule with the modification indicated in (b) below. 1. This document is available for review at or may be purchased from the New Jersey Department of Banking and Insurance, 20 West State …

(a) This subchapter establishes standards for commercial insurance rating plans to modify rates in the development of premiums for specific risks. (b) These standards are intended to: 1. Recognize expected loss differentials based on factors applied using sound underwriting princ…

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. "Base rate" means the unit charge by which the measure of exposure or the amount of insurance specified in a policy of insurance or cover…