New Jersey Administrative Code

The following words and terms, as 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 res…

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

(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 less than 24 months after the end of the fiscal year. (b) The fund may seek approval from the …

(a) All disbursements, payment 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 board of trustees, unless approved pursuant to (b) below. (b) To allow t…

(a) Consistent with N.J.A.C. 11:15-4.6(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 with the Department, and made available to each fund member on or before December 31 of each year. The report shall include: 1. An annual audited statement of the financi…

(a) In addition to any examination conducted pursuant to N.J.A.C. 11:15-4.6(g), 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 appointed pursuant to N.J.A.C. 11:15-4.6(d)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 director of the …

All school officials and members of their immediate families shall comply with N.J.S.A. 18A:12-21 et seq. (the "School Ethics Act"), and any other applicable law governing the conduct of members, officers or employees of school boards. Notes N.J. Admin. Code § 11:15-4.27

(a) The Commissioner shall give prior written notice of any proposed suspension, revocation of authority, cease and desist order, or other enforcement action to the trustees or member as the case may be, or to any person to whom the proposed enforcement action applies specificall…

(a) After notice and opportunity for a hearing, as provided in N.J.A.C. 11:15-4.2 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) Any two or more boards of education may form and become members of a school board joint insurance fund. A school board may take this action by resolution of the board. (b) The resolution shall provide for execution of a written agreement specifically conditioning membership o…

(a) Except as otherwise specifically provided in this subchapter, funds subject to this subchapter shall comply with all of the requirements contained in this subchapter commencing with the fund year immediately following June 17, 1996, or December 14, 1996, whichever is later. (…

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 Public Schools Contracts Law (N.J.S.A. 18A:18A-1 et seq.) and the applicable regulations of the State Investment Council governing the investment of surplus public monies of th…

(a) Each joint insurance fund shall file with the Department for approval by the Commissioner, as provided in N.J.S.A. 18A:18B-4, its bylaws and risk management program and any amendments thereto. In addition, the initial filing shall contain and be accompanied by the information…

(a) The trustees shall prepare and, after the approval by resolution of the governing body of each participating member, shall adopt bylaws for the joint insurance fund. The bylaws shall: 1. Set forth a statement of purpose of the group; 2. Set forth provisions for organization o…

If the Commissioner determines that the bylaws or risk management program of the fund or any subsequent amendments thereto do not contain all of the information set forth in N.J.A.C. 11:15-4.6, are not submitted in the proper format set forth in N.J.A.C. 11:15-4.5, 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 board of trustees on a form acceptable to the Commissioner. The application shall include a copy of the resolution of participation and executed indemnity and trust agreement. The tru…

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

(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. 11:15-5.6(c)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 trustees fail to assess funds required to meet the obligations of the fund, the chairman of the board of…

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 at least 12 months by filing a notification of its intent to do so with the Department with appropriate documentation, including, but not limited t…

(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 trustees, unless approved pursuant to (b) below. (b) To allow the exped…

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

(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 with the Department, and made available to each fund member not later than December 31 for the end of the immediately preceding fiscal year. The report shall include:1. An ann…

(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. 11:15-5.6(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 school officials and members of their immediate families shall comply with N.J.S.A. 18A:12-22 et seq., (the "School Ethics Act"), and any other applicable law governing the conduct of members, officers or employees of school boards. Notes N.J. Admin. Code § 11:15-5.27

(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 trustees or member as the case may be, or to any person to whom the proposed enforcement action applies specificall…

(a) After notice and opportunity for a hearing, as provided in N.J.A.C. 11:15-5.2 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) Any two or more boards of education may form and become members of a school board joint insurance fund formed for the sole purpose of providing contributory or non-contributory group health and term life benefits to the members' employees and their dependents. A school board …

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 "Public Schools Contracts Law" (N.J.S.A. 18A:18A-1 et seq.), and the applicable regulations of the State Investment Council governing the investment of surplus public monies of…

(a) Each joint insurance fund shall file with the Department for approval by the Commissioner as provided in N.J.S.A. 18A:18B-4, its bylaws and risk management program and any subsequent amendments thereto. In addition, the initial filing shall contain and be accompanied by the i…

(a) The prospective trustees of a joint insurance fund shall prepare and, after the approval by resolution of the governing body of each participating member, adopt bylaws for the joint insurance fund. The bylaws shall: 1. Set forth a statement of purpose of the group; 2. Set for…