New Jersey Administrative Code

(a) Any acquisition of an equity security (other than a convertible security or right to purchase a security) by a director or officer of the insurer issuing such security shall be exempt from the operation of N.J.S.A. 17:17B-2 upon condition that: 1. The equity security is acqui…

(a) To the extent specified in (b) below, the Commissioner hereby exempts as not comprehended within the purposes of N.J.S.A. 17:17B-2 any transaction or transactions involving the purchase and sale, or sale and purchase, of any equity security where such purchase is pursuant to …

(a) The following transactions shall be exempt from the provisions of N.J.S.A. 17:17B-2 as not comprehended within the purpose of that section: 1. The acquisition of a security of an insurer, pursuant to a merger or consolidation, in exchange for a security of a company which, pr…

(a) Where a person receives shares of stock of a class having general voting power from an insurer, upon the person's surrender of an equal number of shares of stock of the insurer of a class which does not have general voting power, pursuant to provisions of the insurer's certif…

(a) Any acquisition or disposition of securities made in an exchange of shares of a class (or series thereof) of stock of an insurer for an equivalent number of shares of another class (or series thereof) of stock of the same insurer, pursuant to a right of conversion under the t…

Any security shall be exempt from the operation of N.J.S.A. 17:17B-3 to the extent necessary to render lawful under that section the execution by a broker of an order for an account in which he or she has no direct or indirect interest. Notes N.J. Admin. Code § 11:2-9.19 Amended …

With respect to the equity securities of the insurer, any acquisition or disposition of any equity security by a director or officer of the insurer within six months prior to the date on which the Act shall first become applicable shall not be subject to the operation of N.J.S.A.…

(a) Any security shall be exempt from the operation of N.J.S.A. 17:17B-3 to the extent necessary to render lawful under such section any sale made by or on behalf of a dealer in connection with a distribution of a substantial block of securities, upon the following conditions: 1.…

(a) Whenever any person is entitled, as an incident to his ownership of an issued security and without the payment of consideration, to receive another security "when issued" or "when distributed", the security to be acquired shall be exempt from the operation of N.J.S.A. 17:17B-…

It shall be unlawful for any director or officer of an insurer to effect any foreign or domestic arbitrage transaction in any equity security of such insurer, unless he shall include such transaction in the statements required by N.J.S.A. 17:17B-1, and shall account to such insur…

(a) A statement on this form is required to be filed by every person who is directly or indirectly the beneficial owner of more than ten per cent of any class of any equity security of a New Jersey stock insurance company, or who is a director or an officer of such a company. (b)…

For copies of Form A, write to the New Jersey Department of Banking and Insurance, PO Box 325, Trenton, New Jersey 08625-0325. Notes N.J. Admin. Code § 11:2-9.24 Amended by R.1991 d.4, effective 1/7/1991. See: 22 N.J.R. 1673(a), 23 N.J.R. 103(a). Corrected address. Amended by R.2…

(a) Statements on this form are required to be filed by every person who, at any time during any calendar month, was directly or indirectly the beneficial owner of more than ten per cent of any class of equity security of a New Jersey stock insurance company, or a director or off…

For copies of Form B, write to the Department of Banking and Insurance, PO Box 325, Trenton, New Jersey 08625-0325. Notes N.J. Admin. Code § 11:2-9.26 Amended by R.1991 d.4, effective 1/7/1991. See: 22 N.J.R. 1673(a), 23 N.J.R. 103(a). Corrected address. Amended by R.2001 d.6, ef…

(a) Initial statements of beneficial ownership of equity securities required by N.J.S.A. 17:17B-1 shall be filed on Form A. (b) Statements of changes in such beneficial ownership required by N.J.S.A. 17:17B-1 shall be filed on Form B. (c) All such statements shall be prepared and…

(a) In determining, for the purpose of N.J.S.A. 17:17B-1, whether a person is the beneficial owner, directly or indirectly, of more than 10 percent of any class of any equity security (except voting trust certificates or certificates of deposit for equity securities), such class …

Any person filing a statement may expressly declare therein that the filing of such statement shall not be construed as an admission that such person is, for the purpose of the Act, the beneficial owner of any equity securities covered by the statement. Notes N.J. Admin. Code § 1…

(a) During the period of 12 months following their appointment and qualification, securities held by the following persons shall be exempt from N.J.S.A. 17:17B-1 and 17:17B-2: 1. Executors or administrators of the estate of a decedent; 2. Guardians or committees for an incompeten…

Securities purchased or sold by an odd-lot dealer (1) in odd lots so far as reasonably necessary to carry on odd-lot transactions or (2) in round lots to offset odd-lot transactions previously or simultaneously executed or reasonably anticipated in the usual course of business, s…

(a) The acquisition or disposition of any transferable option, put, call, spread or straddle shall be deemed such a change in the beneficial ownership of the security to which such privilege relates as to require the filing of a statement reflecting the acquisition or disposition…

(a) Beneficial ownership of a security for the purpose of N.J.S.A. 17:17B-1 shall include: 1. The ownership of securities as a trustee where either the trustee or members of his immediate family have a vested interest in the income or corpus of the trust; 2. The ownership of a ve…

(a) This chapter implements provisions of P.L. 1992, c.161 (N.J.S.A. 17B:27A-2 et seq.), the Individual Health Insurance Reform Act, as amended. This chapter establishes procedures and standards for carriers to meet their obligations under N.J.S.A. 17B:27A-2 et seq., and establis…

Words and terms contained in the Act, when used in this chapter, shall have the meanings as defined in the Act, unless the context clearly indicates otherwise, or as such words and terms are further defined by this chapter. "Act" means the New Jersey Individual Health Insurance R…

(a) All coverage under individual health benefits plans delivered or issued for delivery with an effective date of August 1, 1993 or thereafter shall comply with this chapter. (b) Health benefits plans not subject to the Act shall remain subject to the full review and approval of…

All health benefits plans delivered or issued for delivery in New Jersey, as defined by this subchapter, shall be subject to the New Jersey Individual Health Insurance Reform Act, as well as all relevant statutes and rules of New Jersey not inconsistent with, amended or repealed …

Notes N.J. Admin. Code § 11:20-1.5 Amended by R.1998 d.443, effective 8/7/1998. See: 30 New Jersey Register 2581(a), 30 New Jersey Register 3289(a). Inserted "plans" following "health benefits". Repealed by R.2006 d.15, effective 1/3/2006. See: 37 New Jersey Register 2994(a), 38 …

The mission of the New Jersey Individual Health Coverage Program Board is to administer the New Jersey Individual Health Coverage Program in a manner aimed at increasing access to coverage, protecting consumers, educating key stakeholders and other interested persons, and promoti…

(a) This subchapter establishes the informational and procedural requirements for members requesting relief from obligations to pay assessments pursuant to N.J.S.A. 17B:27A-12 (including assessments for IHC Program losses and administrative expenses), or to offer coverage or acce…

Nothing in this subchapter shall be construed as limiting the Commissioner's authority to take such action with respect to insurers, health service corporations or health maintenance organizations as may be authorized by law, including, but not limited to, placing an insurer, hea…

Failure to comply with this subchapter, including all notice requirements set forth herein, may result in the denial of relief requested and imposition of penalties as authorized by law, including any actions that may be taken by the Board pursuant to N.J.S.A. 17B:27A-2 et seq. a…

(a) Words and terms defined at N.J.S.A. 17B:27A-2 and N.J.A.C. 11:20-1, when used in this subchapter, shall have the meanings as defined therein, unless more specifically defined in (b) below or unless the context clearly indicates otherwise. (b) The following words and terms, wh…

(a) Any member seeking relief may submit such request to the Department at any time, except that requests for relief from payment of assessments pursuant to N.J.S.A. 17B:27A-12a(3) shall be submitted to the Department no later than 15 days following the due date of payment of the…

(a) When requesting relief from obligations imposed pursuant to N.J.S.A. 17B:27A-4 or N.J.S.A. 17B:27A-12, the applicant shall provide with its request the following information in a clear, concise, and complete manner: 1. A cover letter stating: i. The name of the applicant; ii.…

(a) All data or information contained in the request for relief filed pursuant to this subchapter shall be confidential and shall not be subject to public disclosure or copying pursuant to the "Right to Know" law, N.J.S.A. 47:1A-1 et seq., or the common law right to know, except …

(a) When the Commissioner determines pursuant to N.J.S.A. 17B:27A-8 or N.J.S.A. 17B:27A-12a(3), as applicable, that the member does not have the financial reserves necessary to underwrite additional coverage or is or would be placed in a financially impaired condition through ful…

(a) A member may request a hearing on a determination by the Commissioner within 20 days from the date of receipt of such determination as expressly permitted by the chapter as follows: 1. A request for a hearing shall be in writing and shall include: i. The name, address, daytim…

Members requesting relief pursuant to this subchapter shall concurrently provide written notice of all such requests to the IHC Program through the Executive Director. Members shall also provide written notice to the IHC Program of all dispositions of such requests by the Commiss…

(a) Any member health maintenance organization (HMO) asserting that it is not required to offer coverage or accept applications pursuant to the requirements of the Act because it does not have the capacity to enroll additional members, pursuant to N.J.S.A. 17B:27A-8a, shall file …

This subchapter sets forth the standards for purchasing a standard health benefits plan or a standard health benefits plan with rider by a person who is covered under an individual plan or a group health benefits plan. Notes N.J. Admin. Code § 11:20-12.1 Amended by R.2013 d.130, …

Notes N.J. Admin. Code § 11:20-12.2 Amended by R.2009 d.45, effective 12/29/2008. See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b). Added definition "Special open enrollment period". Amended by R.2011 d.163, effective 6/6/2011. See: 43 N.J.R. 131(a), 43 N.J.R. 1353(a). Deleted definition…

Notes N.J. Admin. Code § 11:20-12.3 Reserved by 48 N.J.R. 2153(a), effective 10/17/2016

(a) Except as stated in N.J.A.C. 11:20-12.5 with respect to the special enrollment period, a person who is covered under a standard health benefits plan, standard health benefits plan with rider, or group health benefits plan may only elect during the annual open enrollment perio…

Notes N.J. Admin. Code § 11:20-12.4A New Rule, R.2011 d.254, effective 9/13/2011 (operative November 1, 2011). See: 43 N.J.R. 1813(a), 43 N.J.R. 2668(a). Repealed by R.2013 d.130, effective 10/1/2013 (operative January 1, 2014). See: 45 N.J.R. 2310(a), 45 N.J.R. 2385(a). Section …

(a) A person covered under a standard health benefits plan or a standard individual health benefits plan with a rider or group health benefits plan may enroll for coverage under a different standard health benefits plan or standard individual health benefits plan with a rider dur…

(a) This subchapter provides for the quarterly submission of enrollment status reports by all members of the IHC Program, and sets forth the procedures for filing those reports. (b) This subchapter applies to all members of the IHC Program that issue or renew standard health bene…

(a) Words and terms defined at N.J.S.A. 17B:27A-2 and N.J.A.C. 11:20-1, when used in this subchapter, shall have the meanings as defined therein, unless more specifically defined in (b) below or unless the context clearly indicates otherwise. (b) The following words and terms, wh…

(a) Every member of the IHC Program issuing or renewing standard health benefits plans shall complete and file with the Board the enrollment status reports required by this subchapter. (b) Members shall file enrollment status reports on a quarterly basis reflecting the informatio…