New Jersey Administrative Code

Words and terms, when used in this subchapter, shall have the meanings set forth in the Act or at N.J.A.C. 11:20-1.2, unless defined below or unless the context clearly indicates otherwise: "Cease doing business" for purposes of this subchapter means market withdrawal. "Individua…

No carrier with in force individual plans shall cancel an individual plan, except in accordance with N.J.S.A. 17B:27A-6, or nonrenew an individual plan upon the plan's anniversary date, except in accordance with N.J.A.C. 11:20-18.5, 18.6, or 18.7. Notes N.J. Admin. Code § 11:20-1…

(a) No carrier with in force individual plans shall cease to offer and issue all of its individual plans to an eligible person unless the Commissioner has determined pursuant to N.J.S.A. 17B:27A-8b and N.J.A.C. 11:20-11 that the carrier does not have the financial resources neces…

(a) No carrier with in force individual plans, whether or not affiliated with other carriers doing business in the individual plan market in New Jersey, shall refuse to issue or refuse to renew an individual plan, except in accordance with N.J.S.A. 17B:27A-6, or in accordance wit…

(a) No carrier shall cease to issue or nonrenew an individual plan, plan option, or deductible/copayment option required or permitted to be offered by N.J.A.C. 11:20-3.1 until the carrier submits a notice of intent to withdraw a plan, plan option, or deductible/copayment option t…

A carrier that ceases to do business pursuant to N.J.A.C. 11:20-18.5 shall be prohibited from writing new individual plans and new small employer plans in New Jersey for a period of five years beginning on the termination date of the last standard individual health benefits plan …

(a) A carrier issuing all of the standard individual plans in the IHC market on and before January 4, 2009 that elects to offer at least three but not all of the standard individual plans after January 4, 2009, as permitted by N.J.S.A. 17B:27A-4b, that has in-force business in th…

Nothing in this subchapter shall be construed to contravene any rights of policy or contractholders concerning other obligations set forth in a policy or contract issued by a carrier. Notes N.J. Admin. Code § 11:20-18.9

This subchapter shall apply to all petitions to the Board by interested persons to adopt a new rule, or amend or repeal any existing rule by the Board, pursuant to N.J.S.A. 52:14B-4(f). Notes N.J. Admin. Code § 11:20-19.1 Amended by R.2006 d.15, effective 1/3/2006. See: 37 N.J.R.…

(a) Any person who wishes to petition the Board to adopt a new rule or amend or repeal any existing rule shall submit to the Board, in writing, the following information: 1. Name, address, phone, fax, and email address of the petitioner; 2. The substance or nature of the rulemaki…

(a) Upon receipt of a petition in compliance with N.J.A.C. 11:20-19.2, the Board shall file, within 15 days, a notice of petition with the Office of Administrative Law for publication in the New Jersey Register. The notice shall include: 1. The name of the petitioner; 2. The subs…

(a) The "IHC Program" created pursuant to the N.J.S.A. 17B:27A-2 to 16, as amended, has as its members all insurance companies, health service corporations, hospital service corporations, medical service corporations, and health maintenance organizations that issue or have in for…

(a) The Board shall establish the policy and contract forms and benefit levels (standard health benefits plans) to be made available by members. 1. In designing and amending the standard health benefits plans, the Board shall give consideration to the types of coverage currently …

Notes N.J. Admin. Code § 11:20-2.11 Repealed by R.1998 d.443, effective 8/7/1998. See: 30 New Jersey Register 2581(a), 30 New Jersey Register 3289(a). Section was "Assessment for 1992 total reimbursable net paid losses".

(a) Except as described in (a)4 below, every member shall be liable for a portion of the administrative expenses of the IHC Program. Within 90 days of approving a final audited statement of the IHC Program financial statements and the conclusion of all appeals of assessments for …

Notes N.J. Admin. Code § 11:20-2.13 Amended by R.1998 d.443, effective 8/7/1998. See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a). Substituted "Executive Director at the address listed in N.J.A.C. 11:20-2.1(h)" for "Interim Administrator (or Administrator)". Amended by R.2006 d.15, effe…

If a member determined liable for an assessment fails to pay the full amount of the assessment and applicable interest, if any, within 60 days of the date of the invoice, and has neither submitted notice that it is seeking a deferral from the Commissioner, nor requested a hearing…

(a) A member seeking to challenge the amount of an assessment must do so within 20 days of receiving the notice of the assessment pursuant to the procedures for appeals set forth at N.J.A.C. 11:20-20.2. (b) If the Board determines that the nature or extent of errors or conduct by…

(a) The participation in the IHC Program as a member, the establishment of rates, forms or procedures, or any other joint or collective action required by the Act shall not be the basis of any legal action, criminal or civil liability, or penalty against the IHC Program, member o…

Notes N.J. Admin. Code § 11:20-2.17 New Rule, R.1994 d.165, effective 3/1/1994. See: 26 N.J.R. 1200(a), 26 N.J.R. 1507(b). Amended by R.1998 d.443, effective 8/7/1998. See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a). Rewrote the section. The expiration date of N.J.A.C. 11:20-2.17 was e…

If the total amount of a member's assessment invoice would be less than $ 5.00, the member shall not be liable for that amount and that amount shall be reapportioned pursuant to N.J.A.C. 11:20-2.12. This provision shall apply to an invoice for administrative expenses issued pursu…

(a) Words and terms defined at N.J.S.A. 17B:27A-2 as amended, 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 a…

(a) The IHC Program shall have the general powers and authority granted under the laws of this State to insurance companies, health service corporations and health maintenance organizations licensed or approved to transact business in this State, except that the IHC Program shall…

The Plan of Operation and amendments thereto shall become effective upon approval by the Commissioner and submission of final action to the Office of Administrative Law for publication. The Commissioner may amend the Plan of Operation by providing written notice to the Board of a…

(a) The Board shall consist of nine Directors, including the Commissioner or his or her designee, who shall sit ex officio. 1. Four Directors shall be appointed by the Governor, with the advice and consent of the Senate. i. One of the Governor's appointees shall be a representati…

(a) The Board shall make appointments to standing and other committees from among Directors. Each of the standing committees shall include no more than four Directors, but the Chair may appoint additional Directors as needed subject to ratification by the Board at the next subseq…

(a) The fiscal year of the IHC Program shall run from July 1 of each year to June 30 of the following year. (b) All funds of the IHC Program shall be deposited into and disbursements made from the General Treasury in accordance with procedures established and approved by the Depa…

(a) The Board shall have an annual audit of its operations conducted by a qualified independent certified public accountant. 1. The auditor shall be selected and approved by the Board through a competitive bidding process of certified public accountants qualified in New Jersey to…

(a) The Board shall provide for the maintenance and retention of its official records, and may delegate this function to the Executive Director. (b) The Board's records shall consist of the following: 1. Minutes of all Board meetings; 2. Written reports and recommendations of com…

This subchapter shall apply to all appeals from Board determinations and requests for hearing as expressly provided pursuant to this chapter. Notes N.J. Admin. Code § 11:20-20.1 Amended by R.2006 d.15, effective 1/3/2006. See: 37 New Jersey Register 2994(a), 38 New Jersey Registe…

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

Notes N.J. Admin. Code § 11:20-22.1 Reserved by 48 N.J.R. 2153(a), effective 10/17/2016

Notes N.J. Admin. Code § 11:20-22.2 Reserved by 48 N.J.R. 2153(a), effective 10/17/2016

Notes N.J. Admin. Code § 11:20-22.3 Reserved by 48 N.J.R. 2153(a), effective 10/17/2016

Notes N.J. Admin. Code § 11:20-22.4 Reserved by 48 N.J.R. 2153(a), effective 10/17/2016

Notes N.J. Admin. Code § 11:20-22.5 Reserved by 48 N.J.R. 2153(a), effective 10/17/2016

Notes N.J. Admin. Code § 11:20-22.6 Reserved by 48 N.J.R. 2153(a), effective 10/17/2016

Notes N.J. Admin. Code § 11:20-22.7 Reserved by 48 N.J.R. 2153(a), effective 10/17/2016

(a) The purpose of N.J.A.C. 11:20-23.2 through 23.5 is to establish the procedures that the Board uses in rulemaking made pursuant to the New Jersey Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq. The purpose of N.J.A.C. 11:20-23.6 is to establish procedures for public no…

(a) The Board shall provide the following types of public notice for rule proposals pursuant to the New Jersey Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30: 1. The rule proposal shall be f…

(a) The Board, pursuant to the New Jersey Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, may extend the time for submission of public comments on a proposed rulemaking, at its discretion, w…

(a) The Board, in accordance with the New Jersey Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq., and the Office of Administrative Law Rules for Agency Rulemaking, N.J.A.C. 1:30, may conduct a public hearing on a proposed rulemaking, at its discretion, without the need fo…

The Board shall provide notice of new rules, amendments, repeals, or adoptions by posting these rules on its website at www.dobi.nj.gov and to the news media maintaining a press office in the State House complex. Notes N.J. Admin. Code § 11:20-23.5 Amended by 48 N.J.R. 2153(a), e…

(a) The Board shall adopt an annual schedule of regular meetings to be held during the following calendar year. (b) The Board may schedule meetings in addition to those set forth in the annual schedule. (c) The Board shall provide public notice for all meetings by: 1. Posting a n…

(a) For the purpose of disseminating information about the IHC Program, including, but not limited to, information about meeting dates and rulemaking made pursuant to either the New Jersey Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq. or N.J.S.A. 17B:27A-16.1, the Board…

(a) This subchapter sets forth the standards all carriers must meet in offering and issuing standard health benefits plans and standard health benefits plans with riders to eligible persons off the Marketplace in New Jersey. (b) This subchapter sets forth requirements with which …

(a) The policyholder of a standard health benefits plan or a standard health benefits plans with rider shall be a resident, as defined at N.J.A.C. 11:20-1.2. A carrier may require reasonable proof of residency. A dependent of the policyholder may be a nonresident of New Jersey, b…