New Jersey Administrative Code

(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-38 shall be submitted to the Department no later than 15 days following the due date of payment of the ass…

(a) When requesting relief from obligations pursuant to N.J.S.A. 17B:27A-26b or 17B:27A-38, 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. The form of rel…

(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., except for the following items, but only…

(a) When the Commissioner determines pursuant to N.J.S.A. 17B:27A-26b or 17B:27A-38 as applicable, that the member is or would be placed in a financially impaired condition through fulfillment of a coverage or assessment obligation or obligations, the Commissioner shall notify th…

(a) If the Commissioner denies a member's request for relief made pursuant to this subchapter, or if the member objects to the terms of the relief granted, the member may request a hearing on the Commissioner's determination within seven days from the date of receipt of such dete…

Members requesting relief pursuant to this subchapter shall concurrently provide notice of all such requests to the SEH Program through the Interim Administrator or Administrator, as appropriate. Members shall also provide notice to the SEH Program of all dispositions of such req…

(a) Any member HMO asserting that it is not required to offer coverage or accept applications pursuant to the requirements of the Act because it reasonably anticipates that it will not have the capacity in its network of providers within the service area to deliver service adequa…

(a) The purpose of this subchapter is to establish the requirements and procedures by which carriers may cease doing business in the small employer market in this State. Additionally, this subchapter establishes the requirements and procedures by which carriers may cease issuing …

Words and terms, when used in this subchapter, shall have the meanings set forth in the Act or at N.J.A.C. 11:21-1.2 unless defined below or unless the context clearly indicates otherwise: "Affiliate" or "affiliated company" means a carrier that directly or indirectly through one…

(a) No small employer carrier shall nonrenew except in accordance with N.J.S.A. 17B:27A-23a, c, d, f, h and i or refuse to issue any small employer health benefits plan unless the small employer carrier withdraws from the small employer market in New Jersey in accordance with the…

Any small employer carrier that ceases to do business pursuant to this subchapter shall be prohibited from writing new business in the New Jersey small employer market for a period of five years from the date of termination of the last health benefits plan nonrenewed under this s…

(a) No carrier shall cease to issue or nonrenew a standard small employer health benefits plan, plan option or copayment/deductible option required or permitted to be offered pursuant to N.J.A.C. 11:21-3 until the carrier submits a notice of intent to withdraw a plan, plan option…

Failure to comply with the requirements of this subchapter shall result in the imposition of penalties pursuant to N.J.S.A. 17B:27A-43 and any and all other penalties provided by law. Notes N.J. Admin. Code § 11:21-16.6 Recodified from N.J.A.C. 11:21-16.5 by R.2004 d. 108, effect…

Nothing in this subchapter shall be construed to contravene any rights of policyholders concerning cancellation requirements or obligations set forth in a policy or contract issued by a small employer carrier. Notes N.J. Admin. Code § 11:21-16.7 Recodified from N.J.A.C. 11:21-16.…

(a) A carrier may revoke its notice of intent to withdraw, filed with the Commissioner pursuant to N.J.A.C. 11:21-16.3, prior to the date that its withdrawal is complete, by submitting a statement to the Department at the address specified at N.J.A.C. 11:21-16.3(c) and to the Boa…

(a) Each small employer carrier which issues marketing and/or promotional materials in conjunction with the standard health benefits plans may attach its own name or identification to each of the plans, but shall also identify each of those standard health benefits plans by the a…

Small employer carriers shall maintain a complete file of all marketing and promotional material specific to the health benefits plans, which it disseminates to consumers, producers, or otherwise publicly disseminates. Small employer carriers shall retain each piece of promotiona…

(a) Each small employer carrier disseminating marketing and promotional material shall certify that its marketing and promotional material conforms with the requirements of this subchapter. The certification, set forth in Part 2 of Exhibit BB of the Appendix, incorporated herein …

Notes N.J. Admin. Code § 11:21-17.4 Reserved by 48 N.J.R. 2360(a), effective 11/7/2016

(a) A small employer carrier may select those insurance producers, as defined by N.J.S.A. 17:22A-2j, with whom it chooses to contract. No small employer carrier shall terminate or refuse to renew the contract of its insurance producers because of health status-related factors of …

This subchapter shall apply to all petitions made by interested persons for the promulgation, amendment or repeal of any rule by the Board, pursuant to N.J.S.A. 52:14B-4(f). Notes N.J. Admin. Code § 11:21-18.1

(a) Any person who wishes to petition the Board to promulgate, amend or repeal a rule shall submit to the Board, in writing, the following information: 1. Name and address of the petitioner; 2. The substance or nature of the rulemaking which is requested; 3. The reasons for the r…

(a) Upon receipt of a petition in compliance with N.J.A.C. 11:21-18.2 the Board shall, within 15 days, file 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 subst…

(a) The Program has been created pursuant to section 12 of P.L. 1992, c.162 (N.J.S.A. 17B:27A-28) as amended to assure the availability of the standardized health benefits plans to New Jersey small employers, their full-time employees and the dependents of those eligible employee…

(a) The Board shall maintain the books and records of the Program so that financial statements can be prepared to satisfy the Act. Further, these books shall satisfy any additional requirements of the Board and outside auditors. 1. The receipt and disbursement of cash by the Prog…

(a) The Board shall provide for the maintenance and retention of its official records in accordance with the Destruction of Public Records law (N.J.S.A. 47:3-15through 32) and all other applicable laws. (b) The Board's records shall include the following: 1. Minutes of all Board …

(a) The Program shall have an annual audit of its operations conducted by an independent certified public accountant approved by the Board. This audit shall encompass at least the following items: 1. The handling and accounting of assets and money for the Program; and 2. The annu…

Notes N.J. Admin. Code § 11:21-2.13 Reserved by 48 N.J.R. 2360(a), effective 11/7/2016

(a) A member or employee of the Board, including the Executive Director and staff, shall not be liable in an action for damages to any person for any action taken or recommendation made by him or her within the scope of his or her functions as a member or employee, if the action …

(a) This Plan may be amended by a majority vote of the entire Board, subject to approval of the Commissioner as provided hereinafter. A vote on an amendment may be taken at any meeting called, in whole or in part, for the purpose of considering a proposed amendment. Written notic…

Notes N.J. Admin. Code § 11:21-2.16 Recodified to N.J.A.C. 11:21-2.15 by R.1997 d.62, effective 2/3/1997. See: 28 New Jersey Register 4344(a), 29 New Jersey Register 428(a).

Notes N.J. Admin. Code § 11:21-2.17 Reserved by 48 N.J.R. 2360(a), effective 11/7/2016

The words and terms used in this Plan shall have the meanings set forth at N.J.S.A. 17B:27A-17 and N.J.A.C. 11:21-1.2 or as further defined below: "Administrator" or "Executive Director" means that person, persons, or entity selected by the Board to effectuate the administrative …

(a) The Board has the specific authority pursuant to the Act to: 1. Adopt rules and regulations to establish a voluntary risk pooling arrangement. 2. Enter into contracts as are necessary or proper to carry out the provisions and purposes of the Act; 3. Sue or be sued, including …

(a) The Board shall perform its function under this Plan, and in accordance with the Act. The Plan is intended to assure the fair, reasonable and equitable administration of the Program and shall constitute a public record and accordance with the Act. (b) The Plan does not, nor i…

(a) The Program shall exercise its powers through a Board. 1. The Board shall be made up of the Commissioner, the Commissioner of Health and Senior Services, or their designees (who shall serve ex officio) and 16 public members. The composition of the Board shall be as described …

(a) Appointments to Standing and other committees shall be approved by a majority of the Board present. A written record of the proceedings of each committee shall be maintained by the Executive Director. Committee members are responsible for providing staff support, but may reco…

(a) The Executive Director shall be selected by the Board. (b) The Executive Director shall perform the administrative functions required under the Act and the Plan. The Executive Director is responsible, along with the Board, for the fair, equitable and reasonable administration…

(a) Following approval of a final audited Program statement, the Board shall determine the final administrative expense total for the fiscal year, if any. 1. Each member's final assessment shall be reduced by any interim assessment paid by the member or credited to the member by …

Carriers shall submit statements, assessments and other reports as may be required by the Board pursuant to the Act and this chapter. Notes N.J. Admin. Code § 11:21-2.9 Amended by 48 N.J.R. 2360(a), effective 11/7/2016

(a) The purpose of this subchapter is to establish the procedures that the Board uses in providing notice of proposed rulemaking, receiving public comments regarding existing rules and proposed rulemaking, extending the public comment period, conducting a public hearing, and prov…

(a) Unless the Board proposes a rule pursuant to the special procedures set forth at N.J.S.A. 17B:27A-51, the Board shall provide for the following four types of public notice for rule proposals in accord with the New Jersey Administrative Procedure Act, N.J.S.A. 52:14B-1et seq.,…

(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 extend the time for submission of public comments on a proposed rulemaking, at its discre…

(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…

(a) The Board shall adopt an annual schedule of regular meetings to be held by it 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 of a…

(a) For the purpose of disseminating information about the SEH Program, including information about rulemaking and meeting dates, the Board shall maintain a mailing list of carriers and other interested parties. 1. The mailing list of members shall be based upon the member carrie…

(a) The standard health benefits plans established by the Board contain the benefits, limitations, exclusions and other terms set forth in exhibits in the Appendix to this chapter, which is incorporated herein by reference. 1. Plan B, "The Small Group Health Benefits Policy B," s…