New Jersey Administrative Code

(a) The administrator shall maintain records of all determinations for a period of five years. (b) The administrator shall file a copy of each determination, except consent determinations, with the Department in either hard copy or electronic form, as provided in the contract des…

(a) Medical review organizations shall be authorized to determine in connection with the PIP dispute resolution process set forth in this subchapter: 1. Whether the medical treatment or diagnostic test is medically necessary; 2. Whether the treatment is in accordance with medical…

(a) Medical review organizations shall be capable of performing medical reviews for all primary specialties and disciplines. (b) Medical review organizations shall employ a medical director to actively participate in the review of cases to assure quality and consistency. (c) Medi…

In accordance with N.J.S.A. 39:3-29.1, this subchapter concerns the issuance, design, and content of insurance identification cards for motor vehicles issued by insurers in this State. This subchapter shall not apply to policies covering motor vehicles registered with the U.S. De…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Electronic insurance identification card or E-card" means the display of an electronic image on a cellular phone or any other type of p…

(a) Insurers shall issue permanent insurance identification cards in paper and/or electronic format for each motor vehicle insured under an insurance policy. (b) If an insurer issues electronic insurance identification cards, the insurer, at a minimum, shall also issue paper insu…

(a) The front of the card shall include the information provided in N.J.A.C. 11:3-6.3(e)1 through 10. The address for Notification of Commencement of Medical Treatment required by N.J.A.C. 11:3-6.3(e)11 may be printed on the reverse of the card. (b) The card shall meet the follow…

(a) The paper temporary evidence of insurance document shall include the information required by N.J.A.C. 11:3-6.3(e), except as noted below:1. The heading on the document shall read: "State of New Jersey Temporary Evidence of Insurance"; 2. There are no requirements for the weig…

This subchapter implements certain provisions of the Automobile Reparation Reform Act, N.J.S.A. 39:6A-1 et seq., including the Commissioner's authority to establish the amounts and terms of additional personal injury protection benefits that must be made available to insureds ele…

(a) In addition to the personal injury protection benefits that insurers must provide pursuant to N.J.S.A. 39:6A-4 or 39:6A-3.1, insurers shall make available to the named insured, and, at his or her option, to any resident relatives in the name insured's household who are not na…

(a) All policy forms or endorsements that provide personal injury protection benefits required by N.J.S.A. 39:6A-4 shall specify that such benefits shall be afforded by the insurer of the injured person subject to any deductibles or exclusions elected by the policyholder pursuant…

(a) Every rate filer's schedule of rates for additional personal injury protection benefits, other than medical expense benefits, shall provide at least the benefit schedules set forth in Table 1 in (b) below. (b) The additional personal injury protection coverage table follows: …

(a) Additional personal injury protection benefits that are required to be offered by an insurer shall be offered by the insurer at least annually as part of the Coverage Selection Form required pursuant to N.J.S.A. 39:6A-23 and N.J.A.C. 11:3-15. 1. The buyer's guide and coverage…

(a) This rule applies to all automobile policies delivered or issued for delivery in this State, insuring a single individual or husband and wife resident of the same household, as named insured, and under which the insured vehicles therein designated are of the following types o…

This subchapter applies to all automobiles as defined in N.J.S.A. 39:6A-2a, excluding those owned by business entities or insured through any statutorily mandated residual market mechanism, and to all policies or contracts of insurance insuring such automobiles. Notes N.J. Admin.…

(a) Pursuant to N.J.S.A. 17:29C-7, a notice of cancellation shall be effective only when based on one or more of the following reasons: 1. Nonpayment of premium; 2. The driver's license or motor vehicle registration of the named insured has been suspended or revoked during the po…

(a) No notice of cancellation issued pursuant to N.J.A.C. 11:3-8.1 0(a)1, non-payment of premium, shall be effective unless it is mailed or delivered by the insurer in accordance with N.J.S.A. 17:29C-8 to the named insured at least 15 days prior to the effective date of the cance…

(a) Acceptance criteria are the written standards by which an insurer accepts or rejects new business, and/or renews or nonrenews existing business. An insurer shall have separate acceptance criteria for new and renewal business. (b) An insurer is prohibited from using any of the…

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 § 11:3-8.13 New Rule, R.1986 d.418, effectiv…

(a) Any person violating the provisions of this subchapter shall be subject to such penalties as may be authorized by law. (b) In addition to any such penalties, the Commissioner may, after notice and hearing, suspend or revoke the rights of any insurer or group of insurers under…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Acceptance criteria" means the written standards by which an insurer accepts or rejects new business, and/or renews or nonrenews existi…

(a) Every insurer shall make an offer to the insured named policyholder subject to this subchapter to renew such policy upon its expiration date, unless a valid notice of nonrenewal has been sent by the insurer to the insured in accordance with this subchapter. (b) Each renewal o…

(a) Subject to the limitation set forth in N.J.A.C. 11:3-8.7, an insurer may issue a notice of nonrenewal to a named insured who is an eligible person, in the following instances: 1. In accordance with N.J.S.A. 17:29C-7.1f, when the policyholder or other person insured under the …

(a) An insurer may issue a notice of nonrenewal to any ineligible person pursuant to N.J.A.C. 11:3-34.4. (b) For the purpose of determining whether a person is an eligible person pursuant to N.J.A.C. 11:3-34.4, an insurer shall consider those accidents and violations accrued only…

(a) A notice of nonrenewal shall not be valid unless it is mailed or delivered by the insurer to the insured no less than 60 days and no more than 90 days prior to the expiration of the current policy, except that the Commissioner may direct by Order that a notice of nonrenewal m…

(a) No insurer shall nonrenew a policy based on N.J.A.C. 11:3-8.4(a)1 i without having first conducted an investigation and reported the matter in accordance with the insurer's Fraud Detection and Prevention Plan. (b) No insurer shall nonrenew a policy for failure to complete and…

Notwithstanding the provisions of this subchapter, if the plan for automobile insurance established pursuant to N.J.S.A. 17:29D-1 is not accepting new applications for coverage pursuant to N.J.S.A. 17:29D-1(d), no insurer transacting automobile insurance in this State shall refus…

Insurance companies shall maintain records of nonrenewals for not less than five years which shall include a copy of the notice of nonrenewal, data concerning the allowable number of nonrenewals in each territory computed in accordance with N.J.A.C. 11:3-8.4(a)2 and 8.5(c), and d…

(a) Every automobile insurance policy subject to New Jersey rates and providing coverage for an individually owned (or jointly owned by husband and wife; or two or more relatives resident of the household) private passenger automobile and/or any motor vehicle rates as a private p…

Notes N.J. Admin. Code § 11:3-9.2 R.1975 d.130, eff. 7/1/1975. See: 7 New Jersey Register 113(a), 7 New Jersey Register 276(d). Repealed by R.1996 d.246, effective 6/3/1996. See: 27 New Jersey Register 2048(a), 28 New Jersey Register 3002(b). Section was "Private passenger automo…

(a) This subchapter sets forth procedures and requirements with respect to the New Jersey Insolvent Health Maintenance Organization Assistance Association established pursuant to N.J.S.A. 17B:32B-1 et seq. (b) This subchapter shall apply to all member organizations of the Associa…

Failure to comply with this subchapter may result in the denial of relief requested and imposition of penalties as authorized by law. Notes N.J. Admin. Code § 11:4-1.10

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Applicant" means the member organization seeking an exemption, abatement or deferral of its obligation to pay assessments pursuant to s…

(a) Pursuant to N.J.S.A. 17B:32B-1 et seq., the Association is created to administer the Fund established pursuant to N.J.S.A. 17B:32B-6 for purposes of providing payment for eligible claims under a covered health maintenance organization contract on an equitable basis to any cov…

(a) In accordance with N.J.S.A. 17B:32B-9e, the Association shall exempt, abate or defer, in whole or in part, the assessment of a member organization if, in the opinion of the Commissioner, payment of the assessment would endanger the ability of the member organization to fulfil…

(a) Any member organization seeking relief shall submit such request to the Department as set forth in (f) below no later than 15 days following the due date of payment of the assessment. (b) All requests shall be accompanied by a statement averring a need for relief from the obl…

(a) When requesting relief, 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 relief and, if for less than the full amount, specific amount/perce…

(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:32B-9e that payment of the assessment would endanger the ability of the member organization to fulfill its contractual obligations or, based on indicia that relate to the ability to pay the assessment by the member org…

(a) In determining its schedule of charges or rates filed with the Commissioner pursuant to N.J.S.A. 26:2J-8b, or filed in accordance with any other law requiring such filing, no member organization shall include the amount paid or to be paid as assessments under N.J.S.A. 17B:32B…

(a) The purpose of this subchapter is to require insurers to deliver information to purchasers of life insurance that will improve the buyer's ability to select the most appropriate plan of life insurance for the buyer's needs and improve the buyer's understanding of the basic fe…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Annuity" means a contract not included within the definition of life insurance as set forth at N.J.S.A. 17B:17-3, or health insurance a…

(a) The generally applicable requirements are as follows: 1. The insurer shall provide a Buyer's Guide to all prospective purchasers, prior to accepting the applicant's initial premium or premium deposit. However, if the policy for which application is made contains an unconditio…

(a) Each insurer shall maintain, at its home office or principal office, a complete file containing one copy of each document authorized and used by the insurer pursuant to this subchapter for a period of three years following the date of its last authorized use unless otherwise …

Failure of an insurer, its producer, or other authorized representative or agent to provide or deliver to a buyer a Buyer's Guide, an in force illustration, a policy summary or policy data, or any other information required by this subchapter to be provided or delivered to buyers…

If any provisions of this subchapter are held invalid, the remainder shall not be affected. Notes N.J. Admin. Code § 11:4-11.6

This subchapter shall become operative on July 6, 2008. Notes N.J. Admin. Code § 11:4-11.7