New Jersey Administrative Code

(a) Where a replacement is involved in the transaction, the replacing insurer shall: 1. Verify that the required forms are received and are in compliance with this subchapter; 2. Ascertain that the sales material and illustrations used in the replacement meet the requirements of …

(a) Each insurer shall maintain a system of supervision and control to ensure compliance with the requirements of this subchapter. At a minimum, all such systems shall provide for the insurer to: 1. Inform its producers of the requirements of this subchapter and incorporate the r…

(a) Where a replacement is involved in the transaction, the existing insurer shall: 1. Retain and be able to produce all replacement notifications received, indexed by replacing insurer, for at least five years after replacement or until the conclusion of the next regular examina…

(a) In the case of an application that is initiated as a result of a direct response solicitation, the insurer shall require, with or as part of each completed application for a policy or contract, a statement asking whether the applicant, by applying for the proposed policy or c…

(a) Any failure to comply with the requirements of this subchapter shall be considered a violation of N.J.S.A. 17B:30-6. Such violations include, but are not limited to: 1. Any deceptive or misleading information set forth in sales material; 2. Failing to ask the applicant when c…

If any provisions of this subchapter shall be held invalid, the remainder of the subchapter shall not be affected thereby. Notes N.J. Admin. Code § 11:4-2.9

The purpose of this subchapter is to eliminate unfair discrimination in the underwriting, insuring and rating of individuals who are normal insurance risks in spite of blindness, partial blindness, or other physical or mental impairments. Notes N.J. Admin. Code § 11:4-20.1

(a) The following are hereby identified as acts or practices which constitute unfair discrimination between individuals of the same class: 1. Refusing to insure, or refusing to continue to insure, or limiting the amount, extent or kind of coverage available to an individual, or c…

(a) The purpose of this subchapter is to establish guidelines for the filing and review of limited death benefit policy forms which will: 1. Make life insurance available to people who are otherwise uninsurable; 2. Assure that limited death policies are not sold by producers in p…

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. "Advertising" means any advertising materials and sales presentations in the following categories: 1. Printed and published material, aud…

(a) No limited death benefit policy shall be issued in this State unless the insurer has, at the time of application, obtained from the applicant a signed and dated statement attesting that the applicant understands that he or she may qualify for a full death benefit policy which…

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 § 11:4-21.4

The purpose of this subchapter is to permit individual life insurance policies to provide the same cash surrender values and paid-up nonforfeiture benefits to both men and women. No change in minimum valuation standards is intended by these rules. Notes N.J. Admin. Code § 11:4-22…

The following words and terms when used in this subchapter shall have the following meanings: "1980 CSO Table, with or without Ten Year Select Mortality Factors" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the Soci…

(a) For any policy of insurance on the life of either a male or female insured delivered or issued for delivery in this State after September 11, 1981, a life insurer which has elected or which elects an operative date under N.J.S.A. 17B:25-19h(xi) may file with the Department of…

(a) In determining minimum cash surrender values, and amounts of paid up nonforfeiture benefits for any policy of insurance on the life of either a male or female insured on a form of insurance with separate rates for smokers and nonsmokers delivered or issued for delivery in thi…

(a) The preceding rules in this subchapter are intended to address use of gender blended mortality tables as a minimum standard for cash surrender values and paid-up nonforfeiture benefits in the Norris market. (b) The use of gender blended mortality tables as the basis for cash …

Forms which have been filed by the Commissioner pursuant to N.J.S.A. 17B:25-18 containing provisions not in compliance with these rules shall be deemed withdrawn as of September 18, 1996. Notes N.J. Admin. Code § 11:4-22.6 New Rule, R.1996 d.148, effective 3/18/1996. See: 27 New …

It shall not be a violation of N.J.S.A. 17B:30-12c. for an insurer to issue the same kind of policy of life insurance on both a sex-distinct and sex-neutral basis. Notes N.J. Admin. Code § 11:4-22.7 Recodified: This section was N.J.A.C. 11:4-22.4. See: 19 New Jersey Register 1399…

If any provision of this subchapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected thereby. Notes N.J. Adm…

This subchapter provides for the reasonable standardization of coverage and the simplification of terms and benefits of Medicare supplement policies; facilitates comparison of such policies in order to increase public understanding; eliminates provisions which may be misleading o…

(a) Every carrier providing Medicare supplement policies and certificates shall comply with Section 1882(c)(3) of the Social Security Act as enacted by Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 ( P.L. 100-203) by: 1. Acceptance of notice from a Medica…

(a) For both the entire past and future periods for which revised or existing rates are computed to provide coverage, Medicare supplement policy forms or certificate forms shall be expected to return to policyholders and certificateholders, in the form of aggregate benefits under…

(a) Eligible persons are those individuals described in (c) below who seek to enroll under the policy during the period specified in (d) below, and who submit evidence of the date of termination, disenrollment, or Medicare Part D enrollment with the application for a Medicare sup…

(a) No carrier shall deliver or issue for delivery in this State any Medicare supplement policy or certificate, any written application therefor, or any printed rider or endorsements to be applied thereto, unless the forms thereof have been submitted to and filed by the Commissio…

(a) No carrier or other entity shall provide to any producer a first year commission or first year compensation for the sale of Medicare supplement policies or certificates in an amount which exceeds 200 percent of the commission or compensation to be provided by that insurer or …

(a) General rules concerning required disclosure provisions include the following: 1. Medicare supplement policies and certificates shall include a renewal or continuation provision. The language or specification of such provision shall be consistent with the type of policy or ce…

(a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has a Medicare supplement or Medicare Advantage, Medicaid coverage or another health insurance policy or certificat…

(a) Every carrier providing Medicare supplement policies or certificates in this State shall file with the Commissioner a copy of all advertisements to which residents of this State will have access, and through which the carrier intends, or by implication purports to the reasona…

(a) Every carrier, directly or through its producers, shall: 1. Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate; 2. Establish marketing procedures to assure excessive coverage is not sold or issue…

(a) In recommending the purchase or replacement of any Medicare supplement policy or certificate, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. (b) Any sale of Medicare supplement coverage which will provide an i…

(a) This subchapter shall apply to:1. All Medicare supplement policies, as defined by this subchapter, delivered or issued for delivery in this State; 2. All certificates, as defined by this subchapter, issued under group Medicare supplement policies, which certificates have been…

(a) Every carrier shall report annually, on or before March 1, to the Commissioner, the policy and certificate number and date of issuance of each policy or certificate, grouped by individual insureds for every individual resident of this State for which the carrier has in force …

(a) All forms, rates, loss ratio reporting and advertisements submitted for filing with or by the Commissioner shall be submitted to the Office of Life and Health Actuarial Services, New Jersey Department of Insurance, PO Box 470, Trenton, New Jersey 08625-0470. (b) Annual report…

Failure to comply with the terms of this subchapter may result in the assessment of any and all penalties available in accordance with the laws of this State. Notes N.J. Admin. Code § 11:4-23.22 Recodified from N.J.A.C. 11:4-23.21 by R.1999 d.38, effective 12/28/1998 (to expire F…

If any provision of this subchapter or the application thereof to any person or circumstance is held to be invalid for any reason, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected thereby. Notes N.J. Adm…

(a) For all policies with policy years beginning on or after May 21, 2009, the following provisions concerning the use of genetic information and requests for genetic testing shall apply: 1. An issuer of a Medicare supplement policy or certificate shall not deny or condition the …

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. "Aggregate loss ratio" means the ratio of the accumulated value of past benefits (from the original effective date of the form to the dat…

(a) No policy or certificate may be advertised, solicited or issued for delivery in this State as a Medicare supplement policy or certificate unless such policy or certificate contains definitions or terms which conform to the requirements of this section. 1. "Accident," "acciden…

(a) No policy or certificate shall be advertised, solicited, delivered or issued for delivery in this State as a Medicare supplement policy if the policy or certificate contains limitations or exclusions that are more restrictive than those of Medicare, except with respect to pre…

(a) No policy or certificate shall be advertised, solicited, or issued for delivery in this State as a Medicare supplement policy if it does not meet the minimum standards contained in this section. (b) The following general standards apply to Medicare supplement policies and cer…

(a) All policies delivered or issued for delivery in this State prior to January 4, 1993, and all certificates delivered or issued for delivery in this State on or after July 15, 1991 but prior to January 4, 1993 as a Medicare supplement policy or certificate, shall meet the mini…

(a) No policy or certificate shall be advertised, solicited, delivered or issued for delivery in this State as a Medicare supplement policy on or after January 4, 1993 and with an effective date for coverage prior to June 1, 2010 unless it complies with the standards of N.J.A.C. …

(a) No policy or certificate shall be advertised, solicited, delivered or issued for delivery in this State as a Medicare supplement policy or certificate with an effective date for coverage on or after June 1, 2010 unless it complies with the standards of N.J.A.C. 11:4-23.6 and …

(a) Carriers shall not deny or condition the effectiveness or issuance, nor discriminate in the pricing, of Medicare supplement policies or certificates based on the health status, claims experience, receipt of health care by, or medical condition of an applicant if the applicati…

(a) The purpose of this subchapter is to establish a mechanism to provide Plan C coverage of the standardized Medicare supplement plans to persons under 50 years of age residing in this State who are enrolled in Medicare due to disability, or due to end stage renal disease. (b) E…

(a) Every insurer and HMO providing health benefits plans or health maintenance organization subscriber contracts in this State shall be liable for an assessment to pay its equitable share of any net loss incurred by the Under 50 Plan in the previous calendar year, unless the ins…