New Jersey Administrative Code

The effective date of this regulation shall be August 1, 1963. Notes N.J. Admin. Code § 11:4-4.5

(a) The purpose of this subchapter is to implement P.L. 1995, c.73 (the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act) by setting forth standards and procedures whereby all life insurance, health insurance, and annuity forms, and rates whe…

(a) An insurer seeking to file and use a form specified at N.J.A.C. 11:4-40.9 to be eligible for file and use shall, in addition to the items set forth at N.J.A.C. 11:4-40.5(b), submit the following to the Department: 1. A certification memorandum signed and acknowledged by a res…

A form submitted by an insurer to the Commissioner for either prior approval or file and use pursuant to this subchapter shall be accompanied by the service fee(s) set forth at N.J.A.C. 11:1-32 unless the insurer is exempt from the payment of such fees pursuant to section 13 of P…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Annuity" means a contract not included within the definitions of life insurance or health insurance as set forth in this section, under w…

(a) All life, health and annuity forms shall comply with the standards set forth in this subchapter and in any other applicable statutes, rules and published guidelines before being delivered or issued for delivery in this State. (b) No form delivered or issued for delivery in th…

(a) All insurers submitting forms or other correspondence to the Department pursuant to this subchapter shall comply with the following general procedures: 1. All individual health, group health, blanket, prepaid legal contracts, group life and service corporation forms, individu…

(a) No insurer shall deliver or issue for delivery in this State any form unless the form has been approved by the Commissioner pursuant to the procedures set forth in this subchapter, except for those forms eligible for submission to the Commissioner pursuant to the file and use…

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of individual life and annuities variable forms shall include, if applicable, the following items in the submission to the Department: 1. A prospectus; and 2. An actuarial memorandum which d…

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of valuation and non-forfeiture interest rate changes to previously filed forms shall include, if applicable, the following items in the submission to the Department: 1. If the interest rate…

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of certificates of assumption shall include, if applicable, the following items in the submission to the Department: 1. A clear indication whether the assuming and ceding insurers are author…

(a) An insurer may deliver or issue for delivery in this State a form providing life, health or annuity benefits, and accompanying rates if applicable, without obtaining prior approval from the Commissioner pursuant to this subchapter provided the form is set forth in this sectio…

(a) The purpose of this subchapter is to implement P.L. 2001, c. 237 (N.J.S.A. 17B:25-18.4), which establishes a special procedure whereby insurers may forego prior approval of certain life insurance, annuity and variable contract forms. (b) This subchapter shall apply to all ind…

The following words and terms, as used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise: "Annuity" means all contracts meeting the definition set forth at N.J.S.A. 17B:17-5. "Available for sale or use" means that the insurer has…

(a) Forms submitted to the Commissioner on the basis that they have been made available for sale or use in 40 states, subject to state variations that do not alter the unique features or design of the product, shall be eligible for sale or use pursuant to the requirements of this…

(a) Filings pursuant to N.J.A.C. 11:4-40A.3(a) shall include the following: 1. For each form submitted, a separate certification memorandum, signed by a responsible officer of the insurer, which shall include: a statement that the form has been made available for sale or use in 4…

(a) If the Commissioner determines that a certification submitted to the Department by an insurer pursuant to this subchapter is an improper certification, the insurer shall be subject to the following penalties specifically determined by the Commissioner in consideration of the …

(a) Any form and certification submitted pursuant to P.L. 2001, c. 237 prior to April 7, 2003, which was acknowledged by the Commissioner but does not meet the requirements of this subchapter, shall be deemed withdrawn July 6, 2003, and the form may not be available for sale or u…

(a) The purpose of these rules is to implement P.L. 1995, c.73 (the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act) by setting forth the Department's standards for approval of all individual life insurance forms delivered or issued for deli…

(a) The following requirements shall apply to survivorship forms, which provide that the death benefit is payable on the last surviving insured: 1. For any survivorship form with cash values, the values shall be calculated using exact ages, sexes and underwriting classifications.…

(a) The following standards shall apply to coverage which provides a re-entry or requalification feature:1. The Department shall require a certification that the insurer will not attempt to defeat the requalification provision by markedly altering its underwriting standards betwe…

(a) Pursuant to (b) below, the Department shall permit the use of a single policy form to provide more than one product where there are alternative plans. The submission shall include specimen issues of the schedule pages and any related tables of values for each alternative plan…

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 December 31, 1996. Notes N.J. Admin. Code § 11:4-41.13 Amended by R.1997 d.60, effective 2/3/1997. See: 28 New J…

(a) The standards set forth in this section shall apply to individual life insurance policies that: 1. Classify insureds explicitly by smoking and/or tobacco use habits, resulting in premium, cost or benefit differences; and 2. Permit a reclassification resulting in a change in p…

Notes N.J. Admin. Code § 11:4-41.15 Recodified to N.J.A.C. 11:4-41.12 by R.2000 d.130, effective 3/20/2000. See: 31 New Jersey Register 3910(a), 32 New Jersey Register 1024(a).

Notes N.J. Admin. Code § 11:4-41.16 Recodified to N.J.A.C. 11:4-41.13 by R.2000 d.130, effective 3/20/2000. See: 31 New Jersey Register 3910(a), 32 New Jersey Register 1024(a).

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Account value policy" means any policy, including, but not limited to, true universal life (flexible premium universal life) and interest…

(a) No individual life insurance policy, rider, application or endorsement shall contain provisions which are unjust, unfair, inequitable, misleading, contrary to law or to the public policy of this State. (b) The following approval standards shall apply to all individual life in…

(a) The Department shall permit the following exclusions for coverage: 1. Aviation exclusions; 2. Avocation exclusions; 3. War risk exclusions, which may include military, non-combatant civilian and civilian exclusions. i. Regarding military exclusions, risk of death may be exclu…

Bail-out features shall not be permitted. Notes N.J. Admin. Code § 11:4-41.5

Any form which describes death benefits or credited interest in terms of a published index shall state how death benefits and interest shall be determined upon the discontinuance of the index, and that any substitute index is subject to Department approval. Notes N.J. Admin. Code…

(a) Pre-existing condition exclusions shall only be permitted in the case of benefits for disability, as follows:1. The insurer shall not be liable for a disability resulting from any pre-existing condition which is disclosed in the application and excluded by rider. 2. The insur…

(a) Use of the same form for field issue and home office issue contract shall be permitted when the contract terms are written so as to make the difference in the administrative aspect of the issuance and delivery process negligible. (b) The following requirements shall apply to …

(a) The following standards shall apply to other insured coverage, which provides coverage to an insured other than the policy's primary insured: 1. The form shall clearly describe what happens to the insurance on the other insured upon the death of the primary insured. 2. If cov…

(a) This subchapter sets forth standards for provisions contained in group life, group health and blanket insurance contract, policy and certificate forms to assure that the provisions are not unjust, unfair, inequitable, misleading, confusing or unreasonably restrictive and that…

(a) No policy or certificate providing group health insurance shall limit or exclude health benefits as the result of the covered person's sustaining a loss attributable to the actions of a third party. (b) Insurers shall file with the Commissioner no later than December 31, 2002…

(a) A blanket insurance policy or certificate or other group policy or certificate providing health insurance, other than a group health benefits plan, may include an exclusion for losses resulting from the covered person's use of alcohol or drugs, but such exclusion shall be wor…

(a) A group policy or certificate providing health insurance benefits shall not include any provision that restricts, limits, or excludes coverage of services or expenses, directly or indirectly, that otherwise are eligible under the policy or certificate on the grounds that such…

(a) An insurer, in providing the conversion right required by N.J.S.A. 17B:27-19, shall treat the retirement of a covered person under a policy providing group life insurance as a termination of employment and shall permit the covered person to obtain, without evidence of insurab…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise: "Blanket insurance" means a policy or contract of insurance against death or injury resulting from an accident or from accidental means …

(a) The standards contained in this subchapter shall be in addition to any other rules and statutes applicable to group health insurance, group life insurance and blanket insurance contracts, policies and certificates. (b) If a group insurance contract, policy or certificate cont…

(a) The face page of every certificate issued under a blanket insurance policy or a group policy providing health insurance or life insurance delivered or issued for delivery in New Jersey shall state that it is subject to the laws of the State of New Jersey. (b) Group policies a…

(a) Group policies and certificates providing health, life, or blanket insurance shall not limit or exclude benefits because a covered person suffers a loss due to domestic violence. 1. No application or evidence of coverage form shall include questions regarding domestic violenc…

(a) Group health, group life insurance and blanket insurance policies and certificates that provide accident coverage and which include an aggregate limit on the benefits payable in connection with any single accident shall provide that the aggregate limit shall apply on a per co…

(a) Group policies and certificates providing disability income insurance may provide that benefits shall be offset by other income received by the covered person under the following conditions:1. Offsets to group disability benefits may not result in a monthly benefit of less th…

(a) Group policies and certificates providing health insurance in which some portion of the benefits are subject to pre-authorization provisions shall comply with the following: 1. There shall be a caption for the pre-authorization provision in both the policies and certificates …

(a) Blanket and group policies and certificates providing life insurance or accidental death and dismemberment insurance benefits shall not subject such benefits to pre-existing condition exclusions and limitations. (b) Group policies and certificates providing health insurance b…