New Jersey Administrative Code

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 or health insurance, as set forth in this section, under …

No individual or group health insurance policy or contract, individual or group life insurance policy or contract, individual or group long-term care insurance policy or contract, or annuity contract, delivered or issued for delivery in this State may contain a provision purporti…

As of January 1, 2008, forms previously filed, approved or acknowledged by the Commissioner that contain provisions not in compliance with this subchapter shall be deemed withdrawn and shall not be delivered, issued, executed or renewed. Notes N.J. Admin. Code § 11:4-58.4

(a) The purpose of this subchapter is to prescribe disclosure requirements to be utilized in connection with the sale, solicitation or negotiation of annuities directly to consumers, as required by N.J.S.A. 17B:25-34 et seq. (b) This subchapter shall apply to any annuity, both im…

Words and terms as defined in the Act at N.J.S.A. 17B:25-35, when used in this subchapter, shall have the meanings as defined in the Act, unless the context clearly indicates otherwise or as further defined by this subchapter. The following words and terms, when used in this subc…

(a) Pursuant to N.J.S.A. 17B:25-37d, an insurance producer, agent, representative or member of a fraternal benefit society not required to be licensed as an insurance producer pursuant to N.J.S.A. 17:44B-32, or an insurer shall provide a consumer who applies for an annuity a copy…

(a) Pursuant to N.J.S.A. 17B:25-37d, an insurance producer, agent, representative or member of a fraternal benefit society not required to be licensed as an insurance producer pursuant to N.J.S.A. 17:44B-32, or an insurer shall provide to a consumer who applies for an annuity a c…

Failure to comply with this subchapter may result in the imposition of penalties as authorized by law, including penalties as authorized pursuant to N.J.S.A. 17B:25-42. Notes N.J. Admin. Code § 11:4-59.5 Recodified from N.J.A.C. 11:4-59.7 by R.2013 d.014, effective 2/4/2013 (oper…

Notes N.J. Admin. Code § 11:4-59.6 Repealed by R.2013 d.014, effective 2/4/2013 (operative August 4, 2013). See: 44 N.J.R. 1681(a), 45 N.J.R. 211(a). Section was "Insurer supervision procedures".

Notes N.J. Admin. Code § 11:4-59.7 Recodified to N.J.A.C. 11:4-59.5 by R.2013 d.014, effective 2/4/2013 (operative August 4, 2013). See: 44 N.J.R. 1681(a), 45 N.J.R. 211(a). Former N.J.A.C. 11:4-59.7, Penalties, recodified to N.J.A.C. 11:4-59.5.

(a) The purpose of this subchapter is to implement N.J.S.A. 17B:25-34 et seq., and 17B:30-1 et seq., to require producers to act in the best interest of the consumer when making a recommendation of an annuity and to require insurers to establish and maintain a system to supervise…

Words and terms as defined at N.J.S.A. 17B:25-35, when used in this subchapter, shall have the meanings as defined in the Act, unless the context clearly indicates otherwise or as further defined in this subchapter. The following words and terms, when used in this subchapter, sha…

(a) In recommending to a consumer the purchase of an annuity, an insurance producer shall act in the best interest of the consumer pursuant to the circumstances known at the time the recommendation is made, without placing the producer's or the insurer's financial interest ahead …

(a) An insurance producer shall not solicit the sale of an annuity product unless the insurance producer has adequate knowledge of the product to recommend the annuity and the insurance producer is in compliance with the insurer's standards for product training. An insurance prod…

(a) Insurers, general agents, independent agencies, and insurance producers shall maintain or be able to make available to the Commissioner records of the information collected from the consumer and other information used in making the recommendations that were the basis for insu…

(a) An insurer shall be responsible for compliance with this subchapter. If a violation occurs, either because of the action or inaction of the insurer or its insurance producer, the Commissioner may order:1. An insurer to take reasonably appropriate corrective action for any con…

(a) This subchapter applies to all insurers authorized to write health insurance in this State. These standards apply to all individual and group health insurance coverages issued prior to January 1, 2017. Reserve standards for such coverages issued prior to January 1, 2017, incl…

(a) The following applies to the basis for contract reserves: 1. Minimum standards with respect to morbidity or other contingency are those set forth in N.J.A.C. 11:4-6.1 4 and 6.15. Valuation net premiums used under each contract shall have a structure consistent with the gross …

(a) Provided the contract reserve on all contracts to which an alternative method or basis is applied is not less in the aggregate than the amount determined according to the applicable standards specified in N.J.A.C. 11:4-6.1 0, an insurer may use any reasonable assumptions as t…

(a) Annually, an appropriate review shall be made of the insurer's prospective contract liabilities on contracts valued by tabular reserves, to determine the continuing adequacy and reasonableness of the tabular reserves giving consideration to future gross premiums. The insurer …

Increases to, or credits against, reserves carried, arising because of reinsurance assumed or reinsurance ceded, shall be determined in a manner consistent with these minimum reserve standards and with all applicable provisions of the reinsurance contracts which affect the insure…

(a) Minimum morbidity standards for valuation of specified individual contract health insurance benefits are as follows: 1. For disability income benefits due to accident or sickness use: i. When calculating contract reserves: (1) For contracts issued on or after January 1, 1965 …

(a) Minimum morbidity standards for valuation of specified group contract health insurance benefits are as follows:1. For disability income benefits due to accident or sickness use: i. When calculating contract reserves: (1) For contracts issued prior to January 1, 2001: The same…

(a) For contract reserves the maximum interest rate is: 1. For contracts issued prior to January 1, 1973: 3 1/2 percent. 2. For contracts issued on or after January 1, 1973 through December 31, 2000: A rate of interest not exceeding the maximum rate of interest specified in N.J.S…

The mortality basis used for all policies except long-term care individual policies and group certificates and for long-term care individual policies or group certificates issued before January 1, 2001 shall be according to a table (but without use of selection factors) permitted…

(a) Where an insurer calculates tabular reserves using the 1964 CDT, 85CIDA, 85CIDB or any other table based on exposures that include contracts on premium waiver as in-force contracts rather than a table based on "active lives," reserves shall be valued on the following basis: 1…

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise: "Annual-claim cost" means the net annual cost per unit of benefit before the addition of expenses, including claim settlement expenses, a…

(a) Claim reserves are required for all incurred but unpaid claims on all health insurance policies. (b) Appropriate claim expense reserves are required with respect to the estimated expense of settlement of all incurred but unpaid claims. (c) All claim reserves for prior valuati…

(a) The following applies to disability income: 1. The maximum interest rate for claim reserves is specified in N.J.A.C. 11:4-6.1 6. 2. Minimum standards with respect to morbidity are those specified in N.J.A.C. 11:4-6.1 4 and 6.15, except that, at the option of the insurer: i. F…

A generally accepted actuarial reserving method or other reasonable method, if the method is approved by the Commissioner prior to the statement date, or a combination of methods, may be used to estimate all claim liabilities. The methods used for estimating liabilities generally…

(a) Unearned premium reserves are required for all contracts with respect to the period of coverage for which premiums, other than premiums paid in advance, have been paid beyond the date of valuation. (b) If premiums due and unpaid are carried as an asset, such premiums shall be…

(a) The minimum unearned premium reserve with respect to any contract is the pro rata unearned modal premium that applies to the premium period beyond the valuation date, with such premium determined on the basis of: 1. The valuation net modal premium on the contract reserve basi…

The insurer may employ suitable approximations and estimates; including, but not limited to, groupings, averages and aggregate estimation in computing premium reserves. Such approximations or estimates shall be tested periodically to determine their continuing adequacy and reliab…

(a) Contract reserves are required, unless otherwise specified in N.J.A.C. 11:4-6.9(b), for: 1. All individual and group contracts with which level premiums are used; or 2. All individual and group contracts with respect to which, due to the gross premium pricing structure at iss…

(a) The purpose of this subchapter is to establish limitations, consistent with N.J.S.A. 17B:25-36 and the Unfair Trade Practices Act, N.J.S.A. 17B:30-1 et seq., on the use of certifications, professional designations, or forms of advertising by insurance producers, representativ…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance. "Department" means the New Jersey Department …

(a) Consistent with the unfair trade practices set forth in N.J.S.A. 17B:30-1 et seq., an insurance producer, or an agent, representative or member of a fraternal benefit society not required to be licensed as an insurance producer in accordance with N.J.S.A. 17:44B-32, or an ins…

Failure to comply with this subchapter may result in the imposition of penalties as authorized by law, including penalties authorized pursuant to N.J.S.A. 17:22A-45 and 17B:30-17. Notes N.J. Admin. Code § 11:4-60.4

(a) The purpose of this subchapter is to set forth the disclosure and filing requirements for retained asset accounts, and disclosure requirements for all settlement options related to life insurance policies issued in this State. (b) This subchapter shall apply to all insurers a…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Commissioner" means the Commissioner of the New Jersey Department of Banking and Insurance. "Department" means the New Jersey Departmen…

(a) All insurers offering RAAs in this State shall, prior to the issuance of a group policy which provides for the payment of claims through an RAA or on which the opening of an RAA is an option, and prior to the transfer of a death benefit on an individual or group policy to an …

Failure to comply with the provisions of this subchapter shall result in the imposition of penalties as may be authorized by law. Notes N.J. Admin. Code § 11:4-61.4

(a) This subchapter sets forth the requirements for contracts between a pharmacy benefits manager and a contracted pharmacy pursuant to N.J.S.A. 17B:27F-1 et seq., and requires pharmacy benefits managers to certify that new or existing contracts, upon renewal, comply with the req…

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health mai…

(a) Upon execution or renewal of each contract, a pharmacy benefits manager shall, with respect to contracts between a pharmacy benefits manager and a contracted pharmacy: 1. Include in the contract the sources utilized to determine multiple source generic drug pricing, including…

(a) All contracts between a pharmacy benefits manager and a contracted pharmacy shall include a process to appeal, investigate, and resolve disputes regarding multiple source generic drug pricing. The contract provision establishing the process shall include the following: 1. The…

(a) All pharmacy benefits managers shall file a certification with the Department in the form of N.J.A.C. 11:4-62 Appendix Exhibit A, which is incorporated herein by reference, attesting that all pharmacy benefits contracts executed or renewed between the pharmacy benefits manage…