N.J. Admin. Code § 11:15-3.23

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:15-3.23 - Stop-loss insurance and/or reinsurance

(a) Each fund providing primary or underlying coverage on a self-insured basis shall secure stop-loss insurance or reinsurance in a form and amount acceptable to the Commissioner from an insurer authorized or admitted to transact life or health insurance, as applicable, in the State.

(b) Certificates of stop-loss insurance and/or reinsurance showing policy limits and other information shall be available for the inspection of each member and shall be filed with the Commissioner.

(c) Losses in excess of the established self-insurance retention amount shall be borne by the stop-loss carrier(s) according to the terms and conditions of the stop-loss contract(s).

(d) Any proposed change in the terms or limits of stop-loss insurance and/or reinsurance shall be submitted to the Department and the Department of Community Affairs for approval at least 30 days prior to the effective date of the proposed change.

(e) The Commissioner shall waive the requirement set forth in (a) above if such stop-loss insurance or reinsurance is not commercially available or is unreasonably priced, as determined by the fund's executive committee for each fund year, and as approved by the Department and the Department of Community Affairs, and the fund otherwise demonstrates to the Commissioner that it has made adequate provision for excess losses.

1. Any approval by the Department pursuant to (a) above shall be for a period not to exceed either the longer of 12 months from the date of approval or the end of the next succeeding fund year. Any fund seeking to extend the period of the approval shall notify the Department not later than 45 days prior to the expiration of the term of the approval. The notification shall specify the basis upon which the executive committee has determined that stop-loss insurance or reinsurance required pursuant to (a) above is not commercially available or is not reasonably priced, and shall include all actions taken by the fund to obtain required stop-loss insurance or reinsurance. The notification shall also describe actions taken by the fund to provide for excess losses, including, but not limited to, the establishment of contingency reserves, and funding above the level of expected losses.

N.J. Admin. Code § 11:15-3.23

Amended by R.1996 d.535, effective 11/18/1996.
See: 28 New Jersey Register 4036(a), 28 New Jersey Register 4885(a).