N.J. Admin. Code § 11:16-6.3

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:16-6.3 - General requirements and filing format

(a) All insurers shall file for approval a fraud prevention and detection plan ("plan") in accordance with N.J.S.A. 17:33A-15 and this subchapter. No insurer shall use or implement any plan that is not filed and approved.

(b) Insurers shall submit their plan on 81/2 by 11-inch paper. The first page shall show the filer's company name, the filer's identifying number for this filing, National Association of Insurance Commissioners (NAIC) company number(s), and NAIC group name and number. The plan shall include page numbering, a table of contents, and the insurer's anti-fraud prevention and detection training program, protocol, and procedure manual. Subsequent amendments to the plan shall include the effective date, page number, location, and explanation of the amendments.

1. Insurers shall include a brief description of their business model or company profile in the front of the anti-fraud prevention and detection protocol for analysis by the Department in determining compliance with fraud prevention and detection.

(c) Insurers shall file their plan with the Department at the following address:

Fraud Prevention and Detection Plans

New Jersey Department of Banking and Insurance

Market Conduct Examinations and Anti Fraud

Compliance Unit

PO Box 329

Trenton, NJ 08625-0329

N.J. Admin. Code § 11:16-6.3

Amended by R.2005 d.159, effective 5/16/2005.
See: 37 N.J.R. 199(a), 37 N.J.R. 1733(a).
In (c), amended the address.
Amended by R.2014 d.035, effective 2/18/2014.
See: 45 N.J.R. 1989(a), 46 N.J.R. 358(a).
Rewrote the introductory paragraph of (b); and added (b)1.