N.J. Admin. Code § 11:20-2.1

Current through Register Vol. 56, No. 11, June 3, 2024

Section 11:20-2.1 - Purpose and structure

(a) The "IHC Program" created pursuant to the N.J.S.A. 17B:27A-2 to 16, as amended, has as its members all insurance companies, health service corporations, hospital service corporations, medical service corporations, and health maintenance organizations that issue or have in force health benefits plans in this State. The IHC Program's purpose is:

1. To assure the availability of standardized individual health benefits plans in New Jersey on an open enrollment, modified community-rated basis; and

2. To reimburse certain losses of member companies as follows:

i. For the calendar year ending December 31, 1992, pursuant to N.J.S.A. 17B:27A-13;

ii. For each calendar year ending December 31, 1993 through December 31, 1996, and for each two-year calculation period through the 2007-2008 calculation period pursuant to N.J.S.A. 17B:27A-12, as amended; and

iii. For all periods following the 2007-2008 two-year calculation period no loss assessments shall be calculated or collected and no losses shall be reimbursed.

(b) The Board of the IHC Program has been charged pursuant to the Act to administer the IHC Program reasonably and equitably under law.

(c) The IHC Program Plan of Operation sets forth as completely as possible the fair, reasonable and equitable manner in which the Board will administer the IHC Program under law.

(d) The Board shall consist of nine directors, including the Commissioner or his or her designee, who shall serve ex officio.

(e) The Board shall appoint an insurance producer licensed to sell health insurance pursuant to N.J.S.A. 17:22A-1et seq. to advise the Board on issues related to sales of individual health benefits plans issued pursuant to the Act.

(f) Neither the Plan of Operation nor the IHC Program creates any contractual or other rights and obligations between the IHC Program and any entity or other person insured by any carrier.

(g) The IHC Program shall continue in existence subject to termination in accordance with the laws of this State or of the United States. In the event of enactment of a law or laws which, in the determination of the Board and the Commissioner, shall result in the termination of the IHC Program, the IHC Program shall terminate and conclude its affairs. Any funds or assets held by the IHC Program following the payment of all claims and expenses of the IHC Program shall be distributed to the member carriers at that time and in accordance with the then existing assessment formula.

(h) All documents or other communications directed to the Board shall be sent to the Executive Director of the IHC Program at the address set forth below. Communications sent by regular mail must be sent to the PO Box:

New Jersey Individual Health Coverage Program 20 West State Street, 11th Floor PO Box 325 Trenton, NJ 08625-0325 Telephone: (609) 633-1882 x50302 Fax: (609) 633-2030 E-mail: Ellen.derosa@dobi.nj.gov

N.J. Admin. Code § 11:20-2.1

Administrative Change.
See: 27 N.J.R. 1423(a).
Amended by R.1998 d.443, effective 8/7/1998.
See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a).
In (a), rewrote the introductory paragraph 2; and in (h), updated the address.
Amended by R.2006 d.15, effective 1/3/2006.
See: 37 N.J.R. 2994(a), 38 N.J.R. 311(a).
Changed subchapter heading from "Individual Health Coverage Program Temporary Plan of Operation". In (c) and (f), deleted references to the Temporary Plan of Operation; rewrote (h).
Amended by R.2009 d.45, effective 12/29/2008.
See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
In (a)1, inserted "modified"; and in (a)2, substituted "through the 2007-2008 calculation period" for "thereafter".
Amended by R.2011 d.163, effective 6/6/2011.
See: 43 N.J.R. 131(a), 43 N.J.R. 1353(a).
In the address in (h), substituted "50302" for "50306".
Amended by R.2016 d.127, effective 10/17/2016 (operative January 1, 2017).
See: 48 N.J.R. 1555(a), 48 N.J.R. 2153(a).
In the address in (h), inserted "E-mail: Ellen.derosa@dobi.nj.gov".
Amended by R.2018 d.197, effective 6/12/2018.
See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
Rewrote (a)2.