N.J. Admin. Code § 11:20-2.3

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

Section 11:20-2.3 - Powers of the IHC Program and Board

(a) The IHC Program shall have the general powers and authority granted under the laws of this State to insurance companies, health service corporations and health maintenance organizations licensed or approved to transact business in this State, except that the IHC Program shall not have the power to issue health benefits plans directly to either groups or individuals.

(b) The Board shall have the authority to do the following:

1. Define the provisions of standard health benefits plans in accordance with the requirements of the Act and the Plan of Operation;

2. Establish benefits exclusions and limitations for standard health benefits plans in accordance with law;

3. Establish standard policy forms for standard health benefits plans and rider packages;

4. Establish a procedure for the joint distribution of information on standard health benefits plans issued pursuant to N.J.S.A. 17B:27A-4 as amended;

5. Establish reasonable guidelines for the purchase of new individual health benefits plans by persons who are already enrolled or insured by another individual health benefits plan;

6. Review filings submitted by carriers in accordance with the Act and rules promulgated pursuant thereto and the Plan of Operation;

7. Make application on behalf of member carriers for benefits, subsidies, discounts or funds that may be provided either by any health care provider or under State or Federal law or regulation;

8. Appoint from among Board members appropriate legal, actuarial and other committees necessary to provide technical and other assistance in the operation of the IHC Program, in policy and other contract design and any other functions within the authority of the Board;

9. Enter into contracts which are necessary or proper to carry out the provisions and purposes of the Act and the Plan of Operation;

10. Employ or retain such persons, firms or corporations to perform such administrative functions as are necessary for the Board's performance of its duties;

11. Provide procedures for receiving oral and written comments from the public, which may include rules relating to the time and place of any public hearing, and for the length and format of testimony from individuals, groups and organizations;

12. Establish rules, conditions and procedures pertaining to the sharing of IHC Program administrative expenses among the members of the IHC Program;

13. Calculate assessments and assess member carriers their proportionate share of IHC administrative expenses in accordance with this Plan, and make advance interim assessments, as may be reasonable and necessary for organizational and reasonable operating expenses;

i. An interim assessment shall be credited as an offset against any regular assessment due following the close of the fiscal year;

ii. The Board may provide for other credits against assessments as appropriate;

14. Establish and maintain the appropriate accounts necessary to administer the IHC Program;

15. Impose interest penalties upon members for late payment of assessments;

16. Recommend to the Commissioner that actions be instituted in accordance with the Commissioner's authority to impose penalties for violations of the Act;

17. Sue or be sued, including taking any legal actions necessary or proper for recovery of an assessment for, on behalf of, or against the IHC Program or a member carrier;

18. Pursuant to P.L. 1993, c. 164, adopt "actions" necessary to execute the Board's powers pursuant to the provisions of N.J.S.A. 17B:27A-2 et seq.;

19. Borrow money to effect the purposes of the IHC Program;

i. Any notes or other evidence of indebtedness of the Program not in default shall be legal investments for carriers and may be carried as admitted assets; and

20. Contract for an independent actuary and any other professional services the Board deems necessary to carry out its duties under N.J.S.A. 17B:27A-2 et seq. as amended.

N.J. Admin. Code § 11:20-2.3

Amended by R.1998 d.443, effective 8/7/1998.
See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a).
In (b), substituted "authority" for "power" in the introductory sentence, deleted a P.L. reference in 4, and rewrote 6.
Amended by R.2006 d.15, effective 1/3/2006.
See: 37 N.J.R. 2994(a), 38 N.J.R. 311(a).
Rewrote (b).
Amended by R.2009 d.45, effective 12/29/2008.
See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
In (b)6, deleted "rate filings and other" following "Review".
Amended by R.2011 d.163, effective 6/6/2011.
See: 43 N.J.R. 131(a), 43 N.J.R. 1353(a).
Deleted former (b)8; recodified former (b)9 through (b)22 as (b)8 through (b)21; in (b)13, deleted "losses and" preceding "administrative expenses"; and in (b)14, deleted "Program losses and" following "IHC" and "and estimated losses" following the second occurrence of "expenses".
Amended by R.2018 d.197, effective 6/12/2018.
See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
Rewrote (b).