N.J. Admin. Code § 11:20-3.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 11:20-3.3 - Compliance and variability rider

(a) Members may incorporate regulatory changes required to be made to the standard policy forms, standard HMO contract, and standard riders through the use of the Compliance and Variability Rider as set forth as Exhibit D of the Appendix, incorporated herein by reference, if the Board has indicated in the rule adoption of the regulatory changes to the standard policy forms that Compliance and Variability Riders may be used. Carriers may only use the Compliance and Variability Rider to incorporate Board designated text for the period of time specified by the Board in the rule adoption of the regulatory changes to the standard policy forms.

(b) Members may make any changes to the standard policy forms, standard HMO contract, or standard riders promulgated by the Board consistent with the permitted as variable text set forth in Exhibits A and B of the Appendix to this Chapter, as described in the Explanation of Brackets, Exhibit C, through the use of the Compliance and Variability Rider as set forth as Exhibit D of the Appendix.

(c) Members may incorporate text for benefits required to be offered to the Policyholder through the use of the Compliance and Variability Rider as set forth as Exhibit D of the Appendix, if the Board has indicated in the rule adoption of the regulatory changes to the standard policy forms to address the mandated offer that carriers may issue the optional coverage by rider in lieu of including the coverage in the standard policy forms. For example, coverage for autologous bone marrow transplant, as required to be offered pursuant to P.L. 1995, c. 100, may be included using the Compliance and Variability Rider.

(d) Members may address the cost sharing reduction amounts referred to in N.J.A.C. 11:20-3.2(b) on the Compliance and Variability Rider.

(e) Members may not use the Compliance and Variability rider to accomplish benefit modifications as outlined in N.J.A.C. 11:20-3.6.

N.J. Admin. Code § 11:20-3.3

New Rule, R.1996 d.542, effective 12/2/1996.
See: 28 N.J.R. 3704(a), 28 N.J.R. 5075(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 (b), inserted "as described in the Explanation of Brackets, Exhibit T," following "Chapter".
Amended by R.1998 d.503, effective 9/16/1998 (operative November 1, 1998).
See: 30 N.J.R. 3235(b), 30 N.J.R. 3838(a).
In (b), substituted a reference to Exhibit U for a reference to Exhibit F.
Amended by R.2006 d.15, effective 1/3/2006 (operative July 1, 2006).
See: 37 N.J.R. 2994(a), 38 N.J.R. 311(a), 1005(a).
In (a) and (b), substituted "Members" for "Notwithstanding the requirements of N.J.A.C. 11:20-3.2, members", rewrote references to all Exhibits and added (c).
Amended by R.2009 d.45, effective 12/29/2008.
See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
Added (d).
Amended by R.2013 d.130, effective 10/1/2013 (operative January 1, 2014).
See: 45 N.J.R. 2310(a), 45 N.J.R. 2385(a).
Added new (d); and recodified former (d) as (e).