N.J. Admin. Code § 11:20-3A.3

Current through Register Vol. 56, No. 19, October 7, 2024

Section 11:20-3A.3 - Basic and essential health care services plan policy form

(a) Before a member may offer or issue the basic and essential health care services plan policy form, the member shall submit the information set forth below to the Department at Department of Banking and Insurance, Life and Health, Basic and Essential Health Care Services Plan Form Filing, 20 West State Street, P.O. Box 325, Trenton, New Jersey 08625.

1. One copy of the policy form for the basic and essential health care services plan, unless filing a certification as set forth in (b)1 below; and

2. A certification signed by a duly authorized officer of the member that states that:

i. The member will make the basic and essential health care services plan available to eligible persons and will make a good faith effort to market the plan;

ii. Rates for the basic and essential health care services plan have been submitted pursuant to the requirements of N.J.A.C. 11:20-6; and

iii. The benefits in the policy form being submitted include all of the coverages enumerated in section 2.a. of P.L. 2001, c. 368, but do not include any additional benefits.

(b) The Department makes available to members a specimen policy form for the basic and essential health care services plan, set forth in chapter Appendix Exhibit F, incorporated herein by reference. The Department has determined that the plan set forth in Exhibit F includes the coverages required for a basic and essential health care services plan.

1. Members that choose to use the plan specimen policy form as set forth in Exhibit F shall submit, in lieu of a copy of the basic and essential health care services plan policy form, a certification, signed by a duly authorized officer of the company, stating that the company is using the basic and essential health care services plan specimen policy form as included in Exhibit F, including the carrier name, and similar variable text, as appropriate. The certification regarding use of the specimen policy form shall also include the statements required by (a)2 above.

2. Members that choose to use the plan specimen policy form as set forth in Exhibit F with some modifications to the text shall submit the form, redlined to show any differences between the submitted form and the form as contained in Exhibit F. The redlined text of the form shall be submitted with the information set forth in (b)1 above.

(c) The Department shall notify a member in writing of its determination whether the policy form filing is approved within 30 days of the date the filing is received. If the Board does not notify a member of its determination with respect to the filing within 30 days of the date the filing is received, the filing shall be deemed approved.

N.J. Admin. Code § 11:20-3A.3