N.J. Admin. Code § 11:20-7.5

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

Section 11:20-7.5 - Refund plan

(a) If the loss ratio determined in N.J.A.C. 11:20-7.4 is less than 80 percent, the member shall include with the Report a plan to be approved by the Commissioner for a refund to policy and contractholders of an amount equal to the difference between 80 percent of reported premiums and reported claims.

(b) The refund plan shall conform with the following:

1. Refunds shall be made to all contractholders who were covered for any period during the preceding calendar year whose refund is $ 5.00 or greater.

2. The refund amount per contractholder may be determined by multiplying the earned premium from each contractholder's standard health benefits plan and rider or basic and essential health care services plan and rider by the percentage resulting from dividing the total refund calculated in accordance with (a) above by the carrier's total net earned premium from the standard health benefits plans and basic and essential health care services plans, or on the basis of a practical and equitable alternative formula proposed by the carrier and approved by the Commissioner.

3. Refund payments shall be made within 60 days of written approval of the refund plan by the Commissioner.

N.J. Admin. Code § 11:20-7.5