N.J. Admin. Code § 11:21-11.7

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:21-11.7 - Amendments

(a) A carrier may amend a nonstandard health benefits plan that has been approved or deemed approved by the Commissioner by submitting for approval the amendment together with a new, completed Checklist and Certification set forth in Part 5 of Exhibit BB of the Appendix to this chapter.

1. Each such filing shall comply with N.J.A.C. 11:4-40, except that only one copy of the form(s) need be submitted.

2. The carrier shall submit a separate Checklist and Certification for each nonstandard health benefits plan form being amended, clearly identifying the nonstandard health benefits plan form, and the date(s) previous certification(s) made in compliance with this subchapter were filed.

3. The carrier shall certify on the Checklist and Certification, for each plan being amended that the amendment to the nonstandard health benefits plan does not reduce the actuarial value or the benefits coverage of the nonstandard health benefits plan below the benefits coverage of Plan A and the actuarial value of the standard health benefits plan with the lowest actuarial value of the standard health benefits plans created by the Board.

4. The carrier simultaneously shall submit an explanation of the manner in which the amendment to the nonstandard health benefits plan affects the premiums for the health benefits plan, in accordance with N.J.A.C. 11:21-8.

(b) Notwithstanding (a) above, a carrier shall not amend a nonstandard health benefits plan for six months following the date that the first contract or policy under the nonstandard health benefits plan becomes effective with that carrier if the carrier agreed to add the nonstandard health benefits plan to its portfolio at the request of a small employer pursuant to N.J.S.A. 17B:27A-19j(12) and N.J.A.C. 11:21-11.8.

N.J. Admin. Code § 11:21-11.7