N.J. Admin. Code § 11:23-2.3

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

Section 11:23-2.3 - Standards for approval of applications

(a) The Commissioner may issue a license to an applicant or approve an application for registration as a third party administrator if he or she finds that the applicant meets the following standards:

1. All of the materials required by the Act, this chapter or by the Commissioner have been filed;

2. The persons responsible for conducting the applicant's affairs are competent, trustworthy and possess good reputations, and have appropriate experience, training and education;

3. The applicant has demonstrated the ability to assure that its services will be performed in a manner which will ensure the efficient operation of its business, including appropriate financial controls;

4. The standard contract forms to be used by the applicant are acceptable;

5. The applicant has adequate financial arrangements with the benefits payers for which it will perform its services and adequate arrangements for complying with the provisions of N.J.S.A. 17B:30-23 et seq. and N.J.A.C. 11:22-1 and 3, if applicable;

6. The compensation arrangements made between the applicant and benefits payers do not result in the assumption of financial risk by the applicant;

7. The name used by the applicant to do business in this State does not so closely resemble the name of an insurer authorized to do business in this State or otherwise include such descriptive language as to be likely to mislead the public with respect to the nature of its business operations; and

8. The applicant meets all requirements of the Act and these rules and demonstrate the ability to continue to meet all those requirements.

(b) In the case of an applicant for registration, the provisions of paragraphs (a)4, 5 and 6 above shall apply only to services provided by the applicant to benefits payers other than an insurer.

N.J. Admin. Code § 11:23-2.3

Amended by 46 N.J.R. 1695(b), effective 7/21/2014.