N.J. Admin. Code § 11:24A-2.4

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24A-2.4 - Submission of disclosure statements to the Department

(a) The Department shall deem approved those disclosures required by this chapter that a carrier makes within a contract, policy or certificate form submitted to and filed by the Department, or otherwise deemed approved by the Department in accordance with the statutes and rules of this State.

(b) The Department shall deem approved those disclosures required by this chapter to be made by carriers for individual standard health benefits plans if the IHC Program Board of Directors (as authorized by 17B:27A-2 et seq.) has promulgated standard disclosure statements meeting the requirements of 11:24A-2.3 which are to be included within the standard health benefits plan forms or other standard materials that carriers are required to provide to all covered persons in accordance with the rules of the IHC Program at N.J.A.C. 11:20.

(c) The Department shall deem approved those disclosures required by this chapter to be made by carriers for small employer standard health benefits plans if the SEH Program Board of Directors (as authorized by 17B:27A-17 et seq.) has promulgated standard disclosure statements meeting the requirements of 11:24A-2.3 which are to be included within the standard health benefits plans and/or other standard material that carriers are required to provide to all covered persons under small employer health benefits plans in accordance with the rules of the SEH Program at N.J.A.C. 11:21.

(d) In the event the carrier uses a form for its disclosures that is not required to be submitted to the Department, or is not subject to the rules of the IHC or SEH Programs, the carrier shall submit the form to the Department, and shall include with the submission of each disclosure form a statement of the policy or contract form(s) to which the disclosure is applicable, listed by form number and market name, if any, and a certification that the disclosure meets the requirements of N.J.A.C. 11:24A-2.3.

1. A carrier may use the disclosure until such time as the Department disapproves the disclosure and provides notice of the disapproval to the carrier, with the reasons for the disapproval set forth in writing.

2. The Department may disapprove the form for failing to meet the requirements of this subchapter, or because it is deceptive, misleading, or contrary to the public policy of this State.

3. The Department may disapprove the form for failing to meet the readability requirements of 17B:17-17 et seq. (the Life and Health Insurance Policy Language Simplification Act).

N.J. Admin. Code § 11:24A-2.4