N.J. Admin. Code § 11:4-13.4

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

Section 11:4-13.4 - Rate and form filing requirements for fully insured student health plans

(a) Carriers offering student health plans shall adhere to the following requirements for the filing of rates and forms:

1. Each carrier shall submit separate rate and policy form filings in System for Electronic Rate and Form Filing (SERFF) for each student health plan offered, identifying the filings using H22 Student Health Insurance TOI and H22.000 Student Health Insurance sub-TOI;

2. Forms shall be submitted as follows:

i. Forms shall be submitted at least 90 days prior to the effective date of the policy and shall include a certification that the form complies with the essential health benefits set forth in the benchmark plan selected by New Jersey in accordance with 45 CFR 156.100; or

ii. Forms shall be submitted through SERFF, consistent with (a)1 above, and shall include a certification that a previously filed form, identified in the certification by its form number and filing date, complies with the essential health benefits set forth in the benchmark plan selected by New Jersey in accordance with 45 CFR 156.100.

3. Student health plan rate filings shall be submitted at least 90 days before the effective date of the rates;

4. Student health plan rate filings must be submitted for all rate changes and shall include Parts I, II, and III of the Rate Review Justifications explained at http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/RRJ-Instructions-Manual-20150401-Final.pdf; and

5. Carriers shall confirm in the actuarial certification submitted with Part III of the Rate Review Justification that the rates for New Jersey do not subsidize the carrier's student health plans in other states, and carriers shall also specify in the actuarial memorandum the following details:

i. Rate increase by plan and explanation of variation if it is not the same for all plans;

ii. Three years of experience and a description of the basis, which may be school specific;

iii. Explanation of adjustments to base data for unusually high or low volume of large claims;

iv. Show run-out date and incurred but not reported (IBNR) assumption;

v. Support for the trend assumptions, including adjustments made for large claims amounts;

vi. Services included in "other" category;

vii. Adjustments and support for the following factors:

(1) Changes in benefits, if any;

(2) Changes in morbidity, if any;

(3) Demographics changes, if any;

(4) Network changes, if any; and

(5) Other changes, if any.

viii. Credibility assigned to experience and credibility methodology used;

ix. Source and development of manual rate if experience is not 100 percent credible;

x. A rating example;

xi. Quality improvement expenses;

xii. Explanation of any variation in administrative costs by plan; and

xiii. Actuarial value screenshots demonstrating compliance with 60 percent minimum.

N.J. Admin. Code § 11:4-13.4

Adopted by 51 N.J.R. 618(a), effective 5/6/2019