N.J. Admin. Code § 11:4-18.3

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

Section 11:4-18.3 - Definitions

(a) The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise.

1. Terms related to policy renewability are:

i. "Collectively renewable insurance" means all insurance which is made available on any individual basis under mass enrollment procedures to persons under a plan sponsored by an employer, association, or union, or to a group of individuals supplying materials to a central point of collection or handling a common product or commodity, under which the insurer has agreed that renewal will not be refused, subject to any specific age limit, while the insured remains a member of the group specified in the agreement, unless the insurer simultaneously refuses to renew all policies in the same group or all policies bearing the same form number.

ii. "Guaranteed renewable insurance" means all individual insurance which grants an insured the right to continue the policy in force by the timely payment of premiums until at least age 50, or in the case of a policy issued after age 44 for at least five years from the date of issue of the policy, during which period the insurer has no right to make unilaterally any change in any provision of the policy while the policy is in force, except that the insurer may make changes in premium rates by classes.

iii. "Nonrenewable for stated reasons only insurance" means all individual insurance which limits the insurer's right of nonrenewal to stated reasons.

iv. "Noncancellable insurance" or "noncancellable and guaranteed renewable insurance" means all individual insurance which gives the insured the right to continue the insurance in force by the timely payment of premiums set forth in the policy until at least age 50, or in the case of a policy issued after age 44 for at least five years from its date of issue, during which period the insurer has no right to make unilaterally any change in any provision of the policy while it is in force.

2. Terms related to loss ratios are:

i. "Incurred/earned loss ratio" means the ratio of incurred claims to earned premiums.

ii. "Anticipated loss ratio" means the ratio of the present value of the expected benefits, not including dividends, to the present value of the expected premiums, not reduced by dividends, over the entire period for which rates are computed to provide coverage. For purposes of this ratio, the present values must incorporate realistic rates of interest which are determined before federal taxes but after investment expenses.

iii. "Aggregate loss ratio" means the ratio of items (1) to (2) below, where:

(1) Is the accumulated value of past benefits, from the original effective date of a form to the date as of which the ratio is determined, and the present value of future benefits; and

(2) Is the accumulated value of past premiums from the original effective date of that form to the date as of which the ratio is determined, and the present value of future premiums.

NOTE: For purposes of the "aggregate loss ratio", benefits shall not be increased nor premiums reduced by actual or anticipated dividends, and interest shall be included in the accumulated values and present values on the same basis as in the present values for the "anticipated loss ratio".

3. Other terms are:

i. "Accident only coverage" means all individual insurance which covers only losses due to accident.

ii. "Over 65 coverage" means all individual insurance where premiums are rated by age and the attained age is 65 years or more or when the insurance is issued only to persons age 65 or more.

iii. "Policy" means any policy, certificate, rider, endorsement or amendment which is required to be filed pursuant to N.J.S.A. 17B:26-1 and N.J.S.A. 17:44A-21.

N.J. Admin. Code § 11:4-18.3

Amended by R.1988 d.473, effective 10/3/1988 (operative January 31, 1989).
See: 19 New Jersey Register 1620(b), 20 New Jersey Register 2457(c).
Substantially amended.