N.J. Admin. Code § 11:4-18.6

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

Section 11:4-18.6 - Annual review of calendar year experience data on filed individual health insurance policy forms

(a) Each insurer shall maintain records of premiums, claims, and reserves on each policy form as required for the accident and health policy experience exhibit.

(b) If the incurred/earned loss ratios for a particular policy form, based on a substantial volume of reasonably mature business, do not meet the standards set forth in section 5 of this subchapter, the insurer will be required to explain why the premiums should not be regarded as unreasonably high in relation to the benefits provided. After consideration of the explanation and any additional information furnished by the insurer, the department will inform the insurer if the benefits provided are considered unreasonable in relation to the premiums charged. If within 90 days thereafter the insurer does not reduce the premiums or increase the benefits provided in the policy such that the standards set forth in section 5 of this subchapter are met, the department may commence proceedings as provided by law for withdrawal of the filing of the form.

Amended by R.1995 d.327, effective 6/19/1995.
See: 27 New Jersey Register 1513(a), 27 New Jersey Register 2407(a).
Deleted (b) and relettered former (c) as (b).