N.J. Admin. Code § 11:4-23.13

Current through Register Vol. 56, No. 8, April 15, 2024

Section 11:4-23.13 - Filing requirements for policies, certificates and premium rates, including procedures for review and intervention by the Public Advocate, Division of Rate Counsel

(a) No carrier shall deliver or issue for delivery in this State any Medicare supplement policy or certificate, any written application therefor, or any printed rider or endorsements to be applied thereto, unless the forms thereof have been submitted to and filed by the Commissioner.

1. At the expiration of 30 days after submission, the form shall be deemed filed unless affirmatively disapproved for filing by the Commissioner prior thereto.

2. If any such form is disapproved for filing by the Commissioner during the said 30-day period, it may not be delivered or issued for delivery unless and until such disapproval for filing is withdrawn. Such disapproval shall be subject to review in accordance with the Administrative Procedure Act, 52:14B-1 et seq. and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1.

3. The Commissioner may extend the 30-day period no more than another 30 days if written notice is provided to the insurer before the expiration of the initial 30 day period, in which event all but this paragraph shall apply to the extended period.

4. Forms filed by or deemed filed by the Commissioner may subsequently be withdrawn from filing. Insurers shall have the right to a hearing in accordance with the Administrative Procedure Act, 52:14B-1 et seq., and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1. An insurer may continue to deliver or issue for delivery such forms until a final decision in accordance with the withdrawal is rendered, following the request for a hearing, or, if no hearing is requested, delivery or issuance for delivery of such forms may continue no later than 30 days following notice of the withdrawal of that form.

(b) Disapproval for filing, or withdrawals of approval of the filing of any form, must be stated in writing with the grounds therefor included in the statement, in accordance with the rules of this State.

(c) No carrier shall use or revise premium rates for a Medicare supplement policy or certificate unless the rates, rating schedule and supporting documentation have been submitted to and filed by the Commissioner in accordance with the provisions of this subsection, (a) and (b) above, and N.J.S.A. 11:4-23.1 1. Pursuant to 17:29A-53, and in accordance with N.J.A.C. 11:1-45, notices of requests for prior approval rate increases shall be given to individual policyholders, and to group policyholders so as to enable them to notify certificateholders of the filing of the rate increase request. As set forth in N.J.S.A. 52:27EE-48, the Public Advocate, Division of Rate Counsel may intervene in Medicare supplement rate filings which seek a rate increase in excess of seven percent. Intervention by the Public Advocate, Division of Rate Counsel shall be in accordance with the procedures set forth below.

1. Pursuant to N.J.S.A. 52:27EE-48, any revised rate submissions which implement a rate increase exceeding seven percent shall be concurrently submitted to the Department of the Public Advocate, Division of Rate Counsel, at the following address:

Department of the Public Advocate

Division of Rate Counsel

31 Clinton Street

11th Floor

P.O. Box 46005

Newark, NJ 07101

2. The Public Advocate, Division of Rate Counsel, may intervene in Medicare supplement rate filings seeking increases of more than seven percent, by filing a Notice of Intervention with the Commissioner and the filer no later than 30 days after its receipt of the rate submission. If a Notice of Intervention is filed by the Public Advocate, Division of Rate Counsel, the Commissioner shall automatically receive an additional 30 days to review the rate submission, thus creating a total 60-day period for review of rate increases where the Public Advocate has intervened. The Public Advocate's Notice of Intervention shall constitute written notice of this automatic 30-day extension to the filer. The Commissioner may extend the review period for an additional 30 days upon written notice to the filer and the Public Advocate before expiration of the 60-day automatic extension period, pursuant to (a)3 below.

3. The Public Advocate, Division of Rate Counsel, shall provide the Commissioner and the filer with its report and recommendations no later than 30 days after its receipt of the rate increase submission.

4. After the filing of its Notice to Intervention, the Public Advocate, Division of Rate Counsel, shall have the authority to participate as an intervenor in any hearings conducted by the Commissioner pursuant to N.J.S.A. 11:4-23.1 1(f).

(d) The Commissioner shall not file, and carriers shall not submit for filing, more than one Medicare supplement policy or certificate form of each type for each standard Medicare supplement benefit plan, except as the Commissioner may otherwise approve in accordance with (d)2 below.

1. For the purposes of this subchapter, "type" shall mean an individual policy, and a group policy, and at such time as a Medicare Select program shall become effective in this State, an individual Medicare Select policy, and a group Medicare Select policy.

2. The Commissioner may approve carriers, individually, to offer up to four additional policy or certificate forms of the same type for the same standard Medicare supplement benefit plan. Such forms shall be subject to the filing requirements of this section. The four additional policy or certificate forms of the same type shall be limited to one additional form of the same type for:

i. The inclusion of Innovative Benefits;

ii. The addition of either a direct response or an agent marketing method;

iii. The addition of either guaranteed issue or underwritten coverage; and

iv. The offering of Medicare supplement coverage to persons eligible for Medicare by reason of disability.

(e) A carrier shall not discontinue offering any policy or certificate form filed by the Commissioner on or after the effective date of this subchapter unless such form has been withdrawn from filing pursuant to (a)4 above, or the carrier provides notice of discontinuance of offer to the Commissioner at least 30 days prior to such discontinuance, in writing.

1. Discontinuance subject to notice to the Commissioner shall include the following:

i. Failure to actively offer for sale a policy or certificate form for more than 12 consecutive months;

ii. Sale or transfer of Medicare supplement policies or certificates to another carrier; and

iii. Revisions in the rating structure or methodology applicable to a Medicare supplement policy or certificate form which has not been otherwise submitted to and filed by the Commissioner in accordance with N.J.S.A. 11:4-23.1 1.

2. Carriers shall not submit for filing a new form for any Medicare supplement plan of the same type for which the carrier has discontinued issue of a policy or certificate for a period of five years following the notice of discontinuance to the Commissioner. The Commissioner may waive some or all of the five year period, in his or her discretion.

(f) Except for policies or certificates assumed under an assumption reinsurance agreement, the experience of all policy or certificate forms of the same type for a standard Medicare supplement benefit plan shall be combined for purposes of the refund or credit calculation set forth at 11:4-23.1 1(d).

(g) When outpatient prescription drug benefits are removed from a Medicare supplement policy or certificate delivered or issued for delivery in this State as required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the form used to endorse or amend the policy or certificate must be submitted to and filed by the Commissioner in accordance with (a) above.

N.J. Admin. Code § 11:4-23.13

New Rule, R.1991 d.345, effective 7/1/1991.
See: 23 N.J.R. 1264(a), 23 N.J.R. 2014(a).
Prior section 23.9, Requirements for replacement recodified to 23.12.
Amended by R.1993 d.26, effective 1/4/1993.
See: 24 N.J.R. 12(a), 25 N.J.R. 141(a).
Rule on application forms and replacement coverage recodified to 3.15; rule on filing requirements recodified from 23.9; (c) through (f) added.
Recodified from N.J.A.C. 11:4-23.12 by R.1999 d.38, effective 12/28/1998 (to expire February 26, 1999).
See: 31 N.J.R. 181(a).
Former N.J.A.C. 11:4-23.13, Compensation arrangements, recodified to N.J.A.C. 11:4-23.14.
Adopted concurrent proposal, R.1999 d.100, effective 2/26/1999.
See: 31 N.J.R. 181(a), 31 N.J.R. 876(a).
Amended by R.2004 d.344, effective 9/20/2004.
See: 36 N.J.R. 606(a), 36 N.J.R. 4317(a).
In (c), added the second sentence.
Amended by R.2005 d.291, effective 9/6/2005.
See: 37 N.J.R. 1428(a), 37 N.J.R. 3376(a).
Added (g).
Amended by R.2008 d.3, effective 1/7/2008.
See: 39 N.J.R. 3709(a), 40 N.J.R. 184(a).
Section was "Filing requirements for policies, certificates and premium rates". In the introductory paragraph of (c), inserted "the provisions of this subsection," and ", and N.J.A.C. 11:4-23.11" and inserted the last two sentences; and added (c)1 through (c)4.