N.J. Admin. Code § 11:4-34.13

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

Section 11:4-34.13 - Reporting requirements

(a) Every carrier shall maintain records for each agent of that agent's amount of replacement sales as a percent of the agent's total annual sales and the amount of long-term care insurance policies sold by the agent that lapsed as a percent of the agent's total annual sales.

(b) Every carrier shall report annually by June 30 to the Commissioner the 10 percent of its agents with the greatest percentages of lapses and replacements as measured by (a) above. The report shall be in accordance with subchapter Appendix G, incorporated herein by reference.

(c) Every carrier shall report annually by June 30 to the Commissioner the number of lapsed policies as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year. The report shall be in accordance with Appendix G.

(d) Every carrier shall report annually by June 30 to the Commissioner the number of replacement policies sold as a percent of its total annual sales and as a percent of its total number of policies in force as of the preceding calendar year. The report shall be in accordance with subchapter Appendix G.

(e) Every carrier shall report annually by June 30 to the Commissioner, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied. The report shall be in accordance with subchapter Appendix E, incorporated herein by reference.

(f) For purposes of this section:

1. "Policy" means only long-term care insurance;

2. Subject to (e) above, "claim" means a request for payment of benefits under an in force policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;

3. "Denied" means the carrier refuses to pay a claim for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition; and

4. "Report" means on a Statewide basis.

N.J. Admin. Code § 11:4-34.13