N.J. Admin. Code § 11:4-34.30

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

Section 11:4-34.30 - Partnership Policies-general requirements

(a) In order to qualify for New Jersey's Long-Term Care Partnership Program, a long-term care insurance policy shall satisfy the following requirements:

1. The policy shall cover an insured who was a New Jersey resident at the time coverage first became effective under that policy;

2. The policy is a qualified long-term care insurance policy as defined in 26 U.S.C. § 7702B(b);

3. The policy is issued on or after November 23, 2007 (the effective date of the State plan amendment by the Centers for Medicare and Medicaid Services regarding the Partnership Policy Program);

4. If the policy is sold to an individual under the age of 61, it must provide compound annual inflation protection at a rate of at least three percent, or at a rate based on changes in the consumer price index for all urban consumers, U.S. city average, all items, as determined by the Bureau of Labor Statistics of the U.S. Department of Labor;

5. If the policy is sold to an individual aged 61 through 75, the policy must provide inflation protection at least equivalent to a guaranteed purchase option of additional coverage each year in an amount equal to three percent simple growth rate of the original benefits provided under the policy, or at a rate based on changes in the consumer price index for all urban consumers, U.S. city average, all items, as determined by the Bureau of Labor Statistics of the U.S. Department of Labor; and

6. If the policy is sold to an individual aged 76 or older, the insurer is required to offer inflation protection which meets the requirements for a partnership policy sold to an individual 61 through 75.

(b) Any carrier requesting approval of a long-term care insurance policy as a qualified Partnership Policy shall certify in writing that the policy meets all of the consumer protection standards required to qualify as a Partnership Policy as set forth in the certification form included in Appendix J to this subchapter, incorporated herein by reference.

(c) Any long-term care insurance policy (including a certificate issued under a group policy) previously approved by the Department may be certified by a carrier as a qualifying long-term care insurance policy meeting the consumer protection standards set forth therein by completing and submitting the certification form included in Appendix J. Once this certification is submitted to the Department, the carrier may market the policy as a Partnership Policy provided the policy also meets the standards set forth in (a) above.

(d) If a carrier intends to use new policy or certificate forms which have not been previously approved by the Department for sale as a Partnership Policy, the certification in Appendix J shall be included when submitting the new qualifying policy or certificate as part of the Department's standard form filing and approval process.

(e) Any Partnership Policy issued or delivered for issue in New Jersey shall be accompanied by the Notice of Long Term Care Partnership Status set forth in Appendix K to this subchapter, incorporated herein by reference, explaining the benefits associated with a Partnership Policy and indicating at the time of issuance that the policy is a Partnership Policy. In lieu of the notice set forth in Appendix K, a similar notice may be used if it has been filed and approved by the Commissioner. In the case of a group insurance contract, such notice shall be provided to the insured under a certificate upon the issuance of the certificate. In determining whether to provide this notice with respect to a policy, the carrier may rely upon a statement by the policyholder, certificateholder, or insured that the insured is a resident of New Jersey.

N.J. Admin. Code § 11:4-34.30

New Rule, R.2009 d.65, effective 2/17/2009.
See: 40 N.J.R. 6377(a), 41 N.J.R. 881(b).
Former N.J.A.C. 11:4-34.30, Penalties, recodified to N.J.A.C. 11:4-34.32.