N.J. Admin. Code § 11:4-40.9

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

Section 11:4-40.9 - File and use eligibility

(a) An insurer may deliver or issue for delivery in this State a form providing life, health or annuity benefits, and accompanying rates if applicable, without obtaining prior approval from the Commissioner pursuant to this subchapter provided the form is set forth in this section as a type eligible for file and use and is filed with the Commissioner pursuant to the procedures set forth at N.J.A.C. 11:4-40.1 0, or the form is specifically exempt from compliance with this subchapter.

(b) The following types of non-variable individual life insurance forms shall be eligible for file and use pursuant to this section:

1. Scheduled premium term policies without cash values, other than universal/flexible-factor forms, multiple-life forms with survivorship benefits, limited death benefit forms, policies with re-entry options, single premium forms, field issued forms or funeral insurance;

2. Accidental death benefit;

3. Business exchange/substitute insured;

4. Cost of living benefit;

5. Option to purchase additional insurance;

6. Waiver of premium;

7. Spouse and/or child rider; and

8. Applications.

(c) The following types of non-variable individual annuity forms shall be eligible for file and use pursuant to this section:

1. Immediate annuities, other than structured settlement, field issued forms or funeral insurance;

2. Scheduled premium deferred annuities, other than structured settlement, field issued forms or funeral insurance;

3. Flexible premium deferred annuities, other than structured settlement, field issued forms or funeral insurance;

4. Waiver of premium; and

5. Applications.

(d) The following types of individual health insurance forms shall be eligible for file and use pursuant to this section:

1. Business buyout, keyperson and overhead expense disability income policies;

2. Medical expense conversion policies in which a portion of the premium is chargeable to or subsidized by the group policy from which conversion is made;

3. Benefit riders for use with the type of policies set forth at (d)1 and 2 above; and

4. Applications other than those used with medicare supplement and long-term care policies.

(e) The following types of non-variable group life insurance forms shall be eligible for file and use pursuant to this section:

1. Policies and certificate forms which provide life insurance benefits only, and which do not provide cash values or loan values other than funeral expense;

2. Retired lives reserve contracts;

3. Benefit riders for use with the type of policies set forth at (e)1 and 2 above; and

4. Applications and evidence of coverage forms.

(f) The following types of group health insurance forms shall be eligible for file and use pursuant to this section:

1. Policies, certificates and evidence of coverage which provide only temporary disability benefits pursuant to N.J.S.A. 34:15-1 et seq.;

2. Policies and certificates which provide only disability income benefits for loss due to both accident and sickness and which are sold exclusively to employer groups;

3. Benefit riders for use with the type of policies set forth at (f)1 and 2 above; and

4. Applications and evidence of coverage forms.

(g) In the month of September or October of each year, the Department shall conduct a hearing pursuant to P.L. 1995, c.73 for the purpose of determining the specific types of forms eligible for file and use pursuant to this section.

1. The hearing shall be preceded by a notice of hearing published in the New Jersey Register at least 30 days prior to the date of the hearing, which notice shall include information concerning the date by which, and the person to whom, written public comment may be made. Notice shall also be provided to persons who have previously requested receipt of such notice.

2. The notice published in the New Jersey Register and as otherwise provided pursuant to (g)1 above shall also request that persons who wish to testify at the hearing provide the Department with timely notice of this intention, including a brief summary of the subject matter of their testimony.

3. The notice shall indicate whether the hearing shall address the merits of maintaining all forms currently on the file and use eligibility list, or whether the hearing will consider only specific additions, deletions or clarifications regarding the list.

4. The hearing shall be conducted by a hearing officer designated by the Commissioner. The length of testimony permitted at the hearing and the receipt of questions from the floor will be within the discretion of the hearing officer.

5. A transcript of the hearing shall be made and a copy thereof shall be made available to any interested person upon request and payment of the appropriate fee.

6. The record of the hearing shall include the following:

i. Timely-received written public comments;

ii. The transcript of the hearing; and

iii. Any other information which the hearing officer may deem relevant.

7. The record and transcript of the hearing shall be public records pursuant to N.J.S.A. 47:1A-1 et seq. except to the extent that any information is submitted pursuant to a statute or rule providing for confidentiality.

8. Upon review of the file and use eligibility list hearing record, the Commissioner shall determine within 30 days whether any modifications should be made by rule to the current list.

9. If the Commissioner determines during the term of a duly promulgated file and use eligibility list that changed conditions require a modification of the list, the Commissioner may amend the list by rule following a hearing conducted pursuant to this subsection.

N.J. Admin. Code § 11:4-40.9

Public Notice: Hearing to determine forms eligible for filing and use.
See: 28 N.J.R. 4121(a).
Public Notice: Hearing to determine forms eligible for filing and use.
See: 30 N.J.R. 3108(b).
Public Notice: Hearing to determine forms eligible for filing and use.
See: 33 N.J.R. 3379(a).
Amended by R.2001 d.408, effective 11/5/2001.
See: 33 N.J.R. 2263(a), 33 N.J.R. 3747(a).
In (a), added ", or the form is specifically exempt from compliance with this subchapter"; deleted former (g); recodified former (h) as (g) and substituted "(g)1" for "(h)1".
Public Notice: Notice of Public Hearing; Life/Health/Annuity Forms Certification Eligibility.
See: 34 N.J.R. 3544(b).
Public Notice: Life/Health/Annuity Forms certification eligibility.
See: 35 N.J.R. 4144(a).
Amended by R.2004 d.174, effective 5/3/2004.
See: 35 N.J.R. 4437(a), 36 N.J.R. 2197(a).
In (b), deleted former 8 and recodified former 9 as 8; in (c), deleted former 4 and recodified former 5 and 6 as 4 and 5.
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 36 N.J.R. 3940(a).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 37 N.J.R. 3463(a).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 38 N.J.R. 3928(a).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 39 N.J.R. 3566(c).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 40 N.J.R. 5294(b).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 41 N.J.R. 3464(a).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 42 N.J.R. 2150(b).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 43 N.J.R. 3205(a).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 44 N.J.R. 2313(b).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 45 N.J.R. 2274(b).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 46 N.J.R. 2047(a).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 48 N.J.R. 466(a), 1972(b), 2169(a).
Public Notice: Life/Health/Annuity Forms Certification Eligibility.
See: 49 N.J.R. 3259(b).