N.J. Admin. Code § 11:4-56.3

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

Section 11:4-56.3 - Initial registration of self-funded MEWAs

(a) By September 5, 2004, a self-funded MEWA operating in this State prior to June 7, 2004, shall file an application for initial registration with the Commissioner. A self-funded MEWA that was not operating in this State prior to June 7, 2004, shall not commence operations in this State until it submits an application for initial registration to the Commissioner, and said application is approved. The application for registration shall be on a form prescribed by the Commissioner available on the Department's website at http://www.state.nj.us/dobi/division_insurance/mewaapps.htm, and shall include the following:

1. A certification of an officer, director or trustee of the self-funded MEWA that states:

i. The name of the self-funded MEWA, which shall not include the terms "insurance," "mutual," "casualty," "surety," "indemnity," "HMO," "assurance" or any other name likely to mislead;

ii. The names and addresses of the employers who are members of the self-funded MEWA;

iii. The names and addresses of the trustees or other persons responsible for the operations of the self-funded MEWA;

iv. The mailing address and telephone number at which communications to the self-funded MEWA are to be received;

v. The eligibility requirements for membership in the association, if any, to which the self-funded MEWA provides a health benefit plan or plans; and

vi. The fees, if any, charged for membership in the association, if any, to which the self-funded MEWA provides a health benefit plan or plans;

2. A completed Checklist and Certification with information regarding administration, underwriting requirements, and coverage services that assists the Department in verifying compliance with N.J.S.A. 17B:27A-48 can be found on the Department's website at: www.state.nj.us/dobi/division_insurance/lifehealthmain.html;

3. A specimen form of the notice to be provided to employers and employees pursuant to N.J.S.A. 17B:27C-7e;

4. A copy of the trust agreement or other organizational documents relating to the self-funded MEWA, including the agreement to establish a separate trust account for the health benefits plans;

5. A copy of any documents executed by an employer to become a member of the association, if any, to which the self-funded MEWA provides a health benefit plan or plans; and/or obtain coverage from the self-funded MEWA, including the application for membership in the self-funded MEWA;

6. A description of the eligible employers that constitute the association, if any, to which the self-funded MEWA provides a health benefit plan or plans, including their common or similar type of trade or business; the common trade association, professional association or other associations;

7. Biographical affidavits, on a form prescribed by the Commissioner, for all trustees and other persons responsible for the operations of the self-funded MEWA;

8. The names and addresses of all administrators and servicing organizations responsible for the operations of the self-funded MEWA with respect to its health benefits plans;

9. The most recent audited financial statement of the self-funded MEWA;

10. Three-year financial projections for the separate trust account to be established pursuant to N.J.A.C. 11:4-56.8(a);

11. If applicable, an actuarial opinion, prepared by a qualified actuary, that the reserves for health benefits are adequate;

12. If applicable, a calculation of the regulatory action level RBC;

13. A demonstration that the applicant will be able to provide the deposit required by N.J.S.A. 17B:27C-5a;

14. A demonstration, such as a binder, that the applicant will obtain "stop-loss" coverage as defined at N.J.S.A. 17B:27A-17 or N.J.A.C. 11:4-40.2, as applicable, as required by N.J.S.A. 17B:27C-5b and this subchapter at N.J.A.C. 11:4-56.8(g); and an actuarial certification with supporting documentation that the retention level for stop-loss coverage is based on sound actuarial principles; and

15. Any other information from a particular applicant deemed necessary by the Commissioner to determine compliance with the requirements of N.J.S.A. 17B:27C-1 et seq. and this subchapter.

(b) Filings described in (a) above shall be submitted to:

Att: Self-funded MEWA Registration

NJ Department of Banking and Insurance

20 West State Street

PO Box 325

Trenton, NJ 08625-0325

(c) The Commissioner shall review an application for registration and notify the applicant in writing of any deficiencies contained therein within 60 days of receipt. An applicant shall address any deficiencies in its application within 60 days of notice thereof. Upon written request from the applicant and for good cause shown, the Commissioner may extend this 60-day time frame to correct any deficiencies in an application an additional 60 days. The Department shall notify the applicant in writing of its response to any such request.

(d) Upon receipt and review of a complete application, the Commissioner shall approve the application if he or she finds that the MEWA meets the following standards:

1. All of the required application materials described in (a) above have been filed;

2. The persons responsible for conducting the MEWA's affairs are competent, trustworthy, possess good reputations and have appropriate experience, training and education;

3. The applicant has demonstrated that all the requirements of N.J.S.A. 17B:27C-1 et seq. and this subchapter have been met, including compliance with all applicable small employer health benefits laws and financial requirements. In the case of (e) below, the applicant has demonstrated that it will comply with these requirements; and

4. The Commissioner is satisfied that the plan of operation of the separate trust account is sound, supports the continuing operations of the MEWA, and complies with N.J.S.A. 17B:17C-1 et seq. and this subchapter on an ongoing basis.

(e) Within 15 days of notification to the applicant by the Commissioner that the application has been approved, and prior to the issuance of the registration, the applicant shall:

1. Deposit with the Commissioner securities, as defined at and pursuant to the provisions of N.J.S.A. 17B:18-37 and N.J.A.C. 11:2-32, having a market value of $ 200,000 as required by N.J.S.A. 17B:27C-5;

2. Provide a signed copy of the stop-loss or reinsurance agreement; and

3. Provide evidence that the separate trust account for the health benefit plans has been established.

(f) Upon receipt of the materials listed in (e) above, the Commissioner shall issue an initial registration to the applicant.

N.J. Admin. Code § 11:4-56.3

Amended by 51 N.J.R. 618(a), effective 5/6/2019