N.J. Admin. Code § 11:4-56.9

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

Section 11:4-56.9 - Financial reporting of self-funded MEWAs

(a) A self-funded MEWA shall file with the Commissioner an annual report for the separate trust account established pursuant to N.J.A.C. 11:4-56.8 no later than May 15 of each calendar year, or four months and 15 days after the end of each fiscal year of the self-funded MEWA for the immediately preceding year.

1. The annual report shall be completed as prescribed by the National Association of Insurance Commissioners (NAIC) Health Annual Statement Instructions, and completed on a statutory accounting principles basis, in accordance with the NAIC Accounting Practices and Procedures Manual, effective January 1, 2001, both incorporated herein by reference as amended and supplemented (NAIC, 2301 McGee Street, Kansas City, MO 64108).

2. The annual report shall include a certification of, and an opinion by, a qualified actuary that the reserves required by N.J.A.C. 11:4-56.8(f), and included on the self-funded MEWA's annual report, are sufficient.

i. The actuarial certification shall identify the specific methodology used to determine the reserves, and shall specify whether and how the methodology has changed since the last report.

ii. The actuarial opinion shall include the workpapers prepared by the actuary in support of the certification.

3. The annual report shall be submitted using the NAIC health blank in effect at the time of the year reported, and submitted to the following address:

New Jersey Department of Banking and Insurance

Office of Solvency Regulation

20 West State Street, 10th Floor

PO Box 325

Trenton, NJ 08625-0325

(b) A self-funded MEWA shall file with the Commissioner quarterly reports for the separate trust account established pursuant to N.J.A.C. 11:4-56.8 as follows:

1. The quarterly report shall be filed no later than 60 days following the close of each fiscal quarter;

2. The quarterly report shall be completed as prescribed by the NAIC Health Annual Statement Instructions;

3. The quarterly report shall be completed on a statutory accounting principles basis, in accordance with the NAIC Accounting Practices and Procedures Manual, effective January 1, 2001, as amended and supplemented; and

4. The quarterly report shall be submitted using the NAIC health blank in effect at the time of the quarter submitted.

(c) A self-funded MEWA shall file with the Commissioner the following audited annual financial reports for the immediately preceding calendar or fiscal year:

1. For the separate trust account established pursuant to N.J.A.C. 11:4-56.8, completed on a statutory accounting basis; and

2. With respect to all of its operations, completed on a generally accepted accounting principles basis.

(d) The reports shall be filed no later than May 15th (if on a calendar year basis) or four months and 15 days after the end of the fiscal year.

(e) The audited annual reports shall be certified by a qualified independent certified public accountant, who shall be in good standing with the American Institute of Certified Public Accountants and in all states in which the accountant is licensed to practice, and who conforms to the standards of his or her profession as contained in the Code of Professional Ethics of the American Institute of Certified Public Accountants and the Rules and Regulations, Code of Ethics, and Rules of Professional Conduct of the New Jersey Board of Public Accountancy or similar code.

(f) A self-funded MEWA shall file with the Commissioner a Risk-Based Capital Health Report for the separate trust account established pursuant to N.J.A.C. 11:4-56.8, on or before March 1 of each year, for the immediately preceding calendar year, completed as prescribed in a form and containing such information as is required by the instructions adopted by the NAIC.

(g) A self-funded MEWA shall file with the Commissioner proof of the stop-loss coverage required by section N.J.A.C. 11:4-56.8(g) above within 15 days of the renewal date of the stop-loss agreement.

(h) A self-funded MEWA shall file with the Commissioner within 60 days after the end of each fiscal quarter a report certifying that it maintains, in a claim reserve account within the trust account established pursuant to N.J.A.C. 11:4-56.8, cash or liquid assets sufficient to provide for all incurred losses, including paid claims.

N.J. Admin. Code § 11:4-56.9