N.J. Admin. Code § 11:4-6.14
Current through Register Vol. 56, No. 21, November 4, 2024
Section 11:4-6.14 - Specific standards for morbidity for valuation of specified individual contract health insurance benefits(a) Minimum morbidity standards for valuation of specified individual contract health insurance benefits are as follows: 1. For disability income benefits due to accident or sickness use: i. When calculating contract reserves: (1) For contracts issued on or after January 1, 1965 and prior to January 1, 2001: The 1964 Commissioners Disability Table (64 CDT), incorporated herein by reference.(2) For contracts issued on or after January 1, 2001: (A) The 1985 Commissioners Individual Disability Tables A (85CIDA), incorporated herein by reference; or(B) The 1985 Commissioners Individual Disability Tables B (85CIDB), incorporated herein by reference.(3) For contracts issued from January 1, 1999 through December 31, 2000: (A) Optional use of either the 1964 Table or the 1985 Tables.(B) Each insurer shall elect, with respect to all individual contracts issued in any one statement year, whether it will use Tables A or Tables B as the minimum standard. The insurer may, however, elect to use the other tables with respect to individual contracts issued in any subsequent statement year.ii. When calculating claim reserves use: (1) For claims incurred on or after January 1, 2002:(B) The 85CIDA Table so adjusted for the computation of claim reserves shall be known as 85CIDC (The 1985 Commissioners Individual Disability Table C).(2) For claims incurred prior to January 1, 2002, each insurer may elect which of the following to use as the minimum standard: (A) The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the claim is incurred; or(B) The standard as defined in (a)1ii(1) above applied to all open claims.(C) Once an insurer elects to calculate reserves for all open claims on the standard defined in (a)1ii(1) above all future valuations shall be on that basis.2. For hospital benefits, surgical benefits and maternity benefits (scheduled benefits or fixed time period benefits only): i. When calculating contract reserves use: (1) For contracts issued on or after January 1, 1955, and before January 1, 1986: The 1956 Intercompany Hospital Tables and the 1956 Intercompany Surgical Tables, (incorporated herein by reference).(2) For contracts issued on or after January 1, 1986: The 1974 Medical Expense Tables, (incorporated herein by reference).ii. When calculating claim reserves use: No specific standard. See (a)5 below.3. For cancer expense benefits (scheduled benefits or fixed time period benefits only): i. When calculating contract reserves use: (1) For contracts issued on or after January 1, 2001, and, at the option of the insurer, contracts issued on or after January 1, 1986: The 1985 NAIC Cancer Claim Cost Tables, (incorporated herein by reference).ii. When calculating claim reserves use: No specific standard. See (f) below.4. For accidental death benefits: i. When calculating contract reserves use: (1) On contracts issued on or after January 1, 1966: The 1959 Accidental Death Benefits Table, (incorporated herein by reference).ii. When calculating claim reserves use the actual amount incurred.5. For other individual contract benefits. i. When calculating contract reserves for all other individual contract benefits, morbidity assumptions are to be determined as provided in the reserve standards.ii. When calculating claim reserves for all benefits other than disability, claim reserves are to be determined as provided in the standards.N.J. Admin. Code § 11:4-6.14
R.1984 d.512, eff. 11/5/1984.
See: 16 N.J.R. 2225(a), 16 N.J.R. 3039(a).