N.J. Admin. Code § 11:4-6.15

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:4-6.15 - Specific standards for morbidity for valuation of specified group contract health insurance benefits

(a) Minimum morbidity standards for valuation of specified group 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 prior to January 1, 2001: The same basis, if any, as that employed by the insurer as of January 1, 2001;

(2) For contracts issued on or after January 1, 2001: The 1987 Commissioners Group Disability Income Table (87CGDT), (incorporated herein by reference).

ii. When calculating claim reserves use:

(1) For claims incurred on or after January 1, 2001: The 1987 Commissioners Group Disability Income Table (87CGDT);

(2) For claims incurred prior to January 1, 2001: Use of the 87CGDT is optional.

2. For other group contract benefits:

i. When calculating contract reserves: For all other group 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 § 11:4-6.15