N.J. Admin. Code § 11:20-18.6 - General provisions for withdrawal of plan, plan option, or deductible/copayment option

Current through Register Vol. 54, No. 7, April 4, 2022

(a) No carrier shall cease to issue or nonrenew an individual plan, plan option, or deductible/copayment option required or permitted to be offered by 11:20-3.1 until the carrier submits a notice of intent to withdraw a plan, plan option, or deductible/copayment option to the Department and the Commissioner approves such withdrawal in accordance with the provisions of this subchapter.
(b) A carrier may cease to issue and nonrenew an individual plan pursuant to this section only if:
1. The deductible/copayment option is not required to be offered pursuant to 11:20-3.1(b); or
2. In the case of a deductible/copayment option required to be offered pursuant to 11:20-3.1, the carrier meets its obligations to offer at least three standard individual plans and required deductible/copayment options either by offering the plans as indemnity plans or by making the plan or plans available through or in conjunction with a selective contracting arrangement to all New Jersey residents.
(c) A carrier may cease to issue and nonrenew a standard plan option pursuant to this section by offering another approved plan option. Examples of plan options include, but are not limited to, a carrier's option to offer autologous bone marrow transplant coverage in either the policy or contract or in a rider, and an HMO's option to offer plans subject to deductible and coinsurance provisions.
(d) A carrier that seeks to withdraw a plan, plan option, or deductible/copayment option pursuant to this section shall provide the Department with written notification of its intent to withdraw a plan, plan option, or deductible/copayment option. The notice of intent to withdraw a plan, plan option, or deductible/copayment option shall be sent to the Department at the address set forth in 11:20-6.4(a), and shall include the following information:
1. The name of the carrier;
2. The name, address, telephone number, and fax number of the carrier's representative responsible for the application for plan, plan option or deductible/copayment option withdrawal;
3. A specific description of the reasons the carrier is withdrawing the plan, plan option, or deductible/copayment option;
4. A statement of the number of in force plans affected by the withdrawal;
5. Copies of the carrier's most recent enrollment status report filed pursuant to N.J.A.C. 11:20-17;
6. Copies of a nonrenewal notice the applicant intends to send to its policy or contractholders. Nonrenewal notices for policy or contractholders shall contain the following information:
i. A statement that the carrier has elected to nonrenew the plan, plan option, or deductible/copayment option;
ii. The date upon which the plan, plan option, or deductible/copayment option shall be nonrenewed;
iii. A statement that the plan, plan option, or deductible/copayment option is being nonrenewed under the authority of this subchapter;
iv. A notice that the carrier shall make available a replacement plan, plan option, or deductible/copayment option;
v. A statement that the policy or contractholder may contact his or her producer, if any, for additional information regarding the plan, plan option, or deductible/copayment option withdrawal; and
vi. The name, address and telephone number of the employee or agent of the carrier who may be contacted for assistance and information regarding the plan, plan option, or deductible/copayment option withdrawal; and
7. Copies of the proposed nonrenewal notices the applicant intends to send to its producers. Nonrenewal notices for producers shall contain the following information:
i. A statement that the carrier has elected to nonrenew the plan, plan option, or deductible/copayment option;
ii. The date upon which the plan, plan option, or deductible/copayment option shall be nonrenewed;
iii. A statement that the plan, plan option, or deductible/copayment option is being nonrenewed under the authority of this subchapter;
iv. A notice that the carrier shall make available a replacement plan, plan option, or deductible/copayment option;
v. The name, address and telephone number of the employee or agent of the carrier who may be contacted for assistance and information regarding the withdrawal; and
vi. The date upon which the carrier will begin to cease to issue the plan, plan option, or deductible/copayment option.
(e) The Department shall review the notice of intent to withdraw a plan, plan option, or deductible/copayment option to determine whether it complies with the filing requirements of (d) above. The Department shall notify the carrier within 30 days of receipt of a notice of intent to withdraw a plan, plan option or deductible/copayment option, of any deficiencies and the requirements which are necessary to bring the notice into compliance with this section. The Department shall notify the carrier in writing that the withdrawal is either approved or disapproved.
(f) A carrier which has submitted a notice of intent to withdraw a plan, plan option, or deductible/copayment option shall:
1. Not more than 60 days following the Commissioner's approval of a plan, plan option, or deductible/copayment option withdrawal cease issuing the individual plan, plan option, or deductible/copayment option;
2. Not more than 60 days following the Commissioner's approval of a plan, plan option, or deductible/copayment option withdrawal, and not less than 90 days in advance of the effective date of the nonrenewal on the anniversary date of the plan, plan option, or deductible/copayment option, mail a notice, in the same format submitted to the Department pursuant to (d)6 above, to every policy or contractholder, informing the policy or contractholder that the plan, plan option, or deductible/copayment option will be nonrenewed on the anniversary date;
3. Following the initial notice to each policy or contractholder, send a subsequent notice confirming the nonrenewal to each policy or contractholder, which notice shall be included with a monthly premium bill or premium notice issued prior to the date of nonrenewal or, where no monthly premium statement is transmitted, send a notice at least 30 days prior to nonrenewal; and
4. Not less than 90 days in advance of the effective date of the nonrenewal on the anniversary date of the plan or plan option, or deductible/copayment option, mail a notice, in the same format submitted to the Department pursuant to (d)7 above, to the producer of record, if any, for each policy or contract.

Notes

N.J. Admin. Code § 11:20-18.6

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