N.J. Admin. Code § 11:21-11.3 - General standards for continuing and renewing a nonstandard health benefits plan

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

(a) A carrier shall continue and renew a nonstandard health benefits plan in accordance with this subchapter unless the carrier has:
1. Filed a request to withdraw the nonstandard health benefits plan in accordance with the requirements of N.J.A.C. 11:21-13, and the request has been approved by the Commissioner; or
2. The carrier has filed a notice of withdrawal from the small employer market in accordance with the requirements of N.J.A.C. 11:21-16 and N.J.S.A. 17B:27A-23e.
(b) Renewal of a nonstandard health benefits plan shall be provided at the request of a small employer that is covered by the nonstandard health benefits plan issued by the carrier at the time that the request is made.
1. A request made by a small employer that was covered by the nonstandard health benefits plan issued by the carrier, but who is not so covered at the time that the request is made, shall not be deemed a request for renewal.
2. A request made of a carrier by a small employer to renew a nonstandard health benefits plan issued by and inforce under another carrier at the time the request is made shall not be deemed a request for renewal.
(c) Notwithstanding (b) above, a carrier shall not be required to renew a nonstandard health benefits plan under the following circumstances:
1. Nonpayment or payment beyond expiration of the grace period, if any, of the required premium by the policyholder, contractholder or employer;
2. The policyholder, contractholder or employer has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage;
3. The small employer fails to meet either the participation or contribution requirements;
4. In the case of nonstandard health benefits plans issued to or through an association, trust or other multiple employer arrangement, for a small employer if the small employer ceases to be a member of the association, trust or other multiple employer arrangement but only if such coverage is terminated uniformly without regard to any health status-related factor relating to any covered individual;
5. The small employer has decided to cease offering and to nonrenew a particular type of nonstandard health benefits plan in the small employer market, or as permitted or required pursuant to 17B:27A-19; or
6. In the case of a health maintenance organization plan issued to a small employer, an eligible person no longer resides, lives or works in the carrier's approved service area, but only if coverage is terminated uniformly without regard to any health status-related factor of covered individuals; or a small employer no longer has any enrollee in connection with such plan who lives, resides or works in the service area of the carrier and the carrier would deny enrollment with respect to such plan pursuant to 17B:27A-26.
(d) In the event that a small employer is being nonrenewed pursuant to (c)4 above, the carrier shall provide notice to the small employer that the same standard health benefits plan(s) available to the small employer through the association, trust or other multiple employer arrangement are available from the carrier directly along with the other standard health benefits plans and rider options that the carrier offers to other small employers.

Notes

N.J. Admin. Code § 11:21-11.3

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