N.J. Admin. Code § 11:21-7.14 - Permissible rate classification factors

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

(a) For health benefits plans issued or renewed on or after January 1, 2014, a carrier shall not differentiate premium rates charged to different small employers for the same health benefits plan except on the basis of age and geography in accordance with the following restrictions:
1. Rates shall vary by age for each covered person age 21 or older. There shall be a per child rate for children under age 21 with a limit applied to the number of children rate equal to three times the child rate.
2. Geographic categories shall be limited to six territories, each consisting of the areas covered by the counties listed below. A carrier shall determine which territory applies to a small employer on the basis of the address of the small employer's principal place of business. The six territories are the following:
i. Territory A consists of Essex, Hudson, and Union counties;
ii. Territory B consists of Bergen and Passaic counties;
iii. Territory C consists of Monmouth, Morris, Sussex, and Warren counties;
iv. Territory D consists of Hunterdon, Middlesex, and Somerset counties;
v. Territory E consists of Burlington, Camden, and Mercer counties; and
vi. Territory F consists of Atlantic, Cape May, Ocean, Salem, Cumberland, and Gloucester counties.

Notes

N.J. Admin. Code § 11:21-7.14
New Rule, R.1994 d.418, effective 7/15/1994 (operative September 11, 1994).
See: 26 N.J.R. 2843(a), 26 N.J.R. 3442(b).
Recodified from 11:21-7.15 by R.1997 d.62, effective 2/3/1997.
See: 28 N.J.R. 4344(a), 29 N.J.R. 428(a).
Former section recodified to N.J.A.C. 11:21-7.13.
Amended by R.2004 d.107, effective 3/15/2004.
See: 35 N.J.R. 5011(a), 36 N.J.R. 1594(a).
In (b), inserted "or HMO-POS, " following "or HMO" in the introductory paragraph.
Amended by R.2014 d.019, effective 12/19/2013 (operative January 1, 2014).
See: 46 N.J.R. 12(a), 46 N.J.R. 228(a).
Rewrote (a); and deleted (b).

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