17B:27-51.14 Insurer provide health benefits plan, aggregate benefits.
309 words·~1 min read·
/nj/title-17b/chapter-27/17b-27-51-14·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
4. a. Beginning with the calendar year starting on January 1, 2020, and in each calendar year thereafter, an insurer providing a health benefits plan shall return, in the form of aggregate benefits for all large group health insurance policy forms offered by the insurer pursuant to N.J.S.17B:27-26 et seq., at least 85 percent of the aggregate premiums collected for all of the policy forms.
b. An insurer shall annually report to the Commissioner of Banking and Insurance, no later than August 1 of each year, the loss ratio calculated for all of the policy forms for the previous calendar year. In each case in which the loss ratio fails to substantially comply with the 85 percent loss ratio requirement, the insurer shall issue a dividend or credit against future premiums for all policyholders in an amount sufficient to assure that the aggregate benefits paid in the previous calendar year plus the amount of the dividends and credits shall equal 85 percent of the premiums collected.
The insurer shall distribute all dividends and credits by December 31 of the year following the calendar year in which the loss ratio requirements were not satisfied. The insurer's annual report shall include the insurer's calculation of the dividends and credits applicable to all policy forms, as well as an explanation of the insurer's plan to issue dividends or credits.
c. The commissioner shall specify by regulation:
(1)any informational filings required to be submitted by insurers to the commissioner in order to determine whether insurers are in compliance with their loss ratio requirements;
(2)the instructions and format for calculating and reporting loss ratios and issuing dividends or credits;
(3)procedures for the distribution of a dividend or credit in the event of cancellation or termination by a policyholder; and
(4)the instructions and format for submitting annual reports.
L.2019, c.358, s.4.