N.J. Admin. Code § 11:20-17.4 - Contents of the enrollment status report

(a) Members shall report the following information on a quarterly basis on the enrollment status report form separately for each of the standard health benefits plans, broken out into PPO or POS or EPO for Plans A/50, B, C, and D, the HMO plans reported by copay or coinsurance, as well as catastrophic plans. Carriers shall separately report enrollment through the Marketplace and enrollment directly by the carrier.

1. Contracts inforce shall be calculated and reported by adding the number of contracts in force at the beginning of the period to the number of contracts issued during the period, and subtracting the number of contracts lapsed during the period. The enrollment at the start of a quarter shall equal the enrollment at the end of the prior quarter.

2. Persons insured shall be calculated and reported by adding the number of persons insured at the beginning of the period and the number of new insureds during the period, and subtracting the number of insureds lapsed during the period.

3. Inforce Contracts shall be reported separately by rating tier, that is: single person; or multiple person. The sum of the contracts by rating tier shall equal the number of contracts inforce.

4. Inforce contracts shall be reported separately by the primary care provider (PCP) cost sharing, that is, deductible or copayment options applicable to PCP services. Contracts that apply both the deductible and copayment to PCP services shall be reported using the PCP deductible. The sum of the contracts by PCP cost sharing shall equal the number of contracts inforce.

5. The number of contracts sold as a high deductible health plan (HDHP) which are included in (a)4 above shall be reported separately.

6. Inforce plans shall be reported according to actuarial values of the inforce plans.

Notes

N.J. Admin. Code § 11:20-17.4

Amended by R.1998 d.443, effective 8/7/1998.
See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a).
Rewrote (a) and (b).
Amended by R.1998 d.503, effective 9/16/1998 (operative November 1, 1998).
See: 30 N.J.R. 3235(b), 30 N.J.R. 3838(a).
In (a) and (b), inserted references to indemnity for Plan A/50 in the introductory paragraphs.
Amended by R.2003 d.91, effective 1/28/2003.
See: 35 N.J.R. 73(a), 35 N.J.R. 1290(a).
In (a) and (b), inserted references to indemnity or HMO coverage under the basic and essential health services plan following "HMO plans" in the introductory paragraph.
Amended by R.2006 d.15, effective 1/3/2006.
See: 37 N.J.R. 2994(a), 38 N.J.R. 311(a).
Rewrote the section.
Amended by R.2009 d.45, effective 12/29/2008.
See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
In the introductory paragraph of (a), (a)4 and the introductory paragraph of (b), inserted "or POS"; in the introductory paragraph of (b), inserted ", POS"; in (b)2, deleted "and" from the end; in (b)3, substituted "; and" for a period at the end; and added (b)4.
Amended by R.2016 d.127, effective 10/17/2016 (operative January 1, 2017).
See: 48 N.J.R. 1555(a), 48 N.J.R. 2153(a).
Rewrote the section.
Amended by R.2018 d.197, effective 6/12/2018.
See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
Rewrote the section.