N.J. Admin. Code Tit. 11, ch. 20 - INDIVIDUAL HEALTH COVERAGE PROGRAM

  1. Subchapter 1 - GENERAL PROVISIONS (§ 11:20-1.1 to 11:20-1.6)
  2. Subchapter 2 - INDIVIDUAL HEALTH COVERAGE PROGRAM PLAN OF OPERATION (§ 11:20-2.1 to 11:20-2.18)
  3. Subchapter 3 - BENEFIT LEVELS AND POLICY FORMS (§ 11:20-3.1 to 11:20-3.7)
  4. Subchapter 3A - POLICY FORMS (§ 11:20-3A.1 to 11:20-3A.3)
  5. Subchapter 4 - RESERVED, version 3
  6. Subchapter 5 - RESERVED, version 4
  7. Subchapter 6 - INDIVIDUAL HEALTH BENEFITS CARRIERS INFORMATIONAL RATE FILING REQUIREMENTS (§ 11:20-6.1 to 11:20-6.5)
  8. Subchapter 7 - LOSS RATIO AND REFUND REPORTING REQUIREMENTS (§ 11:20-7.1 to 11:20-7.7)
  9. Subchapter 8 - THE IHC PROGRAM ASSESSMENT REPORT (§ 11:20-8.1 to 11:20-8.9)
  10. Subchapter 9 THROUGH 10 - RESERVED
  11. Subchapter 11 - RELIEF FROM OBLIGATIONS IMPOSED BY THE INDIVIDUAL HEALTH INSURANCE REFORM ACT (§ 11:20-11.1 to 11:20-11.11)
  12. Subchapter 12 - PURCHASE OF A STANDARD HEALTH BENEFITS PLAN BY A PERSON COVERED UNDER AN INDIVIDUAL PLAN OR COVERED UNDER A GROUP PLAN (§ 11:20-12.1 to 11:20-12.5)
  13. Subchapter 13 THROUGH 16 - RESERVED
  14. Subchapter 17 - ENROLLMENT STATUS REPORT (§ 11:20-17.1 to 11:20-17.5)
  15. Subchapter 18 - WITHDRAWALS OF CARRIERS FROM THE INDIVIDUAL MARKET AND THE WITHDRAWAL OF PLAN, PLAN OPTION, OR DEDUCTIBLE/COPAYMENT OPTION (§ 11:20-18.1 to 11:20-18.9)
  16. Subchapter 19 - PETITIONS FOR RULEMAKING (§ 11:20-19.1 to 11:20-19.3)
  17. Subchapter 20 - APPEALS FROM ACTIONS OF THE BOARD (§ 11:20-20.1 to 11:20-20.2)
  18. Subchapter 21 - RESERVED
  19. Subchapter 22 - RESERVED (§ 11:20-22.1 to 11:20-22.7)
  20. Subchapter 23 - RULEMAKING; INTERESTED PARTIES; PUBLIC NOTICES; INTERESTED PARTIES MAILING LIST (§ 11:20-23.1 to 11:20-23.7)
  21. Subchapter 24 - PROGRAM COMPLIANCE (§ 11:20-24.1 to 11:20-24.7)
  22. Appendix - APPENDIX, version 29 (Exhibit A to V)

Notes

N.J. Admin. Code Tit. 11, ch. 20
CHAPTER SOURCE AND EFFECTIVE DATE:
Subchapters 1, 2, 3, 8, 12, 17, 19, 20, 23, and 24, and Appendix Exhibits A through D and K, R.2018 d.197, effective 6/12/2018. See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
Subchapters 3A, 6, 7, 11, and 18, and Appendix Exhibits E and J, effective 1/12/2018. See: 50 N.J.R. 905(a).
CHAPTER HISTORICAL NOTE:
Chapter 20, Individual Health Coverage Program, was adopted as emergency new rules by R.1993 d.344, effective 6/14/1993 (to expire August 13, 1993). See: 25 N.J.R. 2945(a). The concurrent proposal of Chapter 20 was adopted as R.1993 d.439, effective 8/13/1993, with changes effective 9/7/1993. See: 25 N.J.R. 2945(a), 25 N.J.R. 4180(a).
Subchapter 2, Individual Health Coverage Program Temporary Plan of Operation, was adopted as R.1993 d.550, effective 10/14/1993. See: 25 N.J.R. 4707(a), 25 N.J.R. 5244(a).
Subchapter 10, Performance Standards and Reporting Requirements, was adopted as R.1994 d.142, effective 2/23/1994. See: 26 N.J.R. 1202(a), 26 N.J.R. 1351(a).
Subchapter 11, Relief from Obligations Imposed by the Individual Health Insurance Reform Act, was adopted as R.1993 d. 654, effective 12/30/1993. See: 25 N.J.R. 4459(a), 25 N.J.R. 5930(b).
Subchapter 12, Eligibility for and Replacement of Standard Health Benefits Plans, was adopted as R.1994 d.54, effective 12/30/1993. See: 26 N.J.R. 87(a), 26 N.J.R. 804(a).
Subchapter 13, Certification of Non-Member Status, was adopted as R.1994 d.177, effective 3/10/1994. See: 26 N.J.R. 1294(a), 26 N.J.R. 1509(a).
Subchapter 17, Enrollment Status Report, was adopted as R.1994 d.53, effective 12/30/1993. See: 26 N.J.R. 90(a), 26 N.J.R. 806(a).
Subchapter 18, Withdrawal of Carriers from the Individual Market and Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, was adopted as R.1998 d. 339, effective 7/6/1998. See: 29 N.J.R. 2615(a), 30 N.J.R. 2502(a).
Pursuant to Executive Order No. 66(1978), Chapter 20, Individual Health Coverage Program, Subchapters 1 through 10, 12, 13, 17, 18 and Appendix Exhibits A through T, were readopted as R.1998 d.443, effective 8/7/1998, and Subchapter 11 was readopted as R.1998 d.454, effective 8/13/1998. Subchapter 19, Petitions for Rulemaking, and Subchapter 20, Appeals from Actions of the Board, were adopted as new rules by R.1998 d.443, effective 8/7/1998. See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a); 30 N.J.R. 2192(a), 30 N.J.R. 3308(a).
In accordance with N.J.S.A. 52:14B-5.1d, the expiration date of Chapter 20, Individual Health Coverage Program, was extended by gubernatorial directive from August 7, 2003 to 270 days following Supreme Court decision in In re Health Coverage Program's Readoption of N.J.A.C. 11:20-1.1 et seq. See: 35 N.J.R. 2898(a).
Subchapter 22, Basic and Essential Health Care Services Plan, was adopted as R.2003 d.91, effective 1/28/2003. See: 34 N.J.R. 73(a), 35 N.J.R. 1290(a).
In accordance with N.J.S.A. 52:14B-5.1d, Chapter 20, Individual Health Coverage Program, expiration date was extended by gubernatorial directive from February 4, 2005 to July 4, 2005. See: 37 N.J.R. 778(a).
Subchapter 4, Standard Application Form; Subchapter 5, Standard Claim Form and Appendix Exhibits G, H, and I, expired effective 7/4/2005. See: 37 N.J.R. 2994(a).
Chapter 20, Individual Health Coverage Program, Subchapters 1 through 3, 6 through 10, 12, 17 through 20, 22 and Appendix Exhibits A through F, J through L, and Q through V, were readopted as R.2006 d.15, effective 12/7/2005, and Subchapter 11 was readopted as R.2006 d.16, effective 12/7/2005. Subchapter 12, Eligibility for and Replacement of Standard Health Benefits Plans and the Basic and Essential Health Care Services Plan, was repealed, and Subchapter 12, Purchase of a Standard Individual Health Benefits Plan or a Basic and Essential Healthcare Services Plan by a Person Covered under an Individual Plan or Eligible for or Covered under a Group Plan, was adopted as new rules by R.2006 d.15, effective 1/3/2006. Appendix Exhibit R, was repealed, by R.2006 d. 15, effective 1/3/2006. Subchapter 23, Rulemaking; Interested Parties; Public Notices; Interested Parties Mailing List, and Subchapter 24, Program Compliance, were adopted as new rules by R.2006 d.15, effective 1/3/2006. Appendix Exhibits A, C, E and U were repealed by R.2006 d.15, effective 1/3/2006 (operative July 1, 2006). Exhibits A, C and E were adopted as new rules. See: 37 N.J.R. 2994(a), 38 N.J.R. 311(a), 38 N.J.R. 1005(a); 37 N.J.R. 3022(a), 38 N.J.R. 332(a).
Exhibit H of the Appendix was adopted as new rules by R.2009 d.45, effective 12/29/2008. See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
Subchapter 6, Individual Health Benefits Carriers Informational Rate Filing Requirement; Subchapter 7, Loss Ratio and Refund Reporting Requirements; and Subchapter 18, Withdrawal of Carriers from the Individual Market and Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, were repealed by R.2009 d.45, effective 12/29/2008 (operative April 20, 2009). See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b), 41 N.J.R. 1875(a).
Subchapter 3A, Policy Forms; Subchapter 6, Individual Health Benefits Carriers Informational Rate Filing Requirements; Subchapter 7, Loss Ratio And Refund Reporting Requirements; and Subchapter 18, Withdrawals of Carriers from the Individual Market and the Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, were adopted as new rules by R.2009 d.128, effective 4/20/2009. See: 41 N.J.R. 73(a), 41 N.J.R. 1866(c).
Subchapter 9, Exemptions, and Subchapter 10, Performance Standards and Reporting Requirements, expired on 12/7/2010.
In accordance with N.J.S.A. 52:14B-5.1b, Subchapters 1, 2, 3, 3A, 6, 7, 8, 11, 12, 17, 18, 19, 20, 22, 23 and 24, and Appendix Exhibits A through H and J through L were scheduled to expire on 6/5/2013. See: 43 N.J.R. 1203(a).
Chapter 20, Individual Health Coverage Program, Subchapters 1, 2, 3, 8, 12, 17, 19, 20, 22, 23 and 24, and Appendix Exhibits A through D, F, G, H, K and L, were readopted as R.2011 d.163, effective 5/12/2011. See: 43 N.J.R. 131(a), 43 N.J.R. 1353(a).
Chapter 20, Individual Health Coverage Program, Subchapters 3A, 6, 7, 11 and 18, and Appendix Exhibits E and J, were readopted as R.2011 d.167, effective 5/12/2011. See: 43 N.J.R. 143(a), 43 N.J.R. 1359(a).
Subchapter 12, Purchase of a Standard Individual Health Benefits Plan or a Basic and Essential Healthcare Services Plan by a Person Covered Under an Individual Plan or Eligible for or Covered Under a Group Plan, was renamed Purchase of a Standard Health Benefits Plan by a Person Covered Under an Individual Plan or Covered Under a Group Plan by R.2013 d.130, effective 10/1/2013 (operative January 1, 2014). See: 45 N.J.R. 2310(a), 45 N.J.R. 2385(a).
Subchapter 22, Basic and Essential Healthcare Services Plan, was repealed by R.2016 d.127, effective 10/17/2016 (operative January 1, 2016). See: 48 N.J.R. 1555(a), 48 N.J.R. 2153(a).
Chapter 20, Individual Health Coverage Program, Subchapters 3A, 6, 7, 11 and 18, and Appendix Exhibits E and J, were readopted with technical changes, effective 1/12/2018. See: Source and Effective Date. See, also, section annotations.
Chapter 20, Individual Health Coverage Program, Subchapters 1, 2, 3, 8, 12, 17, 19, 20, 23, and 24, and Appendix Exhibits A through D and K, were readopted; and Appendix Exhibits F, G, and H were repealed by R.2018 d.197, effective 6/12/2018. See: Source and Effective Date. See, also, section annotations. CHAPTER SOURCE AND EFFECTIVE DATE:
Effective: 12/12/2024.
See: 57 N.J.R. 195(b).
CHAPTER HISTORICAL NOTE:
Chapter 20, Individual Health Coverage Program, was adopted as emergency new rules by R.1993 d.344, effective 6/14/1993 (to expire August 13, 1993). See: 25 N.J.R. 2945(a). The concurrent proposal of Chapter 20 was adopted as R.1993 d.439, effective 8/13/1993, with changes effective 9/7/1993. See: 25 N.J.R. 2945(a), 25 N.J.R. 4180(a).
Subchapter 2, Individual Health Coverage Program Temporary Plan of Operation, was adopted as R.1993 d.550, effective 10/14/1993. See: 25 N.J.R. 4707(a), 25 N.J.R. 5244(a).
Subchapter 10, Performance Standards and Reporting Requirements, was adopted as R.1994 d.142, effective 2/23/1994. See: 26 N.J.R. 1202(a), 26 N.J.R. 1351(a).
Subchapter 11, Relief from Obligations Imposed by the Individual Health Insurance Reform Act, was adopted as R.1993 d. 654, effective 12/30/1993. See: 25 N.J.R. 4459(a), 25 N.J.R. 5930(b).
Subchapter 12, Eligibility for and Replacement of Standard Health Benefits Plans, was adopted as R.1994 d.54, effective 12/30/1993. See: 26 N.J.R. 87(a), 26 N.J.R. 804(a).
Subchapter 13, Certification of Non-Member Status, was adopted as R.1994 d.177, effective 3/10/1994. See: 26 N.J.R. 1294(a), 26 N.J.R. 1509(a).
Subchapter 17, Enrollment Status Report, was adopted as R.1994 d.53, effective 12/30/1993. See: 26 N.J.R. 90(a), 26 N.J.R. 806(a).
Subchapter 18, Withdrawal of Carriers from the Individual Market and Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, was adopted as R.1998 d. 339, effective 7/6/1998. See: 29 N.J.R. 2615(a), 30 N.J.R. 2502(a).
Pursuant to Executive Order No. 66(1978), Chapter 20, Individual Health Coverage Program, Subchapters 1 through 10, 12, 13, 17, 18 and Appendix Exhibits A through T, were readopted as R.1998 d.443, effective 8/7/1998, and Subchapter 11 was readopted as R.1998 d.454, effective 8/13/1998. Subchapter 19, Petitions for Rulemaking, and Subchapter 20, Appeals from Actions of the Board, were adopted as new rules by R.1998 d.443, effective 8/7/1998. See: 30 N.J.R. 2581(a), 30 N.J.R. 3289(a); 30 N.J.R. 2192(a), 30 N.J.R. 3308(a).
In accordance with N.J.S.A. 52:14B-5.1d, the expiration date of Chapter 20, Individual Health Coverage Program, was extended by gubernatorial directive from August 7, 2003 to 270 days following Supreme Court decision in In re Health Coverage Program's Readoption of N.J.A.C. 11:20-1.1 et seq. See: 35 N.J.R. 2898(a).
Subchapter 22, Basic and Essential Health Care Services Plan, was adopted as R.2003 d.91, effective 1/28/2003. See: 34 N.J.R. 73(a), 35 N.J.R. 1290(a).
In accordance with N.J.S.A. 52:14B-5.1d, Chapter 20, Individual Health Coverage Program, expiration date was extended by gubernatorial directive from February 4, 2005 to July 4, 2005. See: 37 N.J.R. 778(a).
Subchapter 4, Standard Application Form; Subchapter 5, Standard Claim Form and Appendix Exhibits G, H, and I, expired effective 7/4/2005. See: 37 N.J.R. 2994(a).
Chapter 20, Individual Health Coverage Program, Subchapters 1 through 3, 6 through 10, 12, 17 through 20, 22 and Appendix Exhibits A through F, J through L, and Q through V, were readopted as R.2006 d.15, effective 12/7/2005, and Subchapter 11 was readopted as R.2006 d.16, effective 12/7/2005. Subchapter 12, Eligibility for and Replacement of Standard Health Benefits Plans and the Basic and Essential Health Care Services Plan, was repealed, and Subchapter 12, Purchase of a Standard Individual Health Benefits Plan or a Basic and Essential Healthcare Services Plan by a Person Covered under an Individual Plan or Eligible for or Covered under a Group Plan, was adopted as new rules by R.2006 d.15, effective 1/3/2006. Appendix Exhibit R, was repealed, by R.2006 d. 15, effective 1/3/2006. Subchapter 23, Rulemaking; Interested Parties; Public Notices; Interested Parties Mailing List, and Subchapter 24, Program Compliance, were adopted as new rules by R.2006 d.15, effective 1/3/2006. Appendix Exhibits A, C, E and U were repealed by R.2006 d.15, effective 1/3/2006 (operative July 1, 2006). Exhibits A, C and E were adopted as new rules. See: 37 N.J.R. 2994(a), 38 N.J.R. 311(a), 38 N.J.R. 1005(a); 37 N.J.R. 3022(a), 38 N.J.R. 332(a).
Exhibit H of the Appendix was adopted as new rules by R.2009 d.45, effective 12/29/2008. See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b).
Subchapter 6, Individual Health Benefits Carriers Informational Rate Filing Requirement; Subchapter 7, Loss Ratio and Refund Reporting Requirements; and Subchapter 18, Withdrawal of Carriers from the Individual Market and Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, were repealed by R.2009 d.45, effective 12/29/2008 (operative April 20, 2009). See: 40 N.J.R. 6904(a), 41 N.J.R. 799(b), 41 N.J.R. 1875(a).
Subchapter 3A, Policy Forms; Subchapter 6, Individual Health Benefits Carriers Informational Rate Filing Requirements; Subchapter 7, Loss Ratio And Refund Reporting Requirements; and Subchapter 18, Withdrawals of Carriers from the Individual Market and the Withdrawal of Plan, Plan Option, or Deductible/Copayment Option, were adopted as new rules by R.2009 d.128, effective 4/20/2009. See: 41 N.J.R. 73(a), 41 N.J.R. 1866(c).
Subchapter 9, Exemptions, and Subchapter 10, Performance Standards and Reporting Requirements, expired on 12/7/2010.
In accordance with N.J.S.A. 52:14B-5.1b, Subchapters 1, 2, 3, 3A, 6, 7, 8, 11, 12, 17, 18, 19, 20, 22, 23 and 24, and Appendix Exhibits A through H and J through L were scheduled to expire on 6/5/2013. See: 43 N.J.R. 1203(a).
Chapter 20, Individual Health Coverage Program, Subchapters 1, 2, 3, 8, 12, 17, 19, 20, 22, 23 and 24, and Appendix Exhibits A through D, F, G, H, K and L, were readopted as R.2011 d.163, effective 5/12/2011. See: 43 N.J.R. 131(a), 43 N.J.R. 1353(a).
Chapter 20, Individual Health Coverage Program, Subchapters 3A, 6, 7, 11 and 18, and Appendix Exhibits E and J, were readopted as R.2011 d.167, effective 5/12/2011. See: 43 N.J.R. 143(a), 43 N.J.R. 1359(a).
Subchapter 12, Purchase of a Standard Individual Health Benefits Plan or a Basic and Essential Healthcare Services Plan by a Person Covered Under an Individual Plan or Eligible for or Covered Under a Group Plan, was renamed Purchase of a Standard Health Benefits Plan by a Person Covered Under an Individual Plan or Covered Under a Group Plan by R.2013 d.130, effective 10/1/2013 (operative January 1, 2014). See: 45 N.J.R. 2310(a), 45 N.J.R. 2385(a).
Subchapter 22, Basic and Essential Healthcare Services Plan, was repealed by R.2016 d.127, effective 10/17/2016 (operative January 1, 2016). See: 48 N.J.R. 1555(a), 48 N.J.R. 2153(a).
Chapter 20, Individual Health Coverage Program, Subchapters 3A, 6, 7, 11 and 18, and Appendix Exhibits E and J, were readopted with technical changes, effective 1/12/2018. See: 50 N.J.R. 905(a).
Chapter 20, Individual Health Coverage Program, Subchapters 1, 2, 3, 8, 12, 17, 19, 20, 23, and 24, and Appendix Exhibits A through D and K, were readopted; and Appendix Exhibits F, G, and H were repealed by R.2018 d.197, effective 6/12/2018. See: 50 N.J.R. 1412(a), 50 N.J.R. 2329(a).
Chapter 20, Individual Health Coverage Program, was readopted, effective 12/12/2024. See: Source and Effective Date.

CHAPTER AUTHORITY:

N.J.S.A. 17:1-8.1, 17:1-15.e, and 17B:27A-2 et seq.

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