Bill Text: NJ A3421 | 2014-2015 | Regular Session | Chaptered
Bill Title: Revises the "Self-Funded Multiple Employer Welfare Arrangement Regulation Act."
Spectrum: Bipartisan Bill
Status: (Passed) 2015-12-09 - Approved P.L.2015, c.172. [A3421 Detail]
Download: New_Jersey-2014-A3421-Chaptered.html
§6 - Note
An Act concerning certain multiple employer welfare arrangements and amending P.L.2001, c.352.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
21. Section 3 of P.L.2001, c.352 (C.17B:27C-3) is amended to read as follows:
3. For purposes of this act:
"Association" means a group of 100 or more persons organized and maintained in good faith for purposes other than that of obtaining insurance, in active existence for more than one year, having a constitution and bylaws that provide that: the association holds regular meetings not less than annually to further the purposes of the members; except for credit unions, the association collects dues or solicits contributions from members; and the members have voting privileges and representation on the governing board and committees.
"Commissioner" means the Commissioner of Banking and Insurance.
"Employee welfare benefit plan" has the meaning set forth in subsection (1) of 29 U.S.C. s.1002.
"Large employer" means a member employer with more than 3[100] 503 eligible employees, as defined by section 1 of P.L.1992, c.162 (C.17B:27A-17).
"Multiple employer welfare arrangement" has the meaning set forth in subsection (40) of 29 U.S.C. s.1002.
"Self-funded multiple employer welfare arrangement" means a self-funded or partially self-funded multiple employer welfare arrangement that provides for health benefits plans that has two or more employers who each have two or more employees and that has one or more of the employer members either domiciled in this State or its principal headquarters or principal administrative office located in this State.
"Small employer" means the same as defined in section 1 of P.L.1992, c.162 (C.17B:27A-17) 3[, and on or after the effective date of P.L. , c. (pending before the Legislature as this bill), the term "small employer" shall mean member employers with not more than 100 eligible employees, as defined by section 1 of P.L.1992, c.162 (C.17B:27A-17)]3 .2
(cf: P.L.2001, c.352, s.3)
2[1.] 2.2 Section 5 of P.L.2001, c.352 (C.17B:27C-5) is amended
to read as follows:
5. a. A self-funded multiple employer welfare arrangement shall deposit 1[, or obtain on its behalf a deposit from an appropriate capital funding source,]1 and continuously maintain with a financial institution licensed in this State, cash or securities as defined in N.J.S. 17B:18-37, having an admitted asset value of not less than [$200,000] 1[$300,000] $200,0001. The deposit shall be held for the benefit and protection of all covered members of the self-funded multiple employer welfare arrangement1[, provided, however, that any permitted underwriting gains may be shared with any entity acting as a source of deposit funds to the extent otherwise consistent with P.L.2001, c.352 (C.17B:27C-1 et seq.)]1. The self-funded multiple employer welfare arrangement shall further maintain a cash reserve for loss in an amount established by a qualified actuary as being adequate to provide for all incurred losses including unpaid claims.
b. 2[1A self-funded multiple employer welfare arrangement may obtain on its behalf the deposit of cash or securities required by subsection a. of this section from an appropriate capital funding source. Permitted underwriting gains may be shared with an entity acting as a source of deposit funds to the extent otherwise consistent with P.L.2001, c.352 (C.17B:27C-1 et seq.). A distribution of underwriting gains shall not take place unless the self-funded multiple employer welfare arrangement has first demonstrated two consecutive years of positive operating results, and thereafter a distribution of underwriting gains shall only include the underwriting gains of the immediately preceding year. A distribution of underwriting gains shall not take place if the self-funded multiple employer welfare arrangement incurred an operating loss in the immediately preceding year.
c.1]2 A self-funded multiple employer welfare arrangement shall maintain aggregate stop-loss coverage, with a retention level of 125 percent of expected claims per year, including provisions to cover incurred, unpaid claims liability in the event of the termination or liquidation of the self-funded multiple employer welfare arrangement, and specific stop-loss coverage, with a retention level determined annually by a qualified actuary based on sound actuarial principles. Any stop-loss contract maintained pursuant to this subsection shall contain a provision that the stop-loss insurer shall give the self-funded multiple employer welfare arrangement and the commissioner a minimum of 180 days' notice of cancellation or nonrenewal. If the self-funded multiple employer welfare arrangement fails to secure replacement coverage within 90 days after receipt of the notice of cancellation or nonrenewal, the trustees of the self-funded multiple employer welfare arrangement shall provide for the orderly liquidation of the self-funded multiple employer welfare arrangement.
(cf: P.L.2001, c.352, s.5)
2[2.] 3.2 Section 6 of P.L.2001, c.352 (C.17B:27C-6) is amended to read as follows:
6. Each self-funded multiple employer welfare arrangement shall file all of the following with the commissioner:
a. No later than May 15th of each calendar year or four months and 15 days after the end of each fiscal year of the self-funded multiple employer welfare arrangement, financial statements audited by a certified public accountant and on forms prescribed by the commissioner, an actuarial opinion rendered by a qualified actuary, a report of its Risk-Based Capital (RBC) as of the end of the immediately preceding calendar year, in a form and containing such information as is required by the instructions adopted by the National Association of Insurance Commissioners for health insurers, as amended from time to time and proof of the deposit required in accordance with section 5 of this act. The opinion shall be based on standards adopted from time to time by the Actuarial Standards Board and on any additional standards that the commissioner may prescribe by regulation. For purposes of this section and section 5 of this act, "qualified actuary" means a member in good standing of the American Academy of Actuaries who meets the requirements set forth in regulations of the commissioner.
b. Within 60 days after the end of each fiscal quarter, unaudited financial statements on forms prescribed by the commissioner, affirmed by an appropriate officer or agent of the self-funded multiple employer welfare arrangement.
c. Within 60 days after the end of each fiscal quarter, a report on forms prescribed by the commissioner certifying that the self-funded multiple employer welfare arrangement maintains cash or liquid assets in a claim reserve account sufficient to meet the requirements of section 5 of this act.
d. The information required to be filed pursuant to subsections a., b., and c. of this section shall be 1[separately]1 certified by 1[a board of trustees] an officer1 of the self-funded multiple employer welfare arrangement. 1[The board of trustees shall consist of one designee selected by each member employer, in addition to at least one independent trustee chosen by majority vote of the members. The board of trustees shall meet at least quarterly.]1
e. 2A majority of the board of trustees of a self-funded multiple employer welfare arrangement shall represent participating employer members, and at least one trustee shall be a non-participating independent trustee chosen by a majority vote of the trustees.
f.2 The self-funded multiple employer welfare arrangement shall 2[1, during its first five years,1]2 establish and maintain a website upon which all of the filings required pursuant to this section and information concerning its governance and financial performance shall be publicly available for a period of at least five years 1after the reporting period1. 2This website shall also, at all times, indicate the status of the deposit required to be continuously maintained with a financial institution licensed in this State, pursuant to subsection a. of section 5 of P.L.2001, c.352 (C.17B:27C-5) and the name of that institution.2
(cf: P.L.2001, c.352, s.6)
2[3.] 4.2 Section 7 of P.L.2001, c.352 (C.17B:27C-7) is amended to read as follows:
7. a. The liability of each member for the obligations of the self-funded multiple employer welfare arrangement shall be individual, several and proportionate, but not joint, except as provided in this section.
b. Each member shall have a contingent assessment liability pursuant to subsection c. of this section. Each benefit plan issued by a self-funded multiple employer welfare arrangement shall contain a statement of the contingent liability. Both the application for benefits and the benefit plan shall contain in contrasting color, not less than 10-point type, the following statement: "This is a fully assessable benefit plan. In the event that the self-funded multiple employer welfare arrangement is unable to pay its obligations, members shall be required to contribute on a pro rata earned premium basis the funds necessary to meet any unfilled obligations."
c. All self-funded multiple employer welfare arrangements shall provide that members are assessed in accordance with the provisions of this section. Each self-funded multiple employer welfare arrangement may assess all members [if its prior fiscal year statement of operations reflected a loss] 2[to the extent deemed necessary by sound actuarial standards and as certified by an appropriate actuarial opinion] if its prior fiscal year statement of operations reflected a loss2. Each self-funded multiple employer welfare arrangement shall assess all members if the arrangement's fund balance or reserve at the end of any accounting period is less than the amount required by law. The minimum assessment shall be the amount necessary to comply with the requirements of sections 5 and 9 of this act. Each member's assessment shall be computed by applying the earned premium for each employer's benefit plan during the prior fiscal year as a percent of the amount of the total of all employers' earned premium for the same year. Each member's assessment shall be that [members's] member's percent times the total assessment levied. 2[Assessments shall be paid by each member within]2 1[45] 2[601 days of being levied.]2 In the event a member fails to pay an assessment, the 2[self-funded multiple employer welfare arrangement shall have the option to terminate the member's participation in the plan within 30 days after the expiration of the period covered by any earned premiums actually paid to date, subject to adequate reserves being set aside for the due payment of any terminal liabilities or incurred but not]2 1[yet revealed] 2[reported1 claims for that member's plan participants, as certified by an appropriate actuarial opinion. Alternatively, the]2 other members shall [be liable] 2[, if in accordance with the plan design, assume liability] be liable2 on a proportionate basis for an additional assessment[. The] 2[, in which case, the] . The2 self-funded multiple employer welfare arrangement, acting on behalf of all members who paid the additional assessment, shall take appropriate legal action to recover the assessment from any member who fails to pay an assessment.
d. [In] 2[The members shall deposit reserves, as certified by a qualified actuarial opinion, sufficient to provide for the payment, in] In2 the event of a rehabilitation, liquidation, conservation or dissolution of a self-funded multiple employer welfare arrangement, [the court, pursuant to section 11 of this act, may assess the members in] 2[of] the court, pursuant to section 11 of this act, may assess the members in2 the amounts needed to pay all incurred but unpaid claims and all [projected claims,] 2[terminal liabilities as of the date of that event. If any such member has not complied with the foregoing, the court, pursuant to section 11 of P.L.2001, c.352 (C.17B:27C-11), may assess that member for those amounts,] projected claims,2 together with the costs and expenses of collecting the assessments, a reasonable loading factor for uncollected assessments and the costs and expenses of the rehabilitation, liquidation, conservation or dissolution.
e. The following notice shall be provided to employers and employees who obtain coverage from a self-funded multiple employer welfare arrangement:
NOTICE
THE SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENT IS NOT AN INSURANCE COMPANY 1[AND DOES NOT PARTICIPATE IN ANY OF THE GUARANTEE FUNDS CREATED BY NEW JERSEY LAW. THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF A SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENT BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED]1 2AND DOES NOT PARTICIPATE IN ANY OF THE GUARANTEE FUNDS CREATED BY NEW JERSEY LAW. THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF A SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENT BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED2.
THE HEALTH CARE BENEFITS THAT YOU HAVE PURCHASED OR ARE APPLYING TO PURCHASE ARE BEING ISSUED BY A SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENT. 2THE SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENT IS REQUIRED TO MAINTAIN SUFFICIENT RESERVES TO PAY FOR ALL INCURRED LOSSES INCLUDING UNPAID CLAIMS.
IT IS IMPORTANT THAT YOU CHECK WITH YOUR EMPLOYER TO DETERMINE WHICH, IF ANY, STATE MANDATED HEALTH CARE BENEFITS MAY BE COVERED BY YOUR ARRANGEMENT.2
FOR ADDITIONAL INFORMATION ABOUT THE MULTIPLE EMPLOYER WELFARE ARRANGEMENT YOU SHOULD ASK QUESTIONS OF YOUR TRUST ADMINISTRATOR AT _______________(this blank should include the "800" consumer service telephone number).
(cf: P.L.2001, c.352, s.7)
2[4.] 5.2 Section 8 of P.L.2001, c.352 (C.17B:27C-8) is amended to read as follows:
8. a. Except as provided by this act, the insurance laws of this State do not apply to the operation of self-funded multiple employer welfare arrangements. A self-funded multiple employer welfare arrangement is not an insurance company or insurer under the laws of this State.
b. Any self-funded multiple employer welfare arrangement shall offer all products that it is actively marketing to any employer, and accept any employer and any employee of that employer who applies for any of those products; provided, however that a self-funded multiple employer welfare arrangement may limit participation to members of the association.
c. Assessments payable by small employer members, except for dental plans, shall be established in accordance with the rating requirements of section 9 of P.L.1992, c.162 (C.17B:27A-25) and regulations promulgated thereunder 2[; provided, however,]2 [that for the first year after the effective date of this act, a self-funded multiple employer welfare arrangement providing benefits in this State prior to the effective date of this act shall: (1) not charge a small employer member an assessment greater than 300 percent of the assessment charged to the lowest rated small employer member of the self-funded multiple employer welfare arrangement; (2) for the second year after the effective date of this act, not charge a small employer member an assessment greater than 250 percent of the assessment charged to the lowest rated small employer member of the self-funded multiple employer welfare arrangement; and (3) for each year thereafter, comply with the rating requirements of section 9 of P.L.1992, c.162 (C.17B:27A-25) and regulations promulgated thereunder] 2[a self-funded multiple employer welfare arrangement may employ an assessment methodology that results in assessments for the highest rated small employer member which are greater than 200 percent of the assessments produced for the lowest rated small employer member for each plan and option]2.
d. [The] If the member is a small employer, the health benefits to be provided by the self-funded multiple employer welfare arrangement shall at all times be 2[1actuarially1]2 equal to or greater than benefits required to be provided in the lowest benefit level standard plan promulgated by the New Jersey Small Employer Health Benefits Program pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.).
e. 2A large employer participating in a multiple employer welfare arrangement shall not be required to adhere to the plan or design elements, or any required coverage offerings applicable to small employers, including but not limited to deductibles, co-pays, and co-insurance amounts. After the effective date of P.L. , c. (now pending before the Legislature as this bill), large employer members of a multiple employer welfare arrangement shall continue to offer all health benefits mandated by State law and in effect on October 1, 2014. Any new or additional health benefits mandated by State law required to be offered after October 1, 2014 shall not be required to be offered by large employers participating in a multiple employer welfare arrangement. Except as provided in P.L. 2001, c. 352 (C. 17B:27C-1 et seq.) as amended by P.L. , c. (now pending before the Legislature as this bill), multiple employer welfare arrangements with large employers shall be otherwise subject to the requirements of State and federal law.
f.2 1[If] Notwithstanding any other provision to the contrary, if1 the member is 2[not]2 a 2[small] large2 employer, the rate manual used to calculate program rates may include appropriate classification factors such as claims experience and utilization, age, gender 2, tobacco use,2 and geography, and such specific underwriting adjustments as may be certified in accordance with subsection d. of section 6 of P.L.2001, c.352 (C.17B:27C-6).
2[f.] g.2 The self-funded multiple employer welfare arrangement may provide to its members a health and wellness program consistent with the United States Department of Labor's requirements 2[, which shall be filed with the commissioner on an annual basis]2 .
2[g.] h.2 The self-funded multiple employer welfare arrangement may provide to its members an internet-based system for the administration, billing and claims processing of its benefits.
(cf: P.L.2001, c.352, s.8)
2[5.] 6.2 This act shall take effect on 2[the]2 1[first] 2[60th1 day]2 1[of the sixth month]1 2[next following enactment] January 1, 2016, except that the Department of Banking and Insurance may take such appropriate anticipatory administrative action, including the promulgation of any regulations, necessary to ensure the implementation of this act on its effective date 2.
Revises the "Self-Funded Multiple Employer Welfare Arrangement Regulation Act."
