New Jersey § 26:2j-37

§ 26:2j-37.

a. No health maintenance organization authorized pursuant to section 6 of this act 1 shall deliver or issue for delivery in this State any medicare supplement contract

or evidence of coverage or any application or notification used in connection with

the issuance or continuance of a medicare supplement contract or evidence of coverage

unless the form of which, including a copy of the underlying plan, has been submitted

to and filed by the commissioner pursuant to the provisions of this subsection. (1) At the expiration of 60 days after submission a form shall be deemed filed unless

prior thereto it has been affirmatively filed or disapproved for filing by the commissioner. (2) No form which is disapproved for filing by the commissioner during the 60-day

period, may be delivered or issued for delivery in this State unless and until the

disapproval for filing is withdrawn. Any disapproval shall be subject to review in accordance with the “Administrative

Procedure Act,” P.L.1968, c. 410 ( C.52:14B-1 et seq. ). Any form which is filed by the commissioner or deemed filed may be delivered or

issued for delivery in this State until such time as any subsequent withdrawal of

the filing by the commissioner, following an opportunity for a hearing held in accordance

with the “Administrative Procedure Act,” P.L.1968, c. 410 ( C.52:14B-1 et seq. ). (3) The commissioner may extend the 60-day period provided in paragraph (1) of this

subsection for not more than 60 additional days by giving written notice of extension

before the expiration of the initial 60-day period. In the event of an extension, all of the provisions of this subsection, except this

provision for an extension, relating to the initial 60-day period shall apply to the

extended period instead of the initial 60-day period. (4) The disapproval for filing or the withdrawal of the filing of any form by the

commissioner shall state in writing the grounds therefor in such detail as is reasonable

to inform the health maintenance organization of the reasons for withdrawal or disapproval. (5) The provisions of this subsection shall not apply to documents which relate only

to the manner of distribution of services or to the reservation of rights and services

under the medicare supplement contract or evidence of coverage and which are used

at the request of the enrollee. (6) The disapproval by the commissioner of any form submitted for filing pursuant

to the provisions of this subsection may be on the ground that the form contains provisions

which are unjust, unfair, inequitable, misleading or contrary to law or to the public

policy of this State. b. Every health maintenance organization providing medicare supplement health care

services to a resident of this State shall file annually with the commissioner its

rates, rating schedule and supporting documentation demonstrating that it is in compliance

with the applicable loss ratio standards of this State. All filings of rates and rating schedules shall be certified by a qualified actuary

and shall demonstrate that the actual and expected costs in relation to services provided

comply with the requirements of this act and any rule or regulation promulgated hereunder. As used in this subsection, “ qualified actuary ” means a person, in good standing, who is a member of the American Academy of Actuaries,

a fellow of the Casualty Actuarial Society, or a person who has otherwise demonstrated

actuarial competence to the satisfaction of the commissioner. c. Services provided under a medicare supplement contract or evidence of coverage

shall be expected to return to enrollees services or other benefits which are reasonable

in relation to the premium or other fee charged. The commissioner shall promulgate regulations to establish minimum standards for

loss ratios under medicare supplement contracts or evidences of coverage on the basis

of paid medicare supplement health care expenses and written earned premiums and fees

in accordance with accepted actuarial principles and practices. 1

N.J.S.A. § 26:2J-36.