N.J. Admin. Code § 11:4-11.3

Current through Register Vol. 56, No. 23, December 2, 2024

Section 11:4-11.3 - Duties of insurers

(a) The generally applicable requirements are as follows:

1. The insurer shall provide a Buyer's Guide to all prospective purchasers, prior to accepting the applicant's initial premium or premium deposit. However, if the policy for which application is made contains an unconditional refund provision of at least 10 days, the Buyer's Guide may be delivered with the policy or prior to delivery of the policy; and

2. The insurer shall provide a policy summary to prospective purchasers where the insurer has identified the policy form as one that will not be marketed with an illustration. The policy summary shall show guarantees only. It shall consist of a separate document with all required information set out in a manner that does not minimize or render any portion of the summary obscure. Any amounts that remain level for two or more years of the policy may be represented by a single number if it is clearly indicated what amounts are applicable for each policy year. Amounts referenced in paragraph 5 of the definition of "policy summary" in 11:4-11.2 shall be listed in total, not on a per thousand or per unit basis. If more than one insured is covered under one policy or rider, death benefits shall be displayed separately for each insured or for each class of insureds if death benefits do not differ within the class. Zero amounts shall be displayed as a blank space. Delivery of the policy summary shall be consistent with the time for delivery of the Buyer's Guide as specified in (a)1 above.

(b) The requirements applicable to existing policies are as follows:

1. Upon request by the policyowner, the insurer shall furnish either policy data or an in force illustration as follows:

i. For policies issued prior to July 6, 1998 (the effective date of N.J.A.C. 11:4-52, Life Insurance Illustrations), the insurer shall furnish policy data, or, at its option, an in force illustration meeting the requirements of N.J.A.C. 11:4-52;

ii. For policies issued after July 6, 1998 (the effective date of N.J.A.C. 11:4-52, Life Insurance Illustrations), that were declared not to be used with an illustration, the insurer shall furnish policy data, limited to guaranteed values, if it has chosen not to furnish an in force illustration meeting the requirements of N.J.A.C. 11:4-52;

iii. If the policy was issued after the effective date of N.J.A.C. 11:4-52 and declared to be used with an illustration, an in force illustration shall be provided; or

iv. Unless otherwise requested, the policy data shall be provided for 20 consecutive years beginning with the previous policy anniversary. The statement of policy data shall include non-guaranteed elements according to the current scale, the amount of outstanding policy loans, and the current policy loan interest rate. Policy values shown shall be based on the current application of non-guaranteed elements in effect at the time of the request. The insurer may charge a reasonable fee, not to exceed $ 10.00, for the preparation of the statement;

2. If a life insurer changes its method of determining scales of non-guaranteed elements on existing policies, it shall, no later than when the first payment is made on the new basis, provide notice to each affected policy owner residing in this State of this change and of its implication on affected policies. This notice requirement shall not apply to policies where, as of the date the notice would be required, the amount payable upon death under the basic policy does not exceed $ 5,000; and

3. If the insurer makes a material revision in the terms and conditions under which it will limit its right to change any non-guaranteed factor, it shall, no later than the first policy anniversary following the revision, advise each affected policy owner residing in this State.

N.J. Admin. Code § 11:4-11.3