• Policy Plan A (MS Word)
• Certificate Plan A (MS Word)
• Policy Plans B - E (MS Word)
• Certificate Plans B - E (MS Word)
• HMO Contract (MS Word)
• HMO Evidence of Contract (MS Word)
• HMO-POS Contract (MS Word)
• HMO-POS Evidence of Contract (MS Word)
• Explanation of Brackets (MS Word)
• Rider for Overage Dependents (MS Word)
• Employer Application (MS Word)
• Employer Certification (MS Word)
  

• Explanation of Brackets for all Plans (PDF)
• Small Employer Plan A (Basic Policy) - Policy (MS Word)
• Small Employer Plan A (Basic Policy) - Certificate (MS Word)
• Small Employer Plans B, C, D, E - Policy (MS Word)
• Small Employer Plans B, C, D, E - Certificate (MS Word)
• Rider For Prescription Drug Insurance (MS Word)
• Small Employer Application (MS Word)
• Small Employer HMO Plan - Evidence of Coverage (MS Word)
• Small Employer HMO Plan - Contract (MS Word)
• Small Employer HMO Point of Service - Evidence of Coverage (MS Word)
• Small Employer HMO Point of Service Plan - Contract (MS Word)
• Small Employer Certification (MS Word)
• Small Employer Open Face Rider (MS Word)

• SEH Exhibit BB, Part 1: Certification of Compliance (MS Word)
• SEH Exhibit BB, Part 1: Certification of Compliance (MS Excel)
• SEH Exhibit BB, Part 2: Certification of Promotional and Marketing Material (MS Word)
• SEH Exhibit BB, Part 6: Use of Optional Benefit Riders (MS Word)
• SEH Exhibit CC:  Market Share Report (MS Word)
• SEH Exhibit GG:  Loss Ratio Report
• SEH Exhibit FF:  Premium Comparison Survey
• Quarterly Enrollment Report [B1 MS Excel] 

Frequency

Deadline

Exhibit

Report Description

Reference

Quarterly

Feb 15
May 15
Aug 15
Nov 15

NA

Quarterly Enrollment

N.J.A.C. 11:21-7.12

Annual*

Mar 1

Exhibit BB 1, 2, 6

Certification of Plan Types, Marketing Material and Riders

N.J.A.C. 11:21-4.2

Annual

Mar 1

Exhibit CC#

Market Share Report#

N.J.A.C. 11:21-10.3

Annual

Mar 1

Exhibit KK#

Report of Nonmember Status#

N.J.A.C. 11:21-8.4

Annual

Aug 1

Exhibit GG##

Loss Ratio Report##

Dividend or Credit Plan (if necessary)##

N.J.A.C. 11:21-7A.3 N.J.A.C. 11:21-7A.5

Annual

Nov 1

Exhibit FF##

Premium Comparison Survey##

N.J.A.C. 11:21-19.3

*Exhibit BB (Parts 1, 2 and 6) must also be filed upon market entry and prior to amending plans

#Exhibits CC and KK are alternative filings (e.g., if a carrier is not offering health benefits plans, it should file Exhibit KK, not CC), but one or the other must be filed annually.

##These reports are made to the Department of Banking and Insurance