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NJ Department of Banking and Insurance
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Home > Insurance Division > Health Insurance Programs > SEH > Forms
SEH Program Forms
 
Standard Plans

NOTE: Below are the Standard forms that MUST be used for new business to be issued on or after January 1, 2017.

 

NOTE: Below are the Standard forms that MUST be used for new business to be issued on or after January 1, 2016.

 
NOTE: Below are the Standard forms that MUST be used for new business to be issued on or after January 1, 2015.
 

NOTE: Below are the Standard Small Employer Application and Certification Forms that MUST be used for new business to be issued on or after January 1, 2017.

 

NOTE: Below are the Standard Forms that MUST be used for new business to be issued on or after January 1, 2014.

 

NOTE: Below are the Standard Forms that are operative January 1, 2013 and can no longer be issued.

 
Reporting Forms
 
Filing Deadlines

Frequency

Deadline

Exhibit

Report Description

Reference

Quarterly
[60 days following the close of each quarter]

Mar 1
Jun 1
Sep 1
Dec 1

NA

Quarterly Enrollment

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

Annual*

Mar 1

Exhibit BB 1, 2

Certification of the use of the standard plans and marketing material

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

Annual

Apr 1

Exhibit CC

Market Share Report

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

Annual

Aug 1

Exhibit GG##

Loss Ratio Report##

Refund or Credit Plan (if necessary)##

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

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

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

##These reports are made to the Department of Banking and Insurance not the SEH Board 

 
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New Jersey Department of Banking and Insurance