NJ Individual Health Coverage Program (IHC)

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Individual Health Coverage Program

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IHC Meeting Notices

IHC Program Board Minutes (All files are PDFs)

2008 Meeting Schedule

2008		06/10/08 > 05/13/08 > 04/08/08 > 03/11/08 > 02/11/08 > 01/08/08
2007		12/11/07 > 11/13/07 > 10/09/07 > 09/11/07 > 07/10/07 > 06/12/07 > 05/08/07 > 04/17/07 > 03/13/07 > 02/13/07 > 01/11/07
2006		12/05/06 > 10/17/06 > 09/12/06 > 08/25/06 > 08/01/06 > 06/20/06 > 05/25/06 > 05/09/06 > 04/11/06 > 03/14/06 > 02/24/06 > 02/14/06 > 01/10/06

Latest News

IHC Audit Reports (All files are PDFs)

Request for Proposal for Auditing of the Administrative Aspect of the Individual Health Coverage Program (PDF)
Bids due June 19, 2008
- Questions and Answers to the RFP for Audit Services for the Administrative Audit
Request for Proposal for Auditing of Losses Reported by Carriers Seeking Reimbursements from the Individual Health Coverage Program (PDF)
Bids due July 8, 2008
- Questions & Answers to the RFP for Audit Services for Losses Reported by Carriers Seeking Reimbursements
Important Notice: Regarding the IHC Program Loss Assessment Regulation (PDF)

IHC Administrative Orders

IHC Program Standard Plans/Enrollment Reports

Order 08-IHC-04 (PDF) - In the Matter of Time Insurance Company's reported losses for the 1997/1998 and 1999/2000 calculation periods and advance payments made by the Individual Health Coverage Program for such reported losses.
Order 08-IHC-03 (PDF) - In the Matter of a refund improperly withheld by Perfect Health Insurance Company in connection with the December 18, 2006 reconciliation of the 1997/1998 assessment
Order 08-IHC-02 (PDF) - In the Matter of the appeal by Humana Insurance Company regarding the New Jersey Individual Health Coverage Program board of Directors' issuance of the October 16, 2007, 2005/2006 loss assessment and the 2008/2009 administrative assessment
Order 08-IHC-01 (PDF) [Attachment] - In the Matter of Time Insurance Company's reported losses for the 1997/1998 and 1999/2000 calculation periods and advance payments made by the individual Health Coverage Program for such reported losses
Order AO07-IHC-04 (PDF) - In the Matter of the challenge and request for hearing by Guardian Life Insurance Company of America regarding the New Jersey Individual Health Coverage Program Board of Directors' issuance of the December, 18, 2006 interim reconciliations of the 1997/1998 and 1999/2000 loss assessments and the 2001/2002 loss assessment
Order AO07-IHC-03 (PDF) - In the Matter of the challenge and request for hearing by Celtic Insurance Company regarding the New Jersey Individual Health Coverage Program Board of Directors' issuance of the December, 18, 2006 interim reconciliations of the 1997/1998 loss assessment
Order AO07-IHC-02 (PDF) - In the Matter of the challenge and request for hearing by Time Insurance Company regarding the New Jersey Individual Health Coverage Program Board of Directors' issuance of the December, 18, 2006 interim reconciliations of the 1997/1998 and 1999/2000 loss assessments and the 2001/2002 loss assessment
Order AO07-IHC-01 (PDF) - In the Matter of the challenge and request for hearing by Guardian Life Insurance Company of America regarding the New Jersey Individual Health Coverage Program Board of Directors' issuance of the December, 18, 2006 interim reconciliations of the 1997/1998 and 1999/2000 loss assessments and the 2001/2002 loss assessment
Order 06-IHC-01 (PDF) - In the Matter of the Challenges by Chubb Colonial Life Insurance Company of America, Guardian Life Insurance Company, Jefferson Pilot Life Insurance Company, John Alden Insurance Company, Massachusetts Mutual Life Insurance Company, Time Insurance Company, and United States Life Insurance Company to the New Jersey Individual Health Coverage Program's Interim Reconciliation of the 1996 Loss Assessment
Order 05-01 (PDF) - In the Matter of the New Jersey Individual Health Coverage Program Board’s Adjustment of Blue Cross and Blue Shield of New Jersey’s Request for Reimbursement of Losses for Calendar Years 1993 and 1994 - Motion to Settle the Record
Order 04-07 (PDF) - In the Matter of the New Jersey Individual Health Coverage Program Board’s Adjustment of Blue Cross and Blue Shield of New Jersey’s Request for Reimbursement of Losses for Calendar Years 1993 and 1994
Order 04-06 (PDF) - In the Matter of Appeal by United States Life Insurance Company of the City of New York of its Loss Assessments by the Individual Health Coverage Program Board for the 1993, 1994, 1995 and 1996 Calculation Periods
Order 04-05 (PDF) - In the Matter of Appeal by United States Life Insurance Company of the City of New York of its Loss Assessments by the Individual Health Coverage Program Board for the 1997/1998 and 1999/2000 Calculation Periods
Order 04-02 (PDF) - In the Matter of Trustmark Insurance Company's Filing of Net Paid Losses and Request for Reimbursement for the 2001/2002 Two-Year Calculation Period
Order 04-01 (PDF) - In the Matter of the Individual Health Coverage Program Board's Agreed Upon Procedures Review of Protective Life Insurance Company's Net Paid Losses for Calendar Years 1997/1998
Order 02-06 (PDF) - In the Matter of Appeal by Cigna Healthcare of New Jersey, Inc., Along With Affiliated Carriers Cigna Healthcare of Northern New Jersey, Inc., Insurance Company of North America, and Life Insurance Company of North America From 1996 Assessment
Order 97-02 (PDF) - In the Matter of Request by Cigna Healthcare of New Jersey Inc. for Exemption From Assessment for 1996 Reimbursable Losses
Order 02-03 (PDF) - In the Matter of Appeal by Reliable Life Insurance Company of its Loss Assessments by the Individual Health Coverage Program Board of Directors for the 1999/2000 Two-Year Calculation Period
Order 02-02 (PDF) - In the Matter of Appeal by United States Life Insurance Company of the City Of New York of its Loss Assessments by the Individual Health Coverage Program Board of Directors for the 1999/2000 Calculation Period
Order 02-01 (PDF) - In the Matter of Application of Health Net Inc. to the New Jersey Individual Health Coverage Program for an Exemption From its Reimbursable Loss Assessment for the 1999/2000 Two-Year Calculation Period

Exhibit A - Standard Plans A/50 - D (MS Word)
Exhibit B - Standard HMO Plan (MS Word)
Exhibit C - Explanation of Brackets (MS Word)
Exhibit D - Compliance and Variability Rider (MS Word)
Exhibit E - Certification of Compliance (MS Word)
- Worksheet (Excel)
Exhibit F - B&E Specimen Form (MS Word)
Exhibit G - Plan Update Rider (MS Word)
Exhibit L - Enrollment Reports
- Part 1 (Excel)
- Part 2 (Excel)

IHC Program Bulletins

Advisory Bulletin 08-IHC-02 (PDF): Adopted Amendments to Address Coverage for Civil Union Partners
Advisory Bulletin 07-IHC-03 (PDF): Notice of 2005/2006 Minimum Enrollment Share; Exemption Requests; Certification of Non-Group Lives
- Spreadsheet identifying the 2005/2006 targets for each carrier (MS Excel)
Advisory Bulletin 07-IHC-02 (PDF): Notice of 2003/2004 Minimum Enrollment Share; Exemption Requests; Certification of Non-Group Lives
- Spreadsheet identifying the 2003/2004 targets for each carrier (MS Excel)
Advisory Bulletin 07-IHC-01 (PDF): Reporting Medicare Part D Premium on Exhibit K
Advisory Bulletin 06-IHC-02 (PDF): IHC Plan Changes Operative July 1, 2006
- Summary (PDF)
IHC Carrier Filing Deadlines (PDF)
Advisory Bulletin 05-IHC-03 (PDF): Riders to the Basic and Essential Health Care Services Plan
Advisory Bulletin 05-IHC-02 (PDF): 2003/2004 Certification of Non-Group Persons
Advisory Bulletin 04-IHC-01 (PDF): HIPAA Alternative Mechanism Compliance - Residency
Advisory Bulletin 02-IHC-01 (PDF): Basic and Essential Health Care Services Plan
Advisory Bulletin 01-IHC-01: Preliminary Notice of 1999/2000 Loss Share and Notice of 2001/2002 Minimum Enrollment Share/Exemption Requests
Bulletin 95-IHC-05: Coverage through Associations and Trusts
Joint Bulletin with SEH 97-03: Amendments to the IHC and SEH Acts (HIPAA Compliance)
Advisory Bulletin 98-IHC-03: Amendments to the Standard Health Benefits Plan
Advisory Bulletin 99-IHC-01: Certification of Compliance
Advisory Bulletin 99-IHC-02: Net Investment Income Reporting on Exhibit K
Advisory Bulletin 99-IHC-03: Notice of 1999/2000 Minimum Enrollment Share and Preliminary Notice of 1997/1998 Loss Share
Advisory Bulletin 99-IHC-04: Adoption of Changes to Standard Individual Health Benefits Plans Text to Include on Compliance and Variability Rider

IHC Assessments (All files are PDFs)

IHC Rule Proposals and Adoptions

PROPOSALS - COMMENT PERIOD OPEN

PROPOSALS - COMMENT PERIOD CLOSED (see Adoptions for any further action)

Comment period through April 2, 2008: Proposed Amendments to the Standard Plans and Regulations to Address Coverage Required by P.L. 2006, c. 103 Relating to Civil Union Partners (PDF)
- Proposed Text for Plans A/50 - D (PDF)
- Proposed Text for the HMO Plan (PDF)
- Proposed Text for the Specimen Basic & Essential Plan (PDF)
Comment period through April 22, 2006: Proposed New Rule N.J.A.C. 11:20-2.17 Concerning the Loss Assessment Methodology beginning 1997/1998 (PDF) - Spreadsheets illustrating the methodology included in the proposed new rule are set forth below. These spreadsheets were created using the best available data and are subject to change if new data becomes available.
- 1997/1998 Loss Assessment (PDF)
- 1999/2000 Loss Assessment (PDF)
- 2001/2002 Loss Assessment (PDF)
Comment period through October 14, 2005: Proposed Re adoption of Parts of N.J.A.C. 11:20 (PDF)
Comment period through April 11, 2005: Proposed New Rule (PDF) - HSA2 - Public Hearing April 6, 2005
- Standard Policy Plan C (PDF)
- Standard Policy Plan D (PDF)
- Explanation of Brackets (PDF)
Comment period through January 18, 2005: Proposed New Rule (PDF) - Public Hearing January 18, 2005
- Standard Policy Plan C (PDF)
- Standard Policy Plan D (PDF)
Comment period through January 8, 2003: Basic and Essential Rule Proposal (PDF)
- Exhibit V (PDF) - Policy Form
- Exhibit L (PDF) - Part 1
- Exhibit L (PDF) - Part 2
Comment period through July 22, 2002: Individual Health Coverage Program; Amendments to Exhibit G
- Exhibit G (PDF)

ADOPTIONS (note the dates for the most current amendments and new rules)

April 17, 2008: Adopted amendment to the Standard Plans and Regulations to Address Coverage Required by P.L. 2006, c.103 Relating to Civil Union Partners (PDF 16K)
- Plans A/50 - D (PDF 300K- 102 pages)

HMO Plan (PDF 263K - 62 pages)
Specimen Basic & Essential Plan (PDF 228K - 61 pages)

October 17, 2006: Adopted New Rule: N.J.S.A. 11:20-2.17 (PDF) - Assessments for Total Reimbursable Net Paid Losses for Two-Year Calculation Periods Beginning with 1997 and 1998
February 24 , 2006: IHC Adoption of Amendments, New Rule, Plan Update Rider (PDF)
- Adopted Appendix Exhibits Operative Date January 3, 2006
  - Exhibit J - Loss Ratio Report (MS Word)
  - Exhibit K - Market Share and Net Paid Loss Report (MS Word)
- Adopted Appendix Exhibits Operative Date July 1, 2006
  - Exhibit A - Standard Plans A/50 - D (MS Word)
  - Exhibit B - Standard HMO Plan (MS Word)
  - Exhibit C - Explanation of Brackets (MS Word)
  - Exhibit D - Compliance and Variability Rider (MS Word)
  - Exhibit E - Certification of Compliance (MS Word)
    - Worksheet (Excel)
  - Exhibit F - B&E Specimen Form (MS Word)
  - Exhibit G - Plan Update Rider (MS Word)
  - Exhibit L - Enrollment Reports
    - Part 1 (Excel)
    - Part 2 (Excel)
December 5, 2005: IHC Re adoption Adoption (PDF)
April 12, 2005: Adopted - HSA High Deductible Health Plans (PDF)
- Standard Policy Plan C (PDF)
- Standard Policy Plan D (PDF)
- Explanation of Brackets (PDF)
January 16 , 2003: Adoption of Basic and Essential Plan (PDF)
- Exhibit G (PDF) - Application
- Exhibit K (PDF) - Assessment Report
- Exhibit L Part 1 (PDF) - Enrollment Reporting
- Exhibit L Part 2 (PDF)
- Exhibit V (PDF) - Specimen Form Basic and Essential Plan
September 13 , 2002: IHC Program rule adoption effective October 7, 2002 (PDF)

2008 June

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