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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, 2014.

 

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, 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

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  

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New Jersey Department of Banking and Insurance