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New Jersey Insolvent Health Maintenance Organization Assistance Association

Plan of Operation


Article 1. Purpose

1.1 The Association is created, pursuant to N.J.S.A. 17B:32B-1 et seq., to protect, subject to certain limitations, Covered Individuals and Providers against the failure or inability of HIP Health Plan of New Jersey, Inc. ("HIP") and American Preferred Provider Plan, Inc. ("APPP") to perform certain Contractual Obligations due to their insolvency.

Article 2. Definitions

The following words and terms as used in this Plan shall have the following meanings:

2.1 "Act" means The New Jersey Insolvent Health Maintenance Organization Assistance Fund Act of 2000, N.J.S.A. 17B:32B-1 et seq.

2.2 "Association" means the New Jersey Insolvent Health Maintenance Organization Assistance Association created by N.J.S.A. 17B:32B-5.

2.3 "Board" means the Board of Directors of the Association.

2.4 "Commissioner" means the Commissioner of Banking and Insurance.

2.5 "Contractual Obligation" means an obligation, arising from a written agreement, policy, certificate or other written evidence of coverage, to a Covered Individual or Provider incurred prior to the declaration of insolvency of HIP and APPP that remains unpaid at the time of their insolvency, but does not include claims by former employees, including medical professional employees for deferred compensation, severance, vacation or other employment benefits.

2.6 "Covered Health Maintenance Organization Contract" means a written agreement, policy, certificate or other written evidence of coverage for health care services issued in New Jersey by HIP or APPP to a Covered Individual, or a written contract between HIP or APPP and a participating Provider, but shall not include any contract with an employer or other person to provide health care benefits on an administrative services only basis.

2.7 "Covered Individual" means an enrollee or member of HIP or APPP.

2.8 "Covered Service" means a health care service, supply or benefit, including prescription drugs, provided to a Covered Individual under a Covered Health Maintenance Organization Contract.

2.9 "Department" means the Department of Banking and Insurance.

2.10 "Director" means a member of the Board of Directors of the Association.

2.11 "Eligible Claim" means a claim for a Covered Service under a Covered Health Maintenance Organization Contract and provided by a Provider or to a Covered Individual prior to the declaration of insolvency of HIP or APPP, but shall not include any claim filed after the claims bar date established by the Superior Court of New Jersey supervising the Insolvent Organization.

2.12 "Fund" means the New Jersey Insolvent Health Maintenance Organization Assistance Fund created by N.J.S.A. 17B:32B-6.

2.13 "Insolvent Organization" means HIP Health Plan of New Jersey, Inc. ("HIP") or American Preferred Provider Plan, Inc. ("APPP").

2.14 "Loss Adjustment Expense or Expenses" means the cost of adjudicating claims and reasonable expenses associated therewith under the Act and this Plan.

2.15 "Member Organization" means a person who holds a certificate of authority to operate a health maintenance organization pursuant to N.J.S.A. 26:2J-1 et seq., and includes any person whose certificate of authority has been suspended, revoked or nonrenewed.

2.16 "Net Written Premiums Received" means direct premiums as reported on the annual financial statement submitted pursuant to N.J.S.A. 26:2J-9.

2.17 "Plan" means the Plan of Operation approved or adopted by the Commissioner pursuant to N.J.S.A. 17B:32B-10.

2.18 "Provider" means a physician, hospital or other person which is licensed or otherwise authorized by this State, or licensed or otherwise authorized under similar laws of another state, to provide Covered Services and which provided Covered Services to Covered Individuals under a Covered Health Maintenance Organization Contract. Provider also includes persons who incurred a Contractual Obligation as defined by the Act by providing home health care services, durable medical equipment, physical therapy services, medical transportation, ambulance services or laboratory services to Covered Individuals.

 

 

Article 3. Plan of Operation

3.1 This Plan shall become effective upon the written approval of, or by adoption by, the Commissioner as provided in N.J.S.A. 17B:32B-10.

3.2 The Plan, and any amendments thereto, as necessary or suitable to assure the fair, reasonable and equitable administration of the Association and Fund, shall be adopted by a majority of the full Board and submitted to the Commissioner for approval. The Plan or any such amendments so submitted shall be effective upon the written approval of the Commissioner or 30 days after submission if the Commissioner has not disapproved them prior to the expiration of the 30 day period.

    1. Within 30 days of consultation with the Board, or such shorter time period as circumstances may require, the Commissioner may certify amendments to the Plan.
    2. A copy of the Plan shall be provided by the Board to any Member Organization or the Commissioner upon request. A copy of the Plan shall be provided by the Board to all other parties upon written request, subject to the fees pursuant to the New Jersey "Right to Know" Law, N.J.S.A. 47:1A-2.

Article 4. Association Membership; Powers and Duties

4.1 All Member Organizations authorized to transact business in this State shall be and remain members of the Association as a condition of their authority to transact business in this State. The Association shall be supervised by the Commissioner and is subject to the provisions of the Act. The powers and duties of the Association shall be exercised by its Board. All Member Organizations shall comply with the provisions of this Plan.

4.2 The Association may:

a. Enter into any contracts necessary or proper to carry out the provisions and purposes of the Act;

b. Sue or be sued, including taking any legal actions including a summary proceeding necessary or proper to recover any unpaid assessments imposed pursuant to N.J.S.A. 17B:32B-9 and to settle claims or potential claims against it;

c. Borrow money to effectuate the purposes of the Act. Any notes or other evidence of indebtedness of the Association not in default shall be legal investment for health maintenance organizations and may be carried as admitted assets;

d. Employ or retain persons necessary to handle the financial transactions of the Association, and to perform other functions as are necessary or proper under the Act, which may include, but shall not be limited to, the oversight of the adjudication of the claims of the Insolvent Organizations in order to ensure conformance with N.J.S.A. 17B:32B-8g and make recommendations to the Board with respect to any remedial action necessary for the adjudication of those claims; and

e. Take any legal action necessary to avoid payment of improper claims.

4.3 The Association shall have standing to appear before any court in New Jersey with jurisdiction over the Insolvent Organizations. Such standing shall extend to all matters germane to the powers and duties of the Association, including, but not limited to, the payment of Eligible Claims. The Association shall also have the right to appear or intervene before a court in another state with jurisdiction over the Insolvent Organizations or with jurisdiction over a third party against whom the Association may have rights through subrogation of the Insolvent Organizations' Covered Individuals or Providers.

4.4 Pursuant to the provisions of the Act, upon payment of Eligible Claims to Covered Individuals and Providers from the Fund pursuant to the Act and this Plan, the Association shall have the same priority against the assets of the Insolvent Organizations as that possessed by such Covered Individuals and Providers entitled to receive payment under the Life and Health Rehabilitation and Liquidation Act, N.J.S.A. 17B:32-31 et seq.

4.5 If the Association or its Board fails to act within a reasonable period of time upon a request by the Commissioner, the Commissioner shall have the powers and duties of the Association provided for in the Act and this Plan with respect to the Insolvent Organizations and the subject matter of the request. The Commissioner will provide the Association or its Board with 30 days notice to consider his or her request, unless circumstances require a shorter time period.

Article 5. Board of Directors; Meetings; Quorum; Voting

    1. The Association shall perform its functions under the Act and this Plan and shall exercise its powers through its Board.

5.2 The members of the Board shall be elected by the Member Organizations, except that no representative of a Member Organization that is or becomes exempt from paying assessments pursuant to N.J.S.A. 17B:32B-9e shall be eligible for membership or remain on the Board. Each Member Organization shall be entitled to one vote in person or by mail or written proxy for each member of the Board to be elected. The Member Organizations receiving the greatest number of votes shall be elected as members of the Board, subject to approval by the Commissioner, and shall designate the name of a representative of the Member Organization who shall serve as Director.

5.3 The Board shall consist of representatives from nine (9) Member Organizations, with voting authority, who shall serve a term of three years; provided, however, that the initial Board shall serve staggered terms as follows: three of the Member Organizations shall serve a term of three years, three of the Member Organizations shall serve a term of two years and three of the Member Organizations shall serve a term of one year. Thereafter, one-third (1/3) of the Board will be subject to election every year. The Directors at the next Board meeting shall determine which Member Organizations shall serve three years, two years and one year. Each member of the Board shall designate his or her alternate from the same Member Organization. The Commissioner, or his or her designee, shall be an ex-officio, non-voting member of the Board.

5.4 For the initial selection of members to the Board, the Commissioner shall send to each Member Organization, by regular mail and fax, a ballot containing the names of the eligible Member Organizations. The Member Organizations shall vote for members of the Board in accordance with the Act and Article 5.2 above. In the event the Commissioner shall determine that all the Member Organizations are not fairly represented, the Commissioner shall disapprove the election of the Directors and order another election. In the interim between such disapproval and the subsequent election, the Commissioner may appoint temporary members of the Board that fairly represent the Member Organizations.

5.5 The Board shall elect a Chairman, Vice Chairman and Secretary, and such other officers as it deems necessary, from among its Directors. Each officer shall serve a term of one year or until a successor is elected.

5.6 Vacancies occurring on the Board shall be filled by special election of the Member Organizations in accordance with Article 5.2 above, subject to approval by the Commissioner. In the event the Commissioner shall determine that all the Member Organizations are not fairly represented, the Commissioner shall disapprove the election of the Director or Directors and order another election. In the interim between such disapproval and the subsequent election, the Commissioner may appoint temporary members of the Board that fairly represent the Member Organizations. Vacancies occurring in elective offices shall be filled by majority vote of the Board. Such persons so elected to the Board and elective offices shall serve the unexpired terms.

5.7 At any meeting of the Board, including telephone conferences, each Director shall have one vote. Five Directors are required at any Board meeting to constitute a quorum. A majority vote of the Directors at a Board meeting at which a quorum is present, either in person or by telephone conference, shall constitute the acts of the Board for the transaction of business, except that an affirmative vote of a majority of the full Board is required to:

a. Approve a contract with a servicing facility for overall administration of the Association consistent with N.J.S.A. 17B:32B-10d;

b. Approve a contract employing or retaining persons for the oversight of the adjudication of claims of the Insolvent Organizations;

c. Authorize any legal proceedings;

d. Provide for a refund to Member Organizations in accordance with this Plan of any surplus monies in the Fund resulting from any assessment pursuant to Article 9.2 below;

    1. Borrow money;
    2. Levy an assessment; or

g. Adopt amendments to the Plan.

5.8 The Board may hold meetings at such times and with such frequency as it deems necessary and appropriate to conduct the business of the Association and to fulfill its obligations under the Act and this Plan, or at such times as may be directed by the Commissioner, but in no event shall the Board meet less than once a year. Such meetings may be held telephonically in accordance with the New Jersey Business Corporation Act.

5.9 A Director who is present at a meeting of the Board at which action on any Association matter is taken shall be conclusively presumed to have assented to the action taken unless such Director's dissent shall be entered in the minutes of the meeting or unless such Director shall file its written dissent to such action with the person acting as the secretary of the meeting before the adjournment of the meeting. Such right to dissent shall not apply to a Director who voted in favor of such action.

5.10 The Secretary of the Board shall provide its Directors, Member Organizations, the Commissioner and his or her designee at least ten (10) days written notice as to the time and place of all Board meetings. Such notice shall be accompanied by an agenda and any supporting documents to be discussed as an agenda item. Unless excluded by virtue of conflict of interest or in accordance with the Open Public Meetings Act, all Directors and the Commissioner, or his or her designee, shall be included in all discussions at such meetings. All Board meetings shall be held in compliance with the Open Public Meeting Act, N.J.S.A. 10:4-6 et seq., including the provision of adequate notice as set forth in N.J.S.A. 10:4-8d.

5.11 The Board shall meet at the offices of the Department unless a different location for such meeting is provided in the written notice in accordance with Article 5.10 above.

Article 6. Board Committees

6.1 The Board may, by resolution passed by a majority of the Board, appoint from its Member Organizations such Committee or Committees as it deems necessary to fulfill its obligations under the Act and this Plan and appoint a Committee Chairperson from its Directors. The Commissioner, or his or her designee, shall serve as an ex-officio, non-voting member of any such Committee. Any such Committee shall be limited to making recommendations to the Board. The Board, by resolution adopted by a majority of the Board, may:

a. Appoint members of and/or fill any vacancy in any such Committee. Committee members may be representatives of Member Organizations and need not be limited to Directors;

b. Adopt one or more persons to serve as alternate members of any such Committee, to act in the absence or disability of members of any such Committee with all of the powers of such absent or disabled member;

c. Abolish any such Committee at its pleasure; and

d. Remove any person from membership on any such committee at any time, with or without cause, except neither the Commissioner nor his or her designee may be unilaterally removed from any Committee.

6.2 Recommendations of any such Committee shall be reported to the Board at its next meeting following such Committee meeting, or if no Board meeting occurs within thirty (30) days following such Committee meeting, within a reasonable time, not to exceed sixty (60) days by providing the Board with a copy of the minutes or written report of such meeting.

6.3 The Committee Chairperson shall provide the Committee members, the Commissioner and his or her designee at least three (3) business days written notice as to the time and place of any Committee meeting. Committee members may consent, in writing, to a waiver of the three (3) business day notice requirement.

6.4 The Committee may hold meetings at such times and with such frequency as it deems necessary and appropriate to fulfill its obligations under the Act and this Plan as directed by the Board. Such meetings may be held telephonically in accordance with the New Jersey Business Corporation Act.

 

 

Article 7. New Jersey Insolvent Health Maintenance Organization Assistance Fund; Establishment of Accounts; Disbursements; Maximum Liability

7.1 For purposes of administration and assessment, the Fund is created, and shall be held in trust and maintained by the Association, for the purposes specified in the Act.

7.2 The Fund is created as a limited purpose trust fund as follows:

a. $50,000,000 to be deposited in the Fund pursuant to N.J.S.A. 17B:32B-17;

b. An additional aggregate sum of not more than $50,000,000 collected through assessments on Member Organizations over a three-year period as provided in N.J.S.A. 17B:32B-9 and Article 9 of this Plan; and

c. Such additional sums collected through any special assessment on Member Organizations pursuant to the Act and Article 9 of this Plan.

7.3 Moneys deposited in the Fund shall be deposited with the New Jersey State Treasurer in the New Jersey Cash Management Fund established pursuant to N.J.S.A. 52:18A-90.4, pending disbursement for the payment of Eligible Claims and expenses as provided in the Act and this Plan.

7.4 a. Monies deposited in the Fund in accordance with the Act shall be used to pay:

1. Eligible Claims of the Insolvent Organizations, including any interim distribution that may be directed by the Commissioner;

2. Loss Adjustment Expenses incurred by the Insolvent Organizations;

3. Actual costs to provide adequate notice of meetings required by the Open Public Meetings Act; and

4. Reasonable travel expenses incurred by the Directors.

b. The Board may make application to the Commissioner after payment of all Eligible Claims and Loss Adjustment Expenses incurred by the Insolvent Organizations for reimbursement from any surplus monies remaining in the Fund of any reasonable administrative expenses incurred by the Association in carrying out its powers and duties in accordance with the Act and this Plan and to the extent that such reimbursement is not contrary to the Act.

7.5 The Deputy Liquidator of each Insolvent Organization shall establish an account in the name of the Association for the payment of Eligible Claims to Covered Individuals and Providers, including any interim distribution as may be directed by the Commissioner, and for the reimbursement of Loss Adjustment Expenses incurred by the Insolvent Organizations. Thereafter, the Board shall provide each Deputy Liquidator with the appropriate resolution and other needed documentation as may be required by the bank for these accounts.

7.6 Except for payments that may be directed by the Commissioner pursuant to Article 7.7 below, the Deputy Liquidator of each Insolvent Organization shall make a presentation to the Board requesting disbursement from the Fund of sufficient monies to pay all or a portion of adjudicated Eligible Claims. Upon review by the Board, the Board shall promptly notify the Commissioner, in writing, of the amount of monies to be disbursed from the Fund to pay such Eligible Claims. After considering the Board's recommendation, the Commissioner shall request the New Jersey State Treasurer to wire transfer monies from the Fund to the accounts established under Article 7.5 above. The Commissioner shall inform the Board of any amounts in dispute.

7.7 The Commissioner may direct the Association to make the following payments from the Fund and the Deputy Liquidators of each Insolvent Organization shall promptly provide the Board with appropriate support therefor:

a. Interim distributions or partial payments for the payment of Eligible Claims to Covered Individuals and Providers on a pro rata basis; and

b. Reimbursements, at least quarterly, to the Insolvent Organizations for Loss Adjustment Expenses incurred by such Insolvent Organization and approved by the Commissioner.

7.8 Monies may be disbursed for payment of Eligible Claims, including any interim distribution as may be directed by the Commissioner, and for reimbursement of approved Loss Adjustment Expenses incurred by the Insolvent Organizations from the accounts established pursuant to Article 7.5 above on a check signed by the Deputy Liquidator or the Chairman of the Board as approved by the Commissioner in accordance with this Article.

7.9 The disbursement of any monies from the accounts established under Article 7.5 above to Covered Individuals and Providers shall be conditioned on the Deputy Liquidators obtaining from each Covered Individual and Provider a refunding agreement, in a form approved by the Commissioner. This refunding agreement shall, in part, notify the Covered Individual or Provider that:

a. The submitted claim may be subject to retrospective verification or audit;

b. The submitted claim shall be subject to appropriate setoffs, including the one-third forgiveness by Providers of their unpaid Contractual Obligation incurred prior to insolvency, which would otherwise be paid by the organization had it not been insolvent;

c. All or part of such payment may be reclaimed by the Association based on the final adjudication of such Covered Individual's or Provider's Eligible Claim; and

d. Covered Individuals and Providers agree to assign their rights to payment against the Insolvent Organizations to the Association.

7.10 The Board shall establish an account in the name of the Association for the payment of costs to provide adequate notice of meetings required by the Open Public Meetings Act, the reasonable travel expenses incurred by the Directors and, as may be allowable under Article 7.4b above, other reasonable administrative expenses incurred by the Association. Monies borrowed by the Association pursuant to N.J.S.A. 17B:32B-8f(3) for the payment of these reasonable administrative expenses may be deposited into this account and may be used to pay such expenses.

    1. The Board shall notify the Commissioner, in writing, at least quarterly, of the costs to provide adequate notice of meetings required by the Open Public Meetings Act and the reasonable travel expenses incurred by each Director. Such written notification shall be accompanied by an itemized account of such costs and travel expenses. Upon approval by the Board and the Commissioner, the Commissioner shall request the New Jersey State Treasurer to wire transfer monies from the Fund to the account established under Article 7.10 above.

7.12 Monies may be disbursed from the account established pursuant to Article 7.10 above on a check signed by the Chairman of the Board as approved by the Commissioner in accordance with Article 7.11 above.

7.13 Directors may be reimbursed from the Fund only for reasonable travel expenses to and from Board and Committee meetings incurred by them as Directors and in accordance with the approval procedures set forth in Article 7.11 above. Directors shall not be compensated from the Fund for their services or other expenses as Directors (e.g. salary, telephone expenses). Travel expenses shall be reimbursed in accordance with the standards and guidelines adopted by the State of New Jersey for reimbursement of such expenses.

7.14 If payment of an Eligible Claim or portion of a claim is delayed due to the insufficiency of monies available in the Fund, the Association shall not be required to pay, and shall have no liability for any interest or late charge for the period that the payment of that claim is delayed.

7.15 In the event that there are insufficient monies available in the Fund to pay all Eligible Claims adjudicated by the Insolvent Organizations, the Board shall, subject to approval by the Commissioner, ask the Commissioner to direct the Deputy Liquidators of each Insolvent Organization to pay each eligible adjudicated claim on a pro rata basis from the Fund.

    1. The maximum liability of the Association for all coverage and expenses provided under the Act and this Plan shall be limited to the amount of the Fund.

7.17 The Board shall notify the Commissioner, in writing, at least quarterly, of the other reasonable administrative expenses incurred by the Association. Such written notification shall be accompanied by an itemized account of such expenses.

Article 8. Adjudication of Claims

8.1 Claims shall be adjudicated under the supervision and direction of the Deputy Liquidators of the Insolvent Organizations' estates in accordance with standard industry practice, subject to available documentation and information. These standards shall include, but shall not be limited to, the establishment of procedures to ensure that:

a. The Eligible Claims or other obligations are paid in accordance with the contractual reimbursement rate payable by the Insolvent Organization to a Covered Individual or Provider to whom the payment is to be made;

b. Claims submitted by Providers or Covered Individuals for payment are for eligible Covered Services under a Covered Health Maintenance Organization Contract, the persons receiving such eligible Covered Services were Covered Individuals, and such eligible Covered Services were rendered by an eligible Provider;

c. In the case of a Provider not in the network of the Insolvent Organization, any payment made to the Provider in accordance with the provisions of N.J.S.A. 17B:32B-15 is made on the basis of reasonable and customary reimbursement and shall not be made at a rate that is disproportionate to the reimbursement rates applicable to Network Providers; and is made only on that portion of the payment due to the Provider by the Insolvent Organization, net of any coinsurance, deductible or copayment due under the Insolvent Organization's contract with the Covered Individual;

d. Eligible Claims are paid in accordance with coordination of benefits regulations or contract provisions;

e. No Eligible Claims are paid that are duplicative; and

f. Claims presented for payment are in compliance with the Insolvent Organization's utilization review requirements. Claims shall be deemed to be in compliance with respect to benefits or services reviewed by a representative that regularly conducted utilization review on behalf of the Insolvent Organization on the site of a Provider prior to the date of insolvency.

8.2 At the discretion of the Commissioner, the Board shall employ the services of a consulting organization with expertise in the adjudication and payment of health benefits claims, other than an organization that is responsible for the payment of claims of the Insolvent Organizations pursuant to the Act, to audit the adjudicated claims of the Insolvent Organization payable by the Association pursuant to the Act to determine whether they have been adjudicated in accordance with N.J.S.A. 17B:32B-8g. The consulting organization shall employ procedures for the audit consistent with industry standards and in accordance with standards established by the Board and approved by the Commissioner, to determine if the adjudication of the claims of the Insolvent Organizations payable by the Association pursuant to the Act meets the standards set forth in N.J.S.A. 17B:32B-8g.

8.3 The cost for the audit of claims provided for in Article 8.2 above shall be borne by the Member Organizations in accordance with N.J.S.A. 17B:32B-8h(3) and this Plan. The cost for the audit of claims provided by this subsection shall not exceed $2,000,000 and shall be collected by a special assessment on Member Organizations in accordance with Article 9.2.b. below.

Article 9. Assessments

9.1 For the purpose of providing the funds necessary to carry out the powers and duties of the Association, the Board shall assess the Member Organizations an aggregate amount not to exceed $50,000,000, to be payable in installments, over a period not to exceed three years, in amounts as may be sufficient to meet the periodic disbursements of the Association as provided by N.J.S.A. 17B:32B-9. Assessments shall be due not less than thirty (30) days after prior written notice to the Member Organizations and shall accrue interest on and after the due date at the percentage of interest prescribed in the Rules Governing the Courts of the State of New Jersey for judgments, awards and orders for the payment of money.

9.2 a. No later than ninety (90) days after the effective date of this Plan, the Board shall assess Member Organizations an aggregate amount of $16.7 million. The Board shall make subsequent assessments on July 1, 2001 and July 1, 2002, in a manner determined by the Commissioner, after consultation with the Board, in such amounts as necessary to fulfill the obligations of the Association pursuant to the Act and this Plan, but in no event shall the assessment in 2001 or 2002 exceed more than one-third of $50,000,000.

b. If the Commissioner, in his or her discretion, determines the need for employing the services of a consulting organization with an expertise in accordance with N.J.S.A. 17B:32B-8h(1) to audit the adjudicated claims of the Insolvent Organizations and to determine whether such claims have been adjudicated in accordance with the standards set forth at N.J.S.A. 17B:32B-8g, the Board shall separately assess Member Organizations an aggregate amount of $2,000,000 to cover the costs and reasonable expenses for such consulting organization. Any such separate assessment shall be made no later than thirty (30) days after the Commissioner's determination for the need of a consulting organization in accordance with N.J.S.A. 17B:32B-8h(1).

9.3 Assessments against Member Organizations shall be made in the proportion that the Net Written Premiums Received on health maintenance organization business in this State by each assessed Member Organization for the most recent calendar year for which premium information is available preceding the year in which the assessment is made bears to such premiums received on total health maintenance organization business in this State for that calendar year by all assessed Member Organizations. The net written premium paid to enroll Medicaid recipients in a Medicaid-contracting health maintenance organization, New Jersey Kid Care and similar State sponsored programs, and Medicare Plus Choice plans shall not be used to calculate any assessment.

9.4 The amount of each Member Organization's assessment necessary to meet the requirements of the Association with respect to the Insolvent Organizations under the Act shall be determined annually on or before of June 1 of each year, with the exception of the initial assessment.

9.5 The Board shall exempt, abate or defer, in whole or in part, the assessment of a Member Organization if, in the opinion of the Commissioner, payment of the assessment would endanger the ability of the Member Organization to fulfill its Contractual Obligations or place the Member Organization in an unsafe or unsound financial condition. If an assessment against a Member Organization is exempted, abated or deferred, in whole or in part, the amount by which that assessment is exempted, abated or deferred shall be assessed against the other Member Organizations in a manner consistent with the basis for assessments set forth in Article 9.3 above. Any request for relief under this Article shall conform with all requirements established by the Commissioner.

9.6 The Board shall issue to each Member Organization paying an assessment pursuant to the Act and this Plan a certificate of contribution, in a form and manner prescribed by the Commissioner, for the amount of the assessment so paid. All outstanding certificates shall be of equal dignity and priority without reference to amount or date of issue. A certificate of contribution may be shown by the organization in its financial statement as an asset in the form and manner and for the amount and period of time as the Commissioner may approve.

Article 10. Operations

10.1 The official address of the Association shall be the address of the office of Financial Solvency in the Department unless otherwise designated by the Board. The Board may use the mailing address of the Association.

    1. The Board may, subject to approval by the Commissioner, employ or retain such persons, firms or corporations to perform such administrative functions as are necessary for the Board's performance of the duties imposed upon the Association. Such persons may include attorneys at law, actuaries, accountants, claims personnel and such other specialists or persons whose advice or assistance is deemed by the Board to be necessary to the discharge of its duties imposed by law. The Board may agree to compensate such persons so as best to serve the interests of the Association and the public. Such persons, firms or corporations shall keep and maintain such records of their activities as may be required by the Board. Compensation and expenses for such persons may be reimbursed from the Fund in accordance with Article 7.4b above.

Article 11. Records and Reports

11.1 Minutes of the proceedings of each Board meeting shall be written. The original of these minutes shall be retained by the Secretary of the Board or by such other person as the Board may designate. Records shall be kept of all negotiations and meetings in which the Association or their representatives are involved to discuss the activities of the Association in carrying out its powers and duties under N.J.S.A. 17B:32B-6. Nothing in this subsection shall limit the duty of the Association to render a report of its activities under Article 11.3 below.

11.2 The Secretary of the Board, in accordance with the Open Public Meetings Act, shall maintain copies of all minutes, reports, recommendations, records and other documents. The Secretary of the Board shall furnish copies of all minutes, reports, recommendations and other documents to each Director, including the Commissioner and his or her designee. The Secretary of the Board shall also furnish copies of all minutes, reports, recommendations and other documents to any Member Organization and the public upon request; provided however, that such minutes, reports, recommendations or other records and comments pertaining to the portions of such proceeding which were closed because of the confidential nature of the matters addressed, shall also be confidential, and distribution of such minutes, reports, recommendations, records and documents shall be limited to the members of the Board, the Commissioner, the Commissioner's designee and the Association's attorneys, employees or agents, considered by the Board to be necessary or pertinent to the discussion of the matters addressed or performance of the actions taken during such confidential proceedings. Copies of minutes, reports, recommendations, records and other such documents requested by the public are subject to the fees in the New Jersey "Right To Know" Law, N.J.S.A. 47:1A-2.

11.3 The Board shall make an annual report as required by N.J.S.A. 17B:32B-13 not later than April 30 of each year to the Commissioner. Such report shall include a financial report for the preceding year in a form approved by the Commissioner, and a review of the activities of the Association during the preceding calendar year.

Article 12. Appeals

    1. Any Member Organization aggrieved by an act of the Board or the Association shall have a right to appeal to the Board. If such Member Organization is aggrieved by the final action or decision of the Board on the appeal, or if the Board declines or fails to act on such appeal within sixty (60) days, the Member Organization may appeal to the Commissioner within thirty (30) days after the action or decision of the Board or at the expiration of the sixty (60) day period within which the Board failed to act on such appeal. Any determination of an appeal shall be subject to review by the Commissioner on the record below, and shall not be considered a contested case under the New Jersey Administrative Procedures Act, N.J.S.A. 52:14B-1 et seq. The Commissioner's determination shall be a final agency decision as provided by the New Jersey Administrative Procedure Act subject to review by the Appellate Division of the Superior Court.
    2. If a Member Organization is appealing an assessment, the amount assessed shall be paid by the Member Organization to the Association and made available to meet the Associations obligations under the Act and this Plan during the pendency of such appeal.

Article 13. Cessation of Activity

13.1 The Board shall establish procedures, subject to approval by the Commissioner, for the orderly cessation of activities upon the exhaustion of monies in the Fund or upon the completion of the payment of Eligible Claims by the Association pursuant to the Act and this Plan.

    1. Any monies remaining in the Fund after payments under Article 7.4 have been made shall be distributed within 120 days of payment of the last of the above, subject to approval by the Commissioner, to the State of New Jersey and to the Member Organizations, in proportion to their contributions to the Fund pursuant to N.J.S.A. 17B:32B-6 and -9 and Article 9 above, including assets accruing from assignment, subrogation, net realized gains and income from investments, and the amount by which the assets of the Fund exceed the amount the Board, in accordance with N.J.S.A. 17B:32B-10e. The Association's subrogated claims against the Insolvent Organizations shall be paid under the Life and Health Rehabilitation and Liquidation Act, N.J.S.A. 17B:32-31 et seq.

 
OPRA
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New Jersey Department of Banking and Insurance