NJDOBI | About the IHC Program/Regulatory Activity

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About the IHC Program/Regulatory Activity

IHC Program Board

Regulations

Rules regarding the IHC Program are set forth in the New Jersey Administrative Code at 11:20, available through LexisNexis free online at www.lexisnexis.com/hottopics/njcode/
The Individual Health Coverage Program Act and subsequent amendments, codified at N.J.S.A. 17B:27A-2 et seq., is available through the New Jersey Office of Legislative Services web site

Regulatory Activity

Carrier Resources (Rate Filings)

2024 Rate Filing Requirements: IHC, SEH, SHP, and ACA-compliant SADP
IHC – Individual
SEH – Small Employer
- SEH Age Rating Factors and Territories
- SEH Rate Chart Template
IHC and SEH
- Benefit Summary Table
- Exhibit A – Actuarial Summary Worksheet
- Exhibit B – Plan Relativity Worksheet
- Exhibit E – Demonstration of Copay Compliance
- Part II Justification Template
- Part III Actuarial Certification Template
- Attachment 1 - NJ OON Law Worksheet (Required also for Large Group Health Benefits Plans)
- IHC and SEH Plan Management
- Bulletin 17-05: Implementation of P.L. 2017, c. 28, Which Requires Certain Coverage for Treatment of Substance Use Disorders and Which Places Certain Restrictions on Opioid and Other Prescription Drugs
- Bulletin 18-12: Short-Term, Limited Duration Insurance
- Bulletin 18-13: Association Health Plans
- Bulletin 20-25: Amendment to Minimum Standards for Health Benefits Plans to Facilitate the Availability of Bronze High Deductible Health Plans Effective for Plan Year 2021
- Bulletin 21-14: Implementation of the Federal No Surprises Act
- P.L. 2008, c.126 Coverage of Hearing Aids. As required by §156.125(a), the age limit for this benefit was removed beginning with plan year 2023.
- Bulletin 23-02: Special Enrollment Period for Medicaid Unwinding
SHP – Student
- Order A16-106: Student Health Plan Rate and Form Filings



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