NJ Department of Banking and Insurance Issues Order A18-102 to Enhance Stability in the Individual Health Benefits Marketplace and Reduce Adverse Selection by Consumers

Insurance Law Alert

April 16, 2018

Cynthia J. Borrelli

Cynthia J. Borrelli



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In the wake of changes to the Affordable Care Act (ACA) and elimination of the individual health coverage (IHC) mandate due to reduction of the ACA’s individual responsibility payment to zero effective December 31, 2018, the New Jersey Department of Banking and Insurance (Department) issued Order No. A18-102 (the Order). The Order requires carriers to submit to the Department no later than April 27, 2018 the following data, in the aggregate with their affiliates offering standard individual health benefit plans in New Jersey, subject to clear identification that the information has been aggregated:

  • Completed enclosure entitled NJ Claims Data Collection Template;
  • Completed enclosure entitled NJ Premium Membership Data Collection Template;
  • EDGE Server Output RIDE (Reinsurance Detail Enrollment Report) for 2015 and 2016;
  • EDGE Server Output RISR (Reinsurance Summary Report) for 2015 and 2016.

The information is required of every carrier continuing to write in the individual health benefits marketplace in New Jersey, as well as any carrier that itself or through an affiliate had enrollment during the 2015, 2016 or 2017 plan years but no covered lives as of 2018 because of the withdrawal from the IHC program market prior to 2018. The Department believes that this additional information will enable the Department to provide guidance with respect to stabilizing the IHC program. 

A copy of the Commissioner’s Order is linked here: http://www.state.nj.us/dobi/orders/a18_102.pdf

The required templates are linked here: NJ Claims Data Collection, NJ Premium Membership Data Collection

Questions should be directed to Cynthia Borrelli.