N.J. Admin. Code § 11:4-42.6

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:4-42.6 - Provisions for aggregate limits

(a) Group health, group life insurance and blanket insurance policies and certificates that provide accident coverage and which include an aggregate limit on the benefits payable in connection with any single accident shall provide that the aggregate limit shall apply on a per conveyance basis for accidents in which a conveyance is involved, and, for accidents in which no conveyance is involved, the policy or contract may provide that the aggregate limit shall apply to each accident.

(b) Each certificate issued under a policy which includes aggregate limit(s) shall include information sufficient for each covered person to determine under which conditions he or she shall have full coverage and when his or her coverage will be reduced by the aggregate limit(s), including, but not limited to:

1. The amount of aggregate limit;

2. The amount of benefits for each separate class of covered persons subject to the same aggregate limit shall be carried over from the group (master) policy to each individual certificate.

(c) The insurer shall certify in the form submission that the aggregate limit shall apply only to that portion of insurance purchased by the policyholder.

(d) The natural death benefit portion of a group policy providing life insurance shall not include an aggregate limit of liability.

N.J. Admin. Code § 11:4-42.6