Annual Statement Instructions

State of New Jersey
DEPARTMENT OF BANKING AND INSURANCE
DIVISION OF INSURANCE
OFFICE OF SOLVENCY REGULATION
CHRIS CHRISTIE
Governor
KENNETH E. KOBYLOWSKI
Commissioner
PO BOX 325
TRENTON, NJ 08625-0325
KIM GUADAGNO
Lt. Governor
PETER L. HARTT
Acting Director
TEL (609) 292-5350 EXT. 50070
FAX (609) 292-6765
December 16, 2014
Dear Sir or Madam,
The purpose of this correspondence is to standardize financial reporting for Third
Party Administrators (TPAs) licensed or registered in New Jersey, and to ensure that data
is properly captured in order to be in compliance with N.J.A.C. 11:23-3.8, for reporting
requirements in 2015 as of 12/31/14. All filings must be postmarked no later than June
1st. Note that any additional or revised filing requirements are outlined in bold.
Please submit updated contact information to Tim Stroud (see end of
correspondence) no later than June 1, 2015. This may be sent either by letter or email. The contact information should include:
Company Name
Contact (individual) and title
Address
Phone number
Fax Number
E-mail address
Any company looking to file an extension must formally submit a written
request to Mr. Tim Stroud by May 15, 2015. Any request for an extension submitted
after May 15, 2015 will be denied.
The Commissioner of Banking and Insurance (Commissioner) has the regulatory
authority (N.J.A.C. 11:23-4.3) to impose enforcement remedies against a TPA for
violations of any regulatory requirements including the late filing of annual reports. The
Commissioner may levy an administrative penalty in an amount not less than $250.00 or
more than $5,000.00 for each day that a TPA is in violation of the regulation. This letter
is reasonable notice that any TPA that files late will be fined on a per day basis.
The TPA filing requirements are as follow: (Note the UNAUDITED Financial
Statements previously due by March 1st are no longer required).
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ITEM
REPORT
DUE DATE
A.
Annual Questionnaire
June 1
B.
Annual Contract Report
fka Annual Report
June 1
C.
Audited Financial Statements
June 1
D.
$100 Annual Filing Fee
June 1
A. Annual Questionnaire (see attached). This report must be completed in its entirety.
If a specific question is not applicable to the TPA, it should be so indicted using
“N/A” or “None”. Note the questionnaire must include an organizational chart
which identifies the corporate structure (Parent company and affiliates or
subsidiaries of the company). The questionnaire must also include the fidelity
bond.
B. Annual Contract Report fka Annual Report.
This report is a summary of the number of benefit payers with which the TPA had a
contract in the previous year, and which covered one or more NJ residents. This
report should be filed on or before June 1. There is no required format for the report.
The report should contain the following information:
•
•
•
Year for which the report is filed (e.g. 2014 Contracts)
Name and address of the TPA. This needs to be on each page of the Annual
Contract Report because it will be separated from the other information
submitted.
Contact Person information for questions (Name, Phone Number, and Email)
I. Summary of Contracts (Required of all TPAs)
1. Number of Benefit Payer Contracts in effect at:
a. the beginning of 2014, and
b. the end of 2014.
2. Number of Benefit Payer Contracts in item1 for Insurance Companies, HMOs,
or other entities regulated by a state Department of insurance.
3. Types of benefits covered (Medical, Rx, Dental, Vision, Behavioral Health,
etc.)
4. Types of service performed (Claims payment, UM, Enrollment, COBRA)
II. Enrollment Report (Required only of TPAs paying Medical Benefits for SelfFunded Plans)
Total enrollment of NJ residents (including dependents) in benefit plans for selffunded plans providing medical benefits (and not just Rx, Dental, or Vision) and
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where the TPA is the administrator of medical claims payment for the plan
sponsor.
Note that Part I of the report does not need to list each benefit payer by name and
type of contract, and Part II does not need to separately list enrollment for each
benefit payer meeting the specification. This is a change from the requirement of
previous years.
C. Audited Financial Statement. An Audited financial Statement for the TPA’s
preceding calendar year prepared on a GAAP basis shall be filed on or before June 1,
2015. The parent company’s consolidated Audited Financial Statement and its
Subsidiaries may be filed to meet this requirement. If the company submits the
parents consolidated statement a company breakdown is recommended.
D. The filing fee of $100.00 shall accompany the June 1st filings and be made payable to
the State of New Jersey – General Treasury.
E. MAILING ADDRESS
Every TPA shall submit 1 copy of the above required reports to:
Tim Stroud
NJ Department of Banking and Insurance
Office of Solvency Regulation
BY US MAIL
PO Box 325
Trenton, NJ 08625-0325
BY OVER NIGHT MAIL
20 West State Street
Trenton, NJ 08608-1206
The Questionnaire and Annual Contract Report can be found on the Departments
website at http://www.state.nj.us/dobi/division_insurance/managedcare/tpapage.htm
If you have any questions concerning this correspondence other than those
pertaining to the Annual Contract Report please contact me at (609) 292-5350 x50070 or
by email at [email protected].
Questions concerning the Annual Contract Report ONLY should be directed
to Neil Vance at (609) 292-5427 x50338 or emailed at [email protected].
Tim Stroud
Insurance Examiner
Office of Solvency Regulation
Cc: Mary Pesce, Supervisor, Office of Solvency Regulation
Neil Vance, Managing Actuary, Office of life & Health
June Duggan, Healthcare Consultant, Office of Solvency Regulation
Richard Kartes, Healthcare Consultant, Office of Solvency Regulation
Mariam Awad, Insurance Examiner, Office of Solvency Regulation
Matt Lakatos, Insurance Examiner , Office of Solvency Regulation
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