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Bill

A 5541

Establishes registered medical assistants

2025 Regular Session Introduced by Alicia Hyndman

New Jersey law tightens oversight of Medicare supplement policies by standardizing form filings, mandating annual loss ratio-based rate reviews, and limiting premium increases to o

REFERRED TO HIGHER EDUCATION
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Bill Summary · A 5541

Summary of Bill A 5541

Note on title: The bill’s introduced content concerns Medicare supplement policy regulation, rate filing, and loss ratios. The title “Establishes registered medical assistants” appears misaligned with the introduced text, which focuses on Medicare supplement policies under New Jersey law.

Purpose and intent

  • To strengthen regulation of Medicare supplement (Medigap) policies in New Jersey.
  • To require insurer compliance with rate filing, loss ratio standards, and consumer protections.
  • To limit premium increases to once per calendar year and to permit annual prepayment of premiums.
  • To clarify the filing and disapproval process for policy forms, riders, and endorsements.

Key provisions

Form filing and disapproval process (Section 6(a))

  • Insurers must submit Medicare supplement policy forms, certificates, applications, riders, or endorsements to the state commissioner for filing.
  • After 30 days, forms are deemed filed unless the commissioner affirmatively files or disapproves.
  • If disapproved, forms may not be delivered or issued unless disapproval is withdrawn; disapproval is subject to Administrative Procedure Act review.
  • The commissioner may extend the initial 30-day period by up to 30 days with written notice.
  • Grounds for disapproval must be stated in writing and sufficiently detailed.
  • The filing and disapproval provisions exclude documents related only to distribution of benefits or reservation-of-rights/benefits used at the insured’s request.
  • Disapproval may be based on provisions that are unjust, unfair, inequitable, misleading, or contrary to law/public policy.

Rate filings and loss ratio standards (Section 6(b) and 6(c))

  • Insurers offering Medicare supplement insurance must file annually with the commissioner the insurer’s rates, rating schedule, and supporting documentation.
  • Filings must demonstrate compliance with applicable loss ratio standards and show that actual and expected losses relative to premiums meet statutory/regulatory requirements.
  • The commissioner is empowered to issue regulations establishing minimum loss ratio standards based on paid claims experience and written premiums, using accepted actuarial principles.

Policy provisions (Section 6(d))

  • Approved Medicare supplement policies must include:
    • (1) Premium increases limited to once per calendar year.
    • (2) An option for policyholders to pay the annual premium in advance.

Effective date

  • The act takes effect immediately and applies to policies issued or renewed after the effective date.

Affected parties

  • Medicare supplement insurers operating in New Jersey.
  • Policyholders and residents purchasing Medicare supplement policies.
  • The New Jersey Department of Banking and Insurance (regulator/commissioner).

Timeline and procedural notes

  • Effective immediately upon enactment.
  • Applies to policies issued or renewed after the effective date.
  • Proposed form filings and rate submissions are subject to 30-day deemed-approval timelines (with possible extensions).
  • Administrative Procedure Act processes govern any disapprovals or withdrawals.

Legislative actions and sponsorship

  • Introduced: April 10, 2025.
  • Status: REFERRED TO HIGHER EDUCATION.
  • Primary sponsor: Alicia Hyndman.
  • Related companion bills: S 5720 (and related A 9802 in prior sessions).

Summary in one line

A 5541 seeks to tighten oversight of Medicare supplement policies in New Jersey by standardizing form filing processes, mandating annual loss ratio-based rate review, requiring minimum loss ratio standards, and restricting premium increases to once per year while allowing advance annual premium payment.

Compiled from official sources — confirm details with the bill’s official record.

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