State Requirements

At least one (1) Designated Responsible Licensed Producer (DRLP) must be provided and have an active resident or non-resident license in New Jersey. Public Adjuster only requires a DRLP hold an active license in New Jersey.

Exception:

• Portable Electronics Insurance

• Pharmacy Benefits Manager

• Pharmacy Services Administrative Organization

Designated Responsible Licensed Producers (DRLPs) must cumulatively cover all requested lines of authority (LOAs)

. Exceptions:

• Exceptions:

• Third Party Administrator
• Third Party Billing Service 
• Pharmacy Benefits Manager
• Pharmacy Services Administrative Organization

Applicants must provide a valid business address in the state. Addresses may not contain a P.O. Box.

Applicant must not have an active non-resident license in New Jersey.

New Jersey will allow reinstatement of a license through NIPR's Resident License Application if submitted one (1) year after expiration date. If within one (1) year, applicant must late renew using NIPR's Resident Renewal Application.

• Exception - Third Party Administrators may late renew up to thirty (30) days after expiration date.

Pharmacy Benefits Manager must submit the following supplemental documentation to the NIPR Attachment Warehouse:

• The Application cover sheet.

• Provide a comprehensive description of the PBM, including its purpose and scope of services.
• Discuss entities with shared boards/management, their relationship to the PBM, and their activities.
• Detail the PBM's experience in managing pharmacy costs, including strategies and outcomes.
• Describe the PBM's methods and locations of operation.
• Include all relevant organizational documents (operating agreement, articles, partnership agreement, etc.).
• Attach governance documents like bylaws and internal rules.
• List names, addresses, and positions of key individuals; include ownership details and any legal actions.
• Provide parent company information if applicable, including ownership charts.
• Submit completed Biographical Affidavits.
• Describe the applicant, its facilities, personnel, and services offered.
• Include a copy of the standard agreement form with pharmacies.
• Attach the contract form with carriers, detailing compliance duties.
• Provide details for each contract, including key persons, affiliates, services, accessibility, and compensation.
• List all legal and regulatory actions involving the applicant or affiliates.
• Provide the total number of claims adjudicated in the previous calendar year.
• List contracted pharmacists/pharmacies and any affiliations.
• List manufacturer contracts, including ownership interests or affiliations.
• List rebate aggregator contracts, including ownership interests or affiliations.
• List switch company contracts, including ownership interests or affiliations.
• List wholesaler contracts, including ownership interests or affiliations.
• Provide a list of health benefits plan contracts, including services and enrollee numbers.
• Include the most recent year-end audited financial statements.
• Provide detailed financial projections for three years, with assumptions.
• Explain compensation methods, including administrative fees and spread pricing.
• Describe rebate usage, including pass-through and at-risk methods.
• List rebates paid to entities, with amounts reconciled to financial statements.

Pharmacy Services Administrative Organization must submit the following supplemental documentation to the NIPR Attachment Warehouse:

• The Application cover sheet.

• Provide a description of the PSAO, including details on entities with shared boards/management and their relationships.
• Describe the PSAO's proposed methods and locations of operation, including significant procedures and programs.
• Include all relevant organizational documents (operating agreement, articles, charter, partnership agreement, etc.).
• Attach bylaws, rules, and regulations governing the registrant’s internal affairs.
• List names, addresses, and positions of key individuals; include ownership details and any legal actions.
• Submit completed Biographical Affidavits.
• Provide parent company information if applicable, including ownership charts.
• Include the most recent year-end audited financial statements.
• Explain in detail how the registrant is compensated for its services.

Third Party Administrators must submit supplemental documentation to the New Jersey Department of Insurance. The list of required documents can be found on the Department’s website at https://www.state.nj.us/dobi/division_insurance/managedcare/tpapage.htm

If applicant responds "yes" to one of the background questions, please submit supporting documents electronically via NIPR's Attachments Warehouse. The documents may also be submitted to the state via mail, email, or fax. All other required documentation must be forwarded directly to the state.