Bill Text: NJ A4270 | 2024-2025 | Regular Session | Introduced
Bill Title: Permits greater diversity in creation of new health sharing ministries and establishes and exempts certain mandates and reporting requirements.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced) 2024-05-02 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A4270 Detail]
Download: New_Jersey-2024-A4270-Introduced.html
Sponsored by:
Assemblyman BENJIE E. WIMBERLY
District 35 (Bergen and Passaic)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
SYNOPSIS
Permits greater diversity in creation of new health sharing ministries and establishes and exempts certain mandates and reporting requirements.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health care sharing ministries and reporting requirements; amending and supplementing P.L.2018, c.31.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. (New section) The Legislature finds and declares that:
a. Health care sharing ministries are organizations whose members share a common set of ethical or religious beliefs and voluntarily share medical expenses among members in accordance with those beliefs.
b. Members of qualified health care sharing ministries are exempt from the required health insurance coverage in this State.
c. The term "health care sharing ministry" in this State is defined solely by the federal definition as incorporated under the federal "Patient Protection and Affordable Care Act," 26 U.S.C. s.5000A et seq., which includes the requirement that a ministry, or a predecessor thereof, be in continuous operation since December 31, 1999.
d. There is no statement of intent in the Affordable Care Act explaining any benefit to a consumer or governmental entity for including the requirement that a health care sharing ministry must be in continuous operation since December 31, 1999.
e. In the years since the enactment of the Affordable Care Act, the term "health care sharing ministry" has proven unworkable as a consumer protection mechanism, with several new organizations using the "predecessor" loophole in the Affordable Care Act's definition to take unfair advantage of consumers in this State.
f. Therefore, to increase transparency, the law should update who health care mandates apply to and establish certain disclosures to enhance transparency.
2. Section 2 of P.L.2018, c.31(C.54A:11-2) is amended to read as follows:
2. As used in this act:
"Affordable Care Act" means the federal "Patient Protection and Affordable Care Act," Pub.L.111-148, as amended by the federal "Health Care and Education Reconciliation Act of 2010," Pub.L.111-152, and any federal rules and regulations adopted pursuant thereto.
"Applicable individual" means the same as defined in 26 U.S.C. s.5000A(d)(1), except that, for purposes of P.L.2018, c.31 (C.54A:11-1 et seq.) s.5000A(d)(2)(B) shall not apply. For purposes of P.L.2018, c.31 (C.54A:11-1 et seq.), "applicable individual" shall not include any individual for any month if that individual is a member of a health care sharing ministry for the month.
"Carrier" means any entity that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a hospital or health service corporation, a multiple employer welfare arrangement, an entity under contract with the State Health Benefits Program or the School Employees' Health Benefits Program to administer a health benefits plan, or any other entity providing a health benefits plan.
"Director" means the Director of Consumer Affairs in the Department of Law and Public Safety.
"Health care sharing ministry" means a not-for-profit organization pursuant to 26 U.S.C. s.501(c)(3) that is exempt from federal income taxes under 26 U.S.C. s.501(a), whose members: (1) share a common set of ethical or religious beliefs and share medical expenses among members in accordance with those beliefs, without regard to the state in which a member resides or is employed; and (2) retain membership even after developing a medical condition.
The term "health care sharing ministry" shall exclude ministries that do not conduct an annual audit that: (1) is performed by an independent certified public accounting firm; (2) follows generally accepted accounting principles; and (3) is made available to the public upon request.
"Minimum essential coverage" means the same as defined in 26 U.S.C. s.5000A(f)(1).
(cf: P.L.2018, c.31, s.2)
3. (New section) a. A health care sharing ministry or other organization that offers or intends to offer a plan or arrangement to facilitate payment or reimbursement of health care costs or services for residents of this State, regardless of whether the ministry or organization is domiciled in this State or another state, shall post on its Internet website 30 days following the effective date of P.L. , c. (C. ) (pending before the Legislature as this bill), and by March 1 each year thereafter the following information:
(1) the total number of individuals and households that participated in the plan or arrangement in this State in the immediately preceding calendar year;
(2) the total number of employer groups that participated in the plan or arrangement in this State in the immediately preceding calendar year, specifying the total number of participating individuals in each participating employer group;
(3) the total number of participants in the plan or arrangement nationally, if the organization or ministry offers a plan or arrangement in other states;
(4) any contracts the ministry or organization has entered into with providers in this State that provide health-care services to plan or arrangement participants;
(5) the total amount of fees, dues, or other payments collected by the ministry or organization in the immediately preceding calendar year from individuals, employer groups, or others who participated in the plan or arrangement in this State, specifying:
(a) the percentage of fees, dues, or other payments retained by the ministry or organization for administrative expenses;
(b) the total dollar amount of requests for reimbursement of health care costs or services submitted in this State in the immediately preceding calendar year by participants in the plan or arrangement or providers that provided health care services to plan or arrangement participants;
(c) the total dollar amount of requests for reimbursement of health care costs or services that were submitted in this State and were determined to qualify for reimbursement under the plan or arrangement in the immediately preceding calendar year;
(d) the total amount of payments made to in-State providers in the immediately preceding calendar year for health care services provided to or received by a plan or arrangement participant; and
(e) the total amount of reimbursements made to plan or arrangement participants in this State in the immediately preceding calendar year for health care services provided to or received by a plan or arrangement participant;
(6) the total number of requests for reimbursement of health care costs or services submitted in this State in the immediately preceding calendar year that were denied, expressed as a percentage of total reimbursement requests submitted in that calendar year, and the total number of reimbursement request denials that were appealed;
(7) the total amount of health care expenses submitted in this State by a plan or arrangement participant or provider in the immediately preceding calendar year that qualify for reimbursement pursuant to the plan or arrangement criteria but that, as of the end of that calendar year, have not been reimbursed, excluding any amounts that the plan or arrangement participants incurring the health care costs must pay before receiving reimbursement under the plan or arrangement;
(8) the estimated number of plan or arrangement participants the ministry or organization is anticipating in this State in the following calendar year, specifying the estimated number of individuals, households, employer groups, and employees;
(9) the specific counties in this State in which the ministry or organization:
(a) offered a plan or arrangement in the immediately preceding calendar year; and
(b) intends to offer a plan or arrangement in the next calendar year;
(10) other states in which the ministry or organization offers a plan or arrangement;
(11) a list of any third parties, not including insurance producers, that are associated with or assist the ministry or organization in offering or enrolling participants in the plan or arrangement in this State, copies of any training materials provided to a third party, and a detailed accounting of any commissions or other fees or remuneration paid to a third party in the immediately preceding calendar year for:
(a) marketing, promoting, or enrolling participants in a plan or arrangement offered by the ministry or organization in this State; or
(b) operating, managing, or administering a plan or arrangement offered by the ministry or organization in this State;
(12) the total number of insurance producers that are associated with or assist the ministry or organization in offering or enrolling participants in this State in the plan or arrangement, the total number of participants enrolled in the plan or arrangement through an insurance producer, copies of any training materials provided to an insurance producer, and a detailed accounting of any commissions or other fees or remuneration paid to an insurance producer in the immediately preceding calendar year for marketing, promoting, or enrolling participants in a plan or arrangement offered by the ministry or organization in this State;
(13) copies of any consumer-facing and marketing materials used in this State in promoting the ministry or organization's plan or arrangement, including plan or arrangement and benefit descriptions and other materials that explain the plan or arrangement;
(14) the name, mailing address, e-mail address, and telephone number of individuals serving as a contact organization for the ministry or organization in this State;
(15) a list of any parent companies, subsidiaries, and other names that the ministry or organization has operated under at any time within the immediately preceding five calendar years;
(16) an organizational chart for the ministry or organization that, to the best of the ministry or organization's good faith knowledge and belief, is accurate and satisfies the requirements of this subsection; and
(17) a certification by an officer of the ministry or organization that, to the best of the ministry or organization's good faith knowledge and belief, the information submitted is accurate and satisfies the requirements of this subsection.
b. In addition to the
disclosures required pursuant to subsection a. of this section, a health care
sharing ministry or organization offering a plan or arrangement to facilitate
payment or reimbursement of health-care costs or services to residents of this
State shall post on its Internet website a conspicuous notice stating that the
plans or arrangements that it offers to its participants are not health
insurance plans. A health care sharing ministry or organization shall also
notify its participants, on its Internet website, that any personal information
collected by the ministry or organization of its participants is protected.
4. (New section) a. A health care sharing ministry or organization operating in this State shall notify the Director of Consumer Affairs in the Department of Law and Public Safety if legal action is taken against the ministry or organization in another state.
b. The Director may issue a notice of noncompliance to a health care sharing ministry or organization that fails to comply with the requirements of P.L. , c. (C. ) (pending before the Legislature as this bill). If a ministry or organization fails to comply with the provisions of P.L. , c. (C. ) (pending before the Legislature as this bill) for more than 45 calendar days after a notice of noncompliance has been issued, the Director shall file an injunction in a court of competent jurisdiction or issue a monetary penalty, to be determined by the Director.
5. (New section) The Director shall adopt, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), rules or regulations as shall be necessary to effectuate the provisions of P.L. , c. (C. ) (pending before the Legislature as this bill).
6. This act shall take effect on the 60th day next following enactment, except that the Director may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill permits greater diversity in the creation of new health sharing ministries and establishes and exempts certain mandates and reporting requirements.
Under the bill, a participant in a health care sharing ministry established after December 31, 1999 will not be considered an applicable individual subject to the State's minimum essential coverage requirement, which requires that every applicable individual maintain health insurance coverage. Currently, a participant in a health care sharing ministry established after December 31, 1999 is considered an applicable individual subject to the State's minimum essential coverage requirements and must maintain health insurance coverage or pay a State-imposed tax.
Additionally, the bill establishes certain reporting requirements for health care sharing ministries and organizations that offer or intend to offer a plan or arrangement to facilitate payment or reimbursement of health care costs or services for residents of this State. The reporting requirements include the total number of individuals and households that participated in the plan or arrangement in the immediately preceding calendar year and the total amount of fees, dues, or other payments collected by the ministry or organization in the immediately preceding calendar year, among other requirements. Ministries or organizations that fail to comply with the reporting requirements under the bill may be subject to certain monetary penalties or other administrative or legal actions.
As used in this bill, "health care sharing ministry" means a not-for-profit organization pursuant to 26 U.S.C. s.501(c)(3) that is exempt from federal income taxes under 26 U.S.C. s.501(a), whose members: (1) share a common set of ethical or religious beliefs and share medical expenses among members in accordance with those beliefs, without regard to the state in which a member resides or is employed; and (2) retain membership even after they develop a medical condition. The term "health care sharing ministry" excludes ministries that do not conduct an annual audit that: (1) is performed by an independent certified public accounting firm; (2) follows generally accepted accounting principles; and (3) is made available to the public upon request.
