Bill Text: NJ A1121 | 2010-2011 | Regular Session | Introduced
Bill Title: Establishes the "Healthy New Jersey Labor-Management" demonstration program.
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced - Dead) 2010-01-12 - Introduced, Referred to Assembly Labor Committee [A1121 Detail]
Download: New_Jersey-2010-A1121-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Assemblywoman ELEASE EVANS
District 35 (Bergen and Passaic)
Assemblywoman CLEOPATRA G. TUCKER
District 28 (Essex)
Co-Sponsored by:
Assemblyman Prieto, Assemblywoman Rodriguez, Assemblymen Green and Giblin
SYNOPSIS
Establishes the "Healthy New Jersey Labor-Management" demonstration program.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act establishing a pilot program to preserve and expand health insurance coverage for low-wage workers.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. The Legislature finds and declares that:
a. A lack of access to affordable health care coverage forces too many New Jersey families to go without needed preventive and other non-emergency care until serious illness requires expensive hospital care;
b. Providing health care coverage for workers increases productivity and can reduce dependence on public assistance and other State-subsidized programs, such as hospital charity care;
c. Labor-management health benefit plans have been shown to be an efficient and effective means of delivering health insurance to low wage workers; and
d. The expanded health care coverage provided by this act builds on New Jersey's longstanding commitment to assure access to quality health care that is provided in an efficient and effective manner at a reasonable cost.
2. As used in this act:
"Commissioner" means the Commissioner of the Department of Human Services;
"Employees" means individuals who work within the State of New Jersey;
"Labor-management health benefit plan" means a federal Internal Revenue service qualified, multi-employer health benefit plan regulated by the federal Department of Labor pursuant to the Employee Retirement Income Security Act of 1974 (29 U.S.C.1001 et seq.)
"Qualified applicant" means a labor-management health benefit plan which can demonstrate: not less than ten years' experience administering health benefits; participation by at least 30 different employers; coverage of at least 2,500 employees; not less than 75% of covered employees receive annual gross income from a contributing employer of $35,000 or less (this amount shall be adjusted annually by the commissioner in direct proportion to the increase or decrease in the consumer price index for all urban consumers in the New York City and Philadelphia areas as reported by the United States Department of Labor); and which agrees to provide all data and information requested by the commissioner and to submit to periodic audits by the commissioner.
3. The Healthy New Jersey Labor-Management demonstration program is established in the Department of Human Services. The purpose of the program shall be to explore the benefits of providing stop-loss insurance and bridge-financing to labor-management health benefit plans in order to expand coverage for individuals who do not currently have employer-sponsored coverage, and to stabilize coverage among individuals who are at risk of losing employer-sponsored coverage.
4. Participation in the program shall be limited to not less than two nor more than five qualified applicants selected by the commissioner in response to a request for proposals. The request for proposals shall require an applicant to submit a multi-year projection of goals and timetables for increasing the total number of individuals covered by the fund as a result of participation in this demonstration program.
5. a. Commencing on July 1, 2008, the program shall provide reimbursement to a participating labor-management health benefit plan, to the extent of available funds, for 95% of claims paid above $50,000 in a calendar year for any New Jersey resident covered by the plan.
b. In addition, the program shall, to the extent that funds are available, provide bridge-financing to help employers phase-in coverage of additional low-wage employees. The bridge-financing shall reimburse the labor-management health benefit plan as follows for every newly covered cohort of employees:
(1) In the first year, the program shall reimburse the plan for one-half of all newly enrolled employees at 65% of the premium cost;
(2) In the second year, the program shall reimburse the plan for the first cohort of newly enrolled employees at 50% of the premium cost, and the second cohort at 65%;
(3) In the third year, the program shall reimburse the plan for the first cohort at 35% of the premium cost and the second cohort at 50%;
(4) In the fourth year, the program shall reimburse the plan for the first cohort at 20% of the premium cost and the second cohort at 35%;
(5) In the fifth year, the program shall reimburse the plan for the first cohort at 5% of the of the premium cost and the second cohort at 20%; and
(6) In the sixth year, the program shall reimburse the plan for the second cohort at 5% of the premium cost.
c. In the event the total amount requested for reimbursement under subsections a. and b. during a calendar year exceeds funds available for distribution during that same calendar year, the commissioner shall provide for the pro-rata distribution of the available funds.
6. For the purposes of this program, the commissioner:
a. Shall consider only those proposals under which a fund participation agreement or collective bargaining agreement is in place which provides that the employer contributes an amount not less than 75% of the costs of the premium for employees to be covered;
b. Shall by regulation establish standards for determining eligibility and other requirements for the program including, but not limited to, the minimum level of benefits and the procedure for distribution of monies;
c. May contract with one or more appropriate entities to assist in administering the program;
d. May, if the commissioner deems it appropriate for the proper administration of the program, purchase stop-loss insurance, reinsurance, or both from an insurance company licensed to write such types of insurance in this State. The stop-loss insurance or reinsurance may be purchased to the extent that funds are available; and
e. Shall be entitled to request and secure the submission of documents and other information by labor-management health benefit plans that participate in the program, to audit and examine any books and records of the participating labor management health benefit plans; and to require such periodic reports as the commissioner deems necessary to ascertain the progress of the program.
7. This act shall take effect immediately.
STATEMENT
This bill establishes the Healthy New Jersey Labor-Management demonstration program in the Department of Human Services. The purpose of the program is to explore the benefits of providing stop-loss insurance and bridge-financing to labor-management health benefit plans in order to expand coverage for individuals who do not currently have employer-sponsored coverage, and to stabilize coverage among individuals who are at risk of losing employer-sponsored coverage.
Participation in the program is limited to not less than two nor more than five qualified applicants, as defined in the bill, who are selected by the Commissioner of the Department of Human Services ("Commissioner") in response to a request for proposals. Applicants are required to submit a multi-year projection of goals and timetables for increasing the total number of individuals covered by the fund as a result of participation in this demonstration program.
Commencing on July 1, 2008, the program is required to provide reimbursement to each approved labor-management health benefit plan, to the extent of available funds, for 95% of claims paid above $50,000 in a calendar year for any New Jersey resident covered by the plan. In addition, the program is required, to the extent of available funds, to provide bridge-financing to help employers phase-in coverage of additional low-wage employees. The bridge-financing shall reimburse the labor-management health benefit plan for every newly covered cohort of employees as follows:
1. In the first year, the program shall reimburse the fund for one-half of all newly enrolled employees at 65% of the premium cost;
2. In the second year, the program shall reimburse the plan for the first cohort of newly enrolled employees at 50% of the premium cost and the second cohort at 65%;
3. In the third year, the program shall reimburse the plan for the first cohort at 35% of the premium cost and the second cohort at 50%;
4. In the fourth year, the program shall reimburse the plan for the first cohort at 20% of the premium cost and the second cohort at 35%;
5. In the fifth year, the program shall reimburse the plan for the first cohort at 5% of the of the premium cost and the second cohort at 20%; and
6. In the sixth year, the program shall reimburse the plan for the second cohort at 5% of the premium cost.
The Commissioner is directed to consider only those proposals under which a fund participation agreement or collective bargaining agreement is in place which provides that the employer contributes an amount not less than 75% of premium costs for covered employees. The Commissioner is also directed to establish eligibility standards and other program requirements, including the minimum level of benefits and the procedure for distribution of monies.
The Commissioner may contract with appropriate entities to assist program administration, to purchase stop-loss insurance, reinsurance, or both, and to request, secure, audit and examine records and information from participating labor-management health benefit plans.
