Bill Text: NJ A3427 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires DOBI to provide notification of suspension or revocation of license or registration of third party administrators.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2016-10-27 - Reported out of Assembly Committee, 2nd Reading [A3427 Detail]
Download: New_Jersey-2016-A3427-Introduced.html
Sponsored by:
Assemblyman DAVID P. RIBLE
District 30 (Monmouth and Ocean)
SYNOPSIS
Requires DOBI to provide notification of suspension or revocation of license or registration of third party administrators.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning third party administrators and amending P.L.2001, c.267.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 14 of P.L.2001, c.267 (C.17B:27B-14) is amended to read as follows:
14. The commissioner may suspend or revoke a license or registration issued pursuant to this act if he finds that the third party administrator:
a. is in an unsound financial condition;
b. is using methods or practices in the conduct of its business that render its further transaction of business in this State hazardous or injurious to the benefits payers with which it has contracted or the public;
c. has failed to pay any judgment rendered against it in this State within 60 days after the judgment has become final;
d. has violated any lawful rule or order of the commissioner or any provision of State law;
e. has refused to be examined or produce its accounts, records and files for examination, or if any of its officers has refused to give information with respect to its affairs or has refused to perform any other legal obligation as to an examination, when required by the commissioner;
f. has, without just cause, refused or failed to pay proper claims or perform services arising under its contracts;
g. at any time fails to meet any qualification for which issuance of the license could have been refused had that failure then existed and been known to the commissioner;
h. has been convicted of, or has entered a plea of guilty or nolo contendere to a felony or crime of the first, second or third degree in this State, without regard to whether adjudication was held;
i. is under suspension or revocation in another state; or
j. has willfully reimbursed enrollees for benefits not eligible under the benefits payer's benefits plan.
If the commissioner finds that one or more grounds exist for the suspension or revocation of a certificate of authority issued under this act, the commissioner may, in lieu of suspension or revocation, impose a fine upon the administrator.
If the commissioner suspends or revokes a license or registration of a third party administrator, the commissioner shall, within 30 days of the suspension or revocation, provide written notification of the suspension or revocation to all of the benefits payers with which the administrator had a contract in effect during the preceding calendar year, as listed in the most recent annual report filed with the commissioner by the administrator pursuant to section 13 of P.L.2001, c.267 (C.17B:27B-13).
(cf: P.L.2001, c.267, s.14)
2. This act shall take effect immediately.
STATEMENT
This bill amends New Jersey law that provides for the licensing and registration of third party administrators. Third party administrators process and pay claims, collect premiums, and handle other administrative responsibilities for group health or dental plans on behalf of insurers or other entities, which are referred to as "benefits payers" in the current law.
The bill provides that if the Commissioner of Banking and Insurance suspends or revokes a license or registration of a third party administrator, the commissioner shall, within 30 days of the suspension or revocation, provide written notification of the suspension or revocation to all of the administrator's benefits payers with which the administrator had a contract in effect during the preceding calendar year, as listed in the most recent annual report filed with the commissioner by the administrator.
