Bill Text: NJ A991 | 2010-2011 | Regular Session | Introduced
Bill Title: Establishes "Regional Network Health Benefits Plan Pilot Program."
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-01-12 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A991 Detail]
Download: New_Jersey-2010-A991-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Assemblyman RUBEN J. RAMOS, JR.
District 33 (Hudson)
SYNOPSIS
Establishes "Regional Network Health Benefits Plan Pilot Program."
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act establishing the "Regional Network Health Benefits Plan Pilot Program."
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. The Legislature finds and declares that:
a. Many health care providers in this State provide free medical care to adults and children who are not covered under a health care benefits plan;
b. While charity care is a vital public service, it is rarely preventative and comprehensive, and it is not cost-efficient either to the State, which partially subsidizes charity care expenditures, or to the health care providers that must shoulder unpaid charity care debts;
c. Recognizing that increasing the number of people with health insurance is in the best interest of the State, health care providers and public health, the Legislature instituted ground-breaking reform in 1992 with the establishment of the New Jersey Individual Health Coverage Program and New Jersey Small Employer Health Benefits Program;
d. These programs showed some initial success in increasing the number of covered persons, however these coverage rates have since fallen as the cost of insurance premiums in the programs has risen;
e. It is important for the State to reverse this downward trend of coverage rates and look for new ways to invigorate the individual and small employer health benefits markets by developing a new health benefits plan that is affordable for individuals and small employers; and
f. Therefore, with these goals in mind, it is appropriate that the Legislature direct the Department of Banking and Insurance to establish the "Regional Network Health Benefits Plan Pilot Program," the purpose of which is to develop a new type of health benefits plan and test whether this new benefits plan has the potential of increasing the number of insured in the State.
2. a. The Commissioner of Banking and Insurance shall establish in the Department of Banking and Insurance the "Regional Network Health Benefits Plan Pilot Program," hereinafter, the pilot program. The program shall:
(1) develop a regional network health benefits plan which shall be offered by a health insurance carrier through the New Jersey Individual Health Coverage Program or New Jersey Small Employer Health Benefits Program, as applicable; and
(2) test whether the regional network health benefits plan has the potential to increase the number of insured persons in this State.
b. Under the pilot program, the regional network benefits plan shall be offered to individuals or small employers living or working in an area of the State that has a high number of uninsured persons, as determined pursuant to subsection c. of this section. Individuals or small employers covered under the regional network health benefits plan shall receive the same coverage and benefits as mandated for plans under the New Jersey Individual Health Coverage Program P.L.1992, c.161 (C.17B:27A-2 et seq.) or New Jersey Small Employer Health Benefits Program pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), as applicable. However, with the exception of emergency care, urgent care, or continuity of care, covered persons will obtain all medical services from a defined, regional network of health care providers.
c. In developing the regional network benefits plan, the Commissioner of Banking and Insurance, in consultation with the Commissioner of Health and Senior Services, shall:
(1) identify an area of the State that contains a high number of uninsured persons and has a sufficient number of eligible health care providers to provide all the health care services covered under the plan;
(2) identify a health insurance carrier that will assist in developing and will offer the regional network health benefits plan through the New Jersey Individual Health Coverage Program and New Jersey Small Employer Health Benefits Program;
(3) provide assistance to the health insurance carrier in establishing a comprehensive network of health care providers that includes those providers who provide the most charity care to residents in the area; and
(4) provide any appropriate assistance to the health insurance carrier in offering and marketing the regional health benefits plan through the New Jersey Individual Health Coverage Program and New Jersey Small Employer Health Benefits Program.
d. The Commissioner of Banking and Insurance shall submit a report to the Governor, the President of the Senate, the Speaker of the General Assembly, and the Chairs of the Senate Health, Human Services and Senior Citizens Committee, the Assembly Financial Institutions and Insurance Committee, and the Assembly Health and Human Services Committee on the pilot program no later than five years after the effective date of this act. The report shall include a detailed summary of the pilot program and the health benefits plan that was developed, the cost of the plan to covered persons, the number of plans sold under the pilot program, an assessment by the commissioner on the potential efficacy of this type of health benefits plan in increasing the number of insured persons in the State if the plan were to be offered Statewide, and any recommendation on whether the State should require that health benefits plans similar to the regional network health benefit plan be offered Statewide through the New Jersey Individual Health Coverage and New Jersey Small Employer Health Benefits Programs.
3. The Commissioner of Banking and Insurance, in consultation with the Commissioner of Health and Senior Services, shall promulgate rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out the purposes of this act.
4. This act shall take effect immediately.
STATEMENT
It is a priority in this State to increase the number of adults and children who are covered under a health insurance plan. In 1992, the Legislature enacted ground-breaking insurance reform through the establishment of the New Jersey Individual Health Coverage Program and New Jersey Small Employer Health Benefits Program. Through these programs, individuals and small employers could obtain affordable insurance for themselves and their employees, respectively. While these programs were successful early on, rising health and insurance costs have since driven many individuals and small employers out of the market. To reinvigorate these markets and increase the number of people covered by insurance, this bill establishes the "Regional Network Health Benefits Pilot Program" in the Department of Banking and Insurance. The purpose of the program is to develop a regional network health benefits plan, described herein, and test the plan's potential efficacy in increasing the number of people with insurance.
The regional network benefits plan shall be offered to individuals or small employers living or working in an area of the State that has a high number of uninsured persons. Individuals or small employers covered under the regional network health benefits plan shall receive the same coverage and benefits levels as mandated for plans available in the New Jersey Individual Health Coverage or Small Employer Health Benefits Programs, as applicable. However, with the exception of emergency care, urgent care, or continuity of care, covered persons will obtain all benefits and medical services from a specified regional network of health care providers that provide the most charity care for that region.
The Commissioner of Banking and Insurance, in consultation with the Commissioner of Health and Senior Services, shall develop the benefits plan with the assistance of a health insurance carrier that will offer it through the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs.
The Commissioner of Banking and Insurance shall submit a report to the Governor, the leaders of the Legislature, and the chairs of certain Senate and General Assembly Committees, five years after the bill's enactment. The report shall include a detailed summary of the pilot program and the benefits plan that was developed under the program and the commissioner's determination whether a similar benefits plan offered Statewide on the individual and small employer markets would be an effective way to increase the number of people with insurance in this State.
