Bill Text: NJ S1045 | 2018-2019 | Regular Session | Introduced
Bill Title: Establishes certain standards for health benefits plans with tiered network.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2018-01-22 - Introduced in the Senate, Referred to Senate Commerce Committee [S1045 Detail]
Download: New_Jersey-2018-S1045-Introduced.html
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
SYNOPSIS
Establishes certain standards for health benefits plans with tiered network.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning certain health insurance networks and supplementing P.L.1997, c.192 (C.26:2S-1 et al.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, the State Health Benefits Commission and the School Employees' Health Benefits Commission.
"Tiered network" means a managed care plan provider network with more than one level or tier of in-network benefits, based on different levels of cost sharing accepted by the health care providers in that network.
2. In the case of a health benefits plan with a tiered network, a carrier shall ensure that:
a. the cost sharing differences for covered persons in various tiers are clearly and conspicuously stated on the carrier's website and in plan documents supplied to the subscriber, in a form and manner to be prescribed by the Department of Banking and Insurance; and
b. variations in cost sharing among provider tiers are reasonable in relation to the premium charged. With respect to this requirement:
(1) a carrier may offer more than two levels or tiers of providers within the tiered network; and
(2) variations among each of the levels or tiers shall be reasonable in relation to the premium charged.
3. This act shall take effect immediately.
STATEMENT
This bill places certain requirements on carriers offering health benefits plans with a tiered network. A tiered network is a managed care plan provider network with more than one level or tier of in-network benefits, based on different levels of cost sharing accepted by the health care providers in that network. Carriers include an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, the State Health Benefits Commission and the School Employees' Health Benefits Commission.
The bill requires a carrier that offers a health benefits plan with a tiered network to clearly and conspicuously state on the carrier's website and in plan documents supplied to the subscriber the cost sharing differences for covered persons in various tiers.
The bill also requires a carrier, in the case of a health benefits plan with a tiered network, to ensure that variations in cost sharing among provider tiers are reasonable in relation to the premium charged. With respect to this requirement, the bill specifies that:
(1) a carrier may offer more than two levels or tiers of providers within the tiered network; and
(2) variations among each of the levels or tiers must be reasonable in relation to the premium charged.
