This bill amends existing health insurance regulations in New Jersey to establish additional network adequacy standards specifically for health insurance carriers that offer managed care plans. It requires the Commissioner of Banking and Insurance to adopt new rules and regulations to ensure that covered individuals have reasonable and timely access to physician specialists, including anesthesiologists, radiologists, pathologists, and emergency medicine physicians, at in-network hospitals and facilities.

The bill also emphasizes the need for a quality management program, provider participation in networks, and a comprehensive complaint and appeals system for covered persons. It aims to enhance consumer protection and quality standards in line with those governing health maintenance organizations in the state. The changes include the replacement of references to the act with the full citation of the law, P.L.1997, c.192 (C.26:2S-1 et seq.), and the addition of specific requirements for access to medical specialists. The act is set to take effect immediately upon passage.

Statutes affected:
Introduced: 26:2S-18