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 emphasizes the importance of access to these specialists as part of the overall adequacy of the provider network.

In the amendments, the bill clarifies that the regulations must include standards for a quality management program, provider participation, and a complaint and appeals system for covered persons. It also mandates that the regulations align with the existing standards governing health maintenance organizations in the state. The bill aims to enhance consumer protection and quality standards in health care, ensuring that patients receive timely access to necessary medical specialists.

Statutes affected:
Introduced: 26:2S-18