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 updates the legal language to clarify that the regulations must align with the existing standards governing health maintenance organizations in the state. It emphasizes the importance of a quality management program, provider participation, and a comprehensive complaint and appeals system for covered persons. The changes aim to enhance consumer protection and ensure that health insurance networks adequately meet the needs of patients seeking specialized medical care.

Statutes affected:
Introduced: 26:2S-18