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. The amendments require the Commissioner of Banking and Insurance to adopt regulations that ensure covered individuals have reasonable and timely access to physician specialists at in-network hospitals and facilities. This includes specialists such as anesthesiologists, radiologists, pathologists, and emergency medicine physicians, thereby enhancing the quality of care available to patients.

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 improve consumer protection and ensure that health insurance carriers maintain adequate provider networks that meet the healthcare needs of their members.

Statutes affected:
Introduced: 26:2S-18