The bill proposes extensive reforms to the governance and structure of the State Health Benefits Commission (SHBC) in New Jersey, increasing its membership from five to eleven and establishing specific qualifications for members, including residency and relevant experience in health insurance. The commission will gain authority to create, modify, or terminate health plans, conduct audits, and resolve disputes through a neutral third-party arbitrator if decisions are not reached within 30 days. Additionally, the bill mandates the publication of an annual report on the health benefits program's fiscal transactions and emphasizes effective cost management in light of rising medical expenses.

Moreover, the bill introduces new requirements for the State Health Benefits Program (SHBP), including an annual review of at least 33 percent of claims by a third-party medical claims reviewer and the limitation of available plans to five specific options for employees and retirees. It outlines contribution rates based on salary and ensures that long-serving employees and certain retirees will not face increased rates. The bill also establishes a framework for managing health plan premiums, requiring assessments of renewal premiums against a baseline and implementing escalator and de-escalator mechanisms for employee contributions. Public employers not participating in the SHBP are mandated to negotiate comparable health plans and must decide on SHBP participation within a year, committing to a minimum enrollment period.

Statutes affected:
Introduced: 52:14-17.27