The bill proposes substantial reforms to the governance and structure of the State Health Benefits Commission (SHBC) in New Jersey, expanding its membership from five to eleven members, which includes key state officials and appointees from public employee organizations. It establishes specific qualifications and terms for these members, emphasizing experience in health insurance plan administration. The bill also allows the commission to retain independent legal counsel in conflict of interest situations and requires the publication of an annual report on the health benefits program's fiscal transactions. Additionally, it eliminates the State Health Benefits Plan Design Committee, transferring its responsibilities to the SHBC, which will now oversee all health plans, including medical, dental, and prescription drug benefits.

Moreover, the bill introduces new requirements for the State Health Benefits Program (SHBP) regarding medical claims management, mandating that at least 33 percent of claims be reviewed annually by a third-party medical claims reviewer, particularly focusing on higher-cost services from providers in New York and Pennsylvania. It limits the SHBP to offering only five specific plans for non-Medicare-eligible employees and retirees, while establishing a detailed contribution structure based on salary and years of service. The bill also outlines provisions for public employers not participating in the SHBP, allowing them to negotiate similar health care plans and requiring them to decide on SHBP participation within a year of enactment. Overall, the legislation aims to streamline health benefits, ensure cost-effectiveness, and maintain affordability for long-serving employees and retirees.

Statutes affected:
Introduced: 52:14-17.27