Sponsored by:
Assemblywoman MARGIE DONLON, M.D.
District 11 (Monmouth)
SYNOPSIS
Requires employees who do not select or waive coverage to be enrolled in lowest cost SHBP or SEHBP health plan.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the enrollment of certain employees in the State Health Benefits Program and School Employees’ Health Benefits Program and supplementing Title 52 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Notwithstanding any law, rule, or regulation to the contrary, any employee of the State who is eligible to participate in the State Health Benefits Program, and does not affirmatively select a health care plan or waive health care coverage, shall be enrolled, along with their dependents, if any, into the health care plan with the lowest overall costs for members and the State as determined by the Evaluation Committee with oversight from the Division of Purchase and Property in the Department of the Treasury, and the State Health Benefits Commission. If it is determined that no plan has the lowest overall costs for both members and the State, the commission shall require the enrollment of such employees, and their dependents, if any, into the health care plan with the lowest overall costs for the State.
b. The Evaluation Committee with oversight from the Division of Purchase and Property in the Department of the Treasury, and the State Health Benefits Commission, in consultation with the program actuary, shall determine the health care plan which has the lowest anticipated overall costs for members and for the State prior to the start of each new plan year and may adjust such determinations as may be appropriate at any time during the plan year.
2. a. Notwithstanding any law, rule, or regulation to the contrary, any employee who is eligible to participate in the School Employees’ Health Benefits Program, and does not affirmatively select a health care plan or waive health care coverage, shall be enrolled, along with their dependents, if any, into the health care plan with the lowest overall costs for members and the employer as determined by the Evaluation Committee with oversight from the Division of Purchase and Property in the Department of the Treasury, and the School Employees’ Health Benefits Commission. If it is determined that no plan has the lowest overall costs for both members and the employer, the commission shall require the enrollment of such employees, and their dependents, if any, into the health care plan with the lowest overall costs for the employer.
b. The Evaluation Committee with oversight from the Division of Purchase and Property in the Department of the Treasury, and the School Employees’ Health Benefits Commission, in consultation with the program actuary, shall determine the health care plan which has the lowest anticipated overall costs for members and for the employer prior to the start of each new plan year and may adjust such determinations as may be appropriate at any time during the plan year.
3. This act shall take effect immediately.
STATEMENT
This bill requires employees who are eligible to participate in the State Health Benefits Program or School Employees’ Health Benefits Program, and who do not affirmatively select a health care plan or waive coverage, to be enrolled, along with their dependents, if any, into the health care plan with the lowest overall costs to members and to the employer, as determined by the Evaluation Committee with oversight from the Division of Purchase and Property in the Department of the Treasury, and the State Health Benefits Commission (SHBC) or School Employees’ Health Benefits Commission (SEHBC), as appropriate. If a determination is made that no plan can be considered to provide the lowest overall cost to both members and the employer, then the SHBC or SEHBC will enroll such employees, along with their dependents, if any, into the plan with the lowest overall costs for the employer.
The bill requires the Evaluation Committee with oversight from the Division of Purchase and Property, and the SHBC or SEHBC, as appropriate, in consultation with their respective program actuaries, to determine the health care plan which has the lowest anticipated overall costs for members and for the employer prior to the start of each new plan year. The bill permits the SHBC and the SEHBC to adjust such determinations as may be appropriate at any time during the plan year.