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Health Insurance Mandates

Understanding Health Insurance Mandates.
What is a benefit mandate bill?

A benefit mandate bill is a bill that requires carriers to offer (and consequently requires individuals and groups to purchase) additional coverage for expenses incurred for specific health care services, treatments or practices.

Are all New Jersey residents covered under plans that are subject to these bills?

No. In fact, most employers receive their coverage under self-funded arrangements exempt from New Jersey law due to a federal law called ERISA. Less than 20% of residents are covered under State-regulated commercial insurance plans. We believe that expensive state mandates encourage more employers to self-fund benefits. As a result, that coverage is exempt from all state regulation including independent utilization review appeal rights, prompt payment, state premium taxes/assessments, and all mandated-benefits laws. This costs the State of New Jersey revenue and leaves consumers without important protections.

Is there reliable information published about New Jersey mandated benefits laws and bills?

The New Jersey Department of Banking Insurance (DOBI) and the Mandated Health Benefits Advisory Commission have published helpful and accurate information about New Jersey mandate laws and bills. The information is available here.

NJAHP’s requested checklist for all benefit mandate bills:
    • Refer to the Mandated Health Benefits Advisory Commission for review prior to moving forward in committee.

 

    • Refer bills impacting the State Health Benefits Program to the Pension and Health Benefits Review Commission for consideration.

 

    • Refer bills to the Office of Legislative Services for a fiscal note.

 

    • To ensure appropriate utilization and control costs and quality, allow carriers to do utilization management, subject to existing state appeal procedures.

 

    • Do not include government-rate setting for the coverage.  Rather, let market forces determine prices.

 

    • Do not include specific medical protocols in mandate bills, as the prevailing wisdom from the medical community may evolve over time.

 

    • For in-force contracts, allow for an effective date on a contract renewal date to avoid problems with the constitutional provision regarding impairment of contracts.

 

  • Provide for an effective date that allows carriers sufficient time to implement appropriately. Carriers are required to submit rate filings to the State and give consumers 60-days advance notice of rate changes, so at least 120 days is generally necessary.  Some bills which requires additional actions (e.g., building of new networks of providers like the autism mandate), require greater time to implement.