Bill > S2273

Introduced Session

This bill requires the School Employees' Health Benefits Program (SEHBP) to offer only three plans, beginning on July 1, 2020, for medical and prescription benefits coverage. The three plans will be the New Jersey Educators Health Plan; the SEHBP NJ Direct 10 plan as adopted and implemented by the School Employees' Health Benefits Commission for plan year 2020; and the SEHBP NJ Direct 15 plan as adopted and implemented by the School Employees' Health Benefits Commission for plan year 2020. The SEHBP applies to the following employers who elect to participate in the SEHBP: local school district, regional school district, county vocational school district, county special services school district, jointure commission, educational services commission, State-operated school district, charter school, county college, any officer, board, or commission under the authority of the Commissioner of Education or of the State Board of Education, and any other public entity which is established pursuant to authority provided by Title 18A of the New Jersey Statutes, but excluding the State public institutions of higher education and excluding those public entities where the employer is the State of New Jersey. The provisions of this bill also apply under section 5 to these same employers even if they do not elect to participate in the SEHBP. The New Jersey Educators Health Plan will have the benefits specified in the bill. The plan offerings, plan terminations, and enrollments required by July 1, 2020, as set forth in this bill, may be delayed until a date after July 1, 2020, but not later than August 1, 2020, if the School Employees' Health Benefits Commission, or an employer that does not participate in the SEHBP, deems the delay to be necessary. The commission or employer may delay implementation until a date the commission or employer determines that implementation will be practicable. The commission or employer must state in writing the reasons for the delay. Under no circumstances shall implementation occur later than August 1, 2020. The bill requires the SEHBP to provide a special enrollment period during which all employees will be required to select affirmatively one of the three plans. If an employee fails to select affirmatively a plan during this special enrollment period, the SEHBP will enroll the employee, and their dependents if any, in the New Jersey Educators Health Plan for plan year beginning July 1, 2020 and ending June 30, 2021. The bill requires the SEHBP to enroll an employee who commences employment on or after July 1, 2020 but before July 1, 2027 in the New Jersey Educators Health Plan. For the plan year that commences July 1, 2027, the employee may select, during any open enrollment period, any one of the three plans provided by the SEHBP. The bill requires the program, for the plan year beginning July 1, 2020, to enroll any retiree who is not Medicare-eligible, and the retiree's dependents if any, in the New Jersey Educators Health Plan for health care benefits as a retiree. The retiree must remain in that plan until June 30, 2027 or until the retiree become eligible for Medicare, whichever comes first. For the plan year that commences July 1, 2021, the SEHBP must also offer a Garden State Health Plan. The plan will be developed by the School Employees' Health Benefits Plan Design Committee. The Garden State Health Plan will provide medical and prescription drug benefits that are equivalent to the level of medical and prescription drug benefits provided by the New Jersey Educators Health Plan, except that the benefits under the Garden State Health Plan will be available only from providers located in the State of New Jersey with certain exceptions. The level of benefits in the New Jersey Educators Health Plan, the Garden State Health Plan, the NJ Direct 10, and the NJ Direct 15 plan will remain unchanged until June 30, 2027. For the plan year that commences July 1, 2027, the benefits in the plans may be modified by the plan design committee. Employers that do not participate in the SEHBP may modify, through collective negotiations agreements, the employee contributions required for New Jersey Educators Health Plan and the Garden State Health Plan, beginning for the plan year that starts July 1, 2027 and thereafter. The bill requires an employee, or a retiree who is not Medicare-eligible and who is required by law to contribute in retirement toward the cost of health care coverage under the program, to contribute annually a percentage of base salary or retirement allowance toward the cost of the health care benefits coverage under the New Jersey Educators Health Plan and the Garden State Health Plan. The percentages are specified in the bill. However, the contribution cannot be less than the contribution of 1.5% of salary that is required by current law. The required contribution toward the cost of health care benefits coverage under the Garden State Health Plan will be one half of the percentages required for the New Jersey Educators Health Plan. However, the contribution cannot be less than the contribution of 1.5% of salary that is required by current law. The amount of the annual contribution for either plan cannot exceed the amount that is the result of a calculation using the chart established under P.L.2011, c.78 that was formerly applicable to determine a contribution that was a percentage of premium. An employee who selects a plan other than the New Jersey Educators Health Plan or the Garden State Health Plan will be required to contribute toward the cost of coverage (1) in accordance with a collective negotiations agreement applicable to that employee as negotiated in accordance with certain requirements of P.L.2011, c.78; (2) as may be required at the discretion of the employer; or (3) as required by a provision of law, whichever is applicable to that employee. The bill requires eligible employers that do not participate in the SEHBP to also offer the equivalent of the New Jersey Educators Health Plan beginning July 1, 2020, and the equivalent of the Garden State Health Plan beginning July 1, 2021, until June 30, 2027. The level of benefits in these two plans will remain unchanged through June 30, 2027. No new plans, other than the New Jersey Educators Health Plan and the Garden State Health Plan, may be provided during that period unless the provisions of collective negotiations agreements entered into before or after the effective of this bill result in additional premium cost reductions. Health care benefits plans that existed before the effective date of the bill may continue to be offered by employers that do not participate in the SEHBP. The employees of employers that do not participate in the SEHBP will also be required to make the contributions described above if they enroll in the equivalent New Jersey Educators Health Plan or the equivalent Garden State Health Plan. Eligible employers may modify, through collective negotiations agreements, the two plans and the contributions required for those plans, for the year beginning July 1, 2027 and thereafter. The enrollment provisions required for these employers for the new plans will be the same as those for the employers who participate in the SEHBP. The bill requires that actual savings realized by a school district as a result of the implementation of this bill be used solely and exclusively by the school district for the purpose of reducing the amount that is required to be raised by the local property tax levy by the school district for school district purposes, except when a school district is spending below adequacy as calculated in accordance with N.J.S.A.18A:7F-70. When a cap on the annual increase in the property tax levy for a school district is imposed by law, the savings realized shall be deducted from the adjusted tax levy for the previous budget year and the difference shall serve as the basis for calculating the adjusted tax levy for the next year. The bill requires certain annual reports from school districts. The bill also requires the SEHBP to: develop a guidance tool to provide employees and retirees with confidential consultations online with regard to the employee's or retiree's decision to select a plan during the period of open enrollment or at other times. develop a comprehensive health and wellness plan intended to provide biometric screening services, chronic condition coaching services, and smoking cessation services. provide for the services, through a contract, of wellness related providers for employees and retirees, and their dependent, enrolled in the program, with access to those service for employers who do not participate in the SEHBP. promote, on an on-going basis, the expansion of the use of patient centered medical homes. seek to adopt, on an on-going basis, efforts and measures to support expanded population health arrangements that manage costs and prevent inappropriate utilization.

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Committee Categories

Chris Brown (R)*,  Craig Coughlin (D)*,  Joe Cryan (D)*,  Ronald Dancer (R)*,  Patrick Diegnan (D)*,  Vin Gopal (D)*,  Linda Greenstein (D)*,  Mila Jasey (D)*,  Declan O'Scanlon (R)*,  Stephen Sweeney (D)*,  Dawn Addiego (D),  Christopher Bateman (R),  Jon Bramnick (R),  Lou Greenwald (D),  Gordon Johnson (D),  Tom Kean (R),  John McKeon (D),  Nancy Muñoz (R),  Annette Quijano (D),  Teresa Ruiz (D),  Samuel Thompson (D), 

Approved P.L.2020, c.44. (on 07/01/2020)

Official Document