Bill > A1017

Introduced Session

This bill allows health insurers licensed in other states to provide individual health benefits plans and small employer health benefits plans to New Jersey residents and to employers in New Jersey under certain conditions and under the oversight of the Commissioner of Banking and Insurance. In order to offer plans in the State, the foreign health insurer would have to offer these plans in its domiciliary state and otherwise be in compliance with all applicable laws in that state. In addition, the foreign health insurer must apply for and obtain a certificate of authority to do business as a foreign health insurer from the Commissioner of Banking and Insurance. The commissioner shall issue the certificate if the commissioner determines that the foreign health insurer meets certain conditions as specified in the bill. Foreign health insurers who provide individual health benefits plans or small employer health benefits plans in the State must make certain disclosures to individual residents or employers, related to the differences between these plans and plans currently permitted to be offered in the State. The bill provides that the commissioner may deny, revoke or suspend a certificate of authority to do business as a foreign health insurer, after notice and an opportunity to be heard, and the commissioner must establish review procedures to handle claims by health care providers and covered persons against foreign health insurers. The bill requires the commissioner to establish grievance and independent claims review procedures with respect to claims by a health care provider or a covered person, with which a foreign health insurer shall comply as a condition of issuing policies in this State. The bill also requires the commissioner to establish fair marketing standards for marketing materials used by foreign health insurers to market individual health benefits plans and small employer health benefits plans in the State. The bill requires foreign health insurers to comply with all applicable requirements of P.L.1947, c.379 (C.17:29B-1 et seq.) (relating to trade practices); P.L.1991, c.208 (C:17B:32A-1 et seq.) (relating to the New Jersey Life and Health Guaranty Association); and the capital and surplus requirements set forth in section 2 of P.L.1995, c.235, as determined to be applicable to foreign health insurers by the commissioner. Finally, the bill requires the Department of Banking and Insurance to adopt regulations to effectuate the purposes of the bill. However, the department's regulations shall not: (1) require a foreign health insurer to modify coverage or benefit requirements, or restrict underwriting requirements or premium ratings, in any way that conflicts with the insurer's domiciliary state's laws or regulations; (2) provide for an expansion of the commissioner's authority over foreign health insurers in a way that conflicts with the provisions of this bill; or (3) require any individual health benefits plan or small employer health benefits plan issued by the foreign health insurer to be countersigned by an insurance agent or broker residing in this State. Health insurance regulations vary from state to state and, as a result, the cost for individual health coverage and small employer health coverage also varies widely. By allowing insurers licensed in other states to offer coverage to individuals and employers in this State, the intent of the bill is to provide New Jersey residents with access to a wider range of affordable health benefits plans.

Committee Categories

Nancy Muñoz (R)*,  Jay Webber (R)*,  John DiMaio (R),  Parker Space (R),  Harold Wirths (R), 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/11/2022)

Official Document