Bill > S1971

This bill requires health insurance carriers offering plans on the state-based exchange, which is a marketplace for individuals and small businesses to purchase health insurance, to adhere to specific rate filing requirements. It defines key terms like "carrier" (an entity regulated by the state's insurance laws), "Commissioner" (the head of the Department of Banking and Insurance), and "qualified health plan" (a health plan meeting federal standards under the Affordable Care Act). The bill mandates that the Commissioner review rates for individual and small employer health benefits plans, ensuring compliance with state and federal laws, including factors like risk pooling, benefit design, and consumer purchasing power, especially for those eligible for subsidies. Notably, for plans in the "silver" metal level, which typically offers a balance of cost and coverage, carriers must base their rates on specific assumptions about how enrollees will use different versions of these plans based on cost-sharing reductions, and starting in 2026, assume a 90% average actuarial value for these plans. The bill also allows for different plan designs by geographic area and requires that if a gold or silver level plan is offered in an area, both levels must be made available. Finally, it permits carriers to transfer members from a silver to a gold plan under specific conditions, such as the gold plan having better value and lower premiums, with proper notification to the member, and sets an effective date of January 1, 2026, for these provisions.

Business and Industry

https://www.njleg.state.nj.us/bill-search/2024/S1971