Bill > S1971

This bill imposes new rate filing requirements for individual and small employer health benefits plans available through New Jersey's state-based health insurance exchange. The bill requires the Commissioner of Banking and Insurance to review health plan rates with specific considerations, including compliance with risk pooling requirements, evaluation of plan benefits, and analysis of factors that impact pricing. For silver-tier health plans, carriers must base pricing on a specific distribution of cost-sharing reduction variants, initially using 2022 enrollment data and later assuming an average actuarial value of 90 percent. The bill allows carriers some flexibility in plan design, such as offering different plan designs by rating area and providing network access beyond geographic rating areas. It also includes a provision that permits carriers to automatically transfer members from silver-level to gold-level plans under certain conditions, such as when the gold plan has a higher actuarial value and lower premium. The bill seeks federal funding to cover the cost of rate reviews and will take effect immediately, applying to health benefits plans delivered or renewed on or after January 1, 2026. Key terms like "actuarial value" refer to the percentage of total covered medical expenses that a health plan is expected to pay for enrolled individuals.

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