Bill
Bill > A6208
NJ A6208
NJ A6208Establishes arbitration and notification process for health insurance carriers and provider networks when dispute arises over maintaining providers as in-network.
summary
Introduced
12/08/2025
12/08/2025
In Committee
12/08/2025
12/08/2025
Crossed Over
Passed
Dead
01/12/2026
01/12/2026
Introduced Session
2024-2025 Regular Session
Bill Summary
This bill establishes a binding arbitration process for when carriers and providers that are in the carrier's network of providers are in dispute. Specifically, when carriers and provider are in dispute over pricing and reimbursement and negotiations to resolve the dispute have failed, the bill allows either party to initiate binding arbitration to determine the terms of the provisions of the contract regarding pricing and reimbursement. Among the items the bill stipulates with regards to the arbitration is 1) that the arbitration be initiated by filing a request with the Department of Banking and Insurance; 2) the party requesting arbitration is to notify the other party that arbitration has been initiated and state its final offer before arbitration and in response, the other party is to inform the party initiating the arbitration of its final offer; and 3) the arbitrator's decision is to be one of the two amounts submitted by the parties as their final offers and is to be binding on both parties. Under the bill, if a dispute remains 60 days prior to the expiration of a contract between a carrier and provider and arbitration is not initiated, arbitration shall automatically be initiated. Reimbursement for health care services offered by the provider in the dispute are to continue without alteration until the first day of the next plan year. Thirty days prior to open enrollment of the current plan year in which there is a dispute between a carrier and a provider, notice that the provider in the dispute will be out-of-network as of the commencement of the next plan year is to be sent to the insured of the carrier.
AI Summary
This bill establishes a binding arbitration process for resolving contract disputes between health insurance carriers and provider networks over pricing and reimbursement terms. When negotiations between a carrier and an in-network provider fail to resolve pricing disagreements, either party can initiate arbitration by filing a request with the Department of Banking and Insurance. The arbitration process requires each party to submit a final offer, and an independent arbitrator will select one of these two offers as the binding resolution. The arbitrator must provide detailed written findings within 30 days and split arbitration expenses equally between parties, unless the carrier is found to have negotiated in bad faith. If a contract dispute remains unresolved 60 days before the contract's expiration, arbitration will be automatically initiated. During the dispute, healthcare service reimbursements will continue unchanged until the start of the next plan year. Additionally, the carrier must notify insured individuals 30 days before open enrollment if a provider will become out-of-network in the next plan year, ensuring transparency for patients potentially affected by network changes. The bill aims to provide a structured, neutral process for resolving healthcare contract negotiations and protecting patient interests.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 12/08/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2024/A6208 |
| BillText | https://pub.njleg.gov/Bills/2024/A6500/6208_I1.HTM |
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