Bill
Bill > A1018
summary
Introduced
01/13/2026
01/13/2026
In Committee
01/13/2026
01/13/2026
Crossed Over
Passed
Dead
Introduced Session
2026-2027 Regular Session
Bill Summary
This bill requires health insurance carriers to provide an adequate network of physicians. Under the bill, a carrier will ensure that a network have a sufficient number of physicians to ensure that 100 percent of covered persons reside no more than: (1) a 20 minute drive or 10 miles, whichever is less, from at least three primary care physicians within each type of primary care specialty as defined in the bill and within the geographic boundaries of the State; and (2) a 30 minute drive or 15 miles, whichever is less, from at least three office-based medical specialists within each specialty as defined in the bill and within the geographic boundaries of the State. Under the bill, a network will be required to have a sufficient number of physicians to: (1) meet the health needs of covered persons; (2) provide an appropriate choice of physicians sufficient to render services covered by the health benefits plan; and (3) reasonably ensure that covered persons have timely access to in-network facilities. The bill provides that a carrier will be required to submit a plain language description of the network to the commissioner with information sufficient to allow the commissioner to determine whether the network is in compliance with the provisions of the bill. The commissioner will investigate the information supplied in the description to ensure compliance. Annually thereafter, the carrier will be required to submit an updated, plain language description of the network to the commissioner and must certify that the network described remains compliant with the provisions of the bill. Additionally, the bill requires the Commissioner of Banking and Insurance and the Commissioner of Human Services to establish a system by which a covered person may file a formal complaint concerning network adequacy with the Department of Banking and Insurance or the Department of Human Services. The bill also requires a carrier to display the plain language description of each network available to the public in a conspicuous location within its internet website within 20 days of the submission of the description to the commissioner.
AI Summary
This bill requires health insurance carriers, which include insurance companies and health maintenance organizations, to ensure their networks of physicians are adequate for their members. Specifically, carriers must have enough primary care physicians so that 100% of their covered individuals live within a 20-minute drive or 10 miles, whichever is less, of at least three primary care physicians of each specialty. Similarly, for office-based medical specialists, covered individuals must live within a 30-minute drive or 15 miles, whichever is less, of at least three specialists in each field. The bill also mandates that networks must meet the health needs of covered individuals, offer a suitable choice of physicians for covered services, and ensure timely access to in-network facilities, with specific timeframes for emergency and urgent care, routine appointments, and physical examinations. Carriers must submit a clear, easy-to-understand description of their network to the Commissioner of Banking and Insurance and the Commissioner of Health, who will review it for compliance, and this description must be updated and recertified annually. Furthermore, a system will be established for covered individuals to file formal complaints about network adequacy with the Department of Banking and Insurance or the Department of Human Services, and carriers must prominently display their network descriptions on their websites. While telehealth and telemedicine services are permitted, they do not count towards meeting these network adequacy requirements, nor do non-physician providers like physician assistants or nurses. The bill also allows self-funded health plans governed by ERISA to opt-in to these requirements and outlines penalties for non-compliance, with the commissioners required to report annually to the legislature on network descriptions and adopt necessary regulations.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/13/2026)
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/2026/A1018 |
| BillText | https://pub.njleg.gov/Bills/2026/A1500/1018_I1.HTM |
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