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It’s a very busy time in Trenton at the State House as we near the mandatory June 30 budget deadline. We wanted to update you on a few of the major bills that NJBIA is working on this week. If you have any questions, please contact Mary Beaumont.

“Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act”– S-1285 (Vitale, Weinberg, Cruz-Perez)/ A-1952 (Coughlin, Schaer, Singleton)
NJBIA Position: Support

The bill addresses the ever-increasing healthcare costs for “surprise” medical bills and is necessary not only for employers, employees and all consumers, but also for the state to realize savings in the public employee health benefits plans.

Background: This bill establishes requirements for price transparency and disclosure by healthcare providers and insurance carriers so it’s easier for consumers to understand potential out-of-network costs. It also establishes a dispute resolution process for the payment of “surprise” medical bills that can occur inadvertently or in emergency situations when someone receives treatment from a healthcare provider or at a facility that is not in the person’s health plan network.

Status: The bill was released by the Senate Budget Committee on Monday and is on the Senate board list for tomorrow. This is a victory for business, but the work is not over yet. We need your help to get this legislation on the Governor’s desk! Please ask your Senator to support S-1285.


S-4 (Vitale) Clarifies charitable role of health service corporation, revises procedures and terms for its board of directors, establishes process to determine efficient level of surplus, and requires timely publication of certain information by the NJ Department of Banking and Insurance (DOBI).
NJBIA Position: Opposed

NJBIA is opposed to any legislation that would appropriate funds from Horizon’s capital reserves, which under nationally followed best practices are dedicated for the protection of Horizon’s 3.8 million policyholders. This is money that New Jersey businesses, their employees, and policyholders have paid in premiums, and it must be kept in reserve to pay future healthcare bills. It is unfair to divert Horizon policyholders’ money to pay for other state programs.

Background: This legislation makes broad changes to the Horizon Blue Cross Blue Shield corporate governance structure and places new limits on how much surplus the health insurer could keep in reserves. The bill creates a public process for review of Horizon’s surplus by the Commissioner of Banking and Insurance and permits use of those funds for state budget purposes and projects.

Status: On Senate board list for vote tomorrow.


S-2399 (Sarlo, Oroho)/ A-4956 (Mukerji) Requires healthcare providers, carriers, and employers to make certain disclosures regarding healthcare costs and allows SHBP to negotiate directly with hospitals in certain circumstances.
NJBIA Position: Opposed

NJBIA has always supported comprehensive reforms to combat surprise billing that include BOTH transparency of billing information for consumers, insurers and providers, AND cost containment measures. Without this balanced approach, employers, their employees and all taxpayers and consumers will continue to pay the escalating costs in the form of higher insurance premiums.

Background: This bill requires health care providers, carriers, and employers to make certain disclosures regarding voluntary out-of-network healthcare costs and allows SHBP to negotiate directly with hospitals in certain circumstances. While the legislation expands the type of information that must be given to patients by insurers and healthcare providers about costs and payments for voluntary in-network medical procedures, it does not include any cost containment measures. It also does not include protections against balance-billing for surprise medical bills in emergency situations or when someone receives treatment inadvertently from a healthcare provider or at a facility that is not in the person’s health plan network.

Status: S-2399 is awaiting Senate action, and could be posted on the Senate board list for a vote tomorrow; A-4956 is in the Assembly Health Committee.


Telemedicine and Telehealth – S-291 (Vitale, Whelan)/ A-1464 (Lampitt, Coughlin)
NJBIA Position: Support

NJBIA supports telemedicine services because they can help reduce healthcare costs. In 2016, the cost of health insurance premiums reached $7,151 for single HMO coverage and $18,754 for family coverage in the Northeast, according to the Kaiser/HRET Survey of Employer-Sponsored Health Benefits. The national average for all plans is $6,435 for single coverage and $18,142 for family coverage.

Background: Under the bill, a healthcare provider may remotely provide healthcare services to a patient in the state, and a proper patient-provider relationship may be established, through the use of telemedicine. A healthcare provider would also be authorized to engage in telehealth activities as may be necessary to support and facilitate the provision of healthcare services to patients in the state.

Any healthcare provider who engages in telemedicine would be required to ensure that a proper provider-patient relationship is established, and must maintain a complete record of the patient’s care, and comply with all applicable state and federal statutes and regulations regarding recordkeeping, confidentiality, and disclosure of the patient’s medical record. Treatment and consultation recommendations, which are made through the use of telemedicine or telehealth, are to be subject to the same standard of care or practice standards as are applicable to in-person settings.

Status: The bill passed both Houses on June 22 and was sent to the Governor.

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