[First Reprint]

ASSEMBLY, No. 4538

STATE OF NEW JERSEY

219th LEGISLATURE

 

INTRODUCED AUGUST 13, 2020

 


 

Sponsored by:

Assemblywoman  PAMELA R. LAMPITT

District 6 (Burlington and Camden)

Assemblywoman  ANNETTE QUIJANO

District 20 (Union)

 

Co-Sponsored by:

Assemblywomen Vainieri Huttle, Timberlake, Downey, Assemblyman Houghtaling, Assemblywoman Swain and Assemblyman Benson

 

 

 

 

SYNOPSIS

     Requires dental insurers to provide credits for reduced usage during coronavirus disease 2019 pandemic.

 

CURRENT VERSION OF TEXT

     As reported by the Assembly Financial Institutions and Insurance Committee on October 19, 2020, with amendments.

  


An Act concerning certain credits and rate reductions for dental insurers related to the coronavirus disease 2019 pandemic.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.  a.  A carrier writing a dental benefits plan in this State shall issue to each 1[subscriber] policyholder in good standing1 with a plan that was in effect on March 1[21] 271 , 2020 a credit as provided in subsection b. of this section 1[which reflects the actuarial value of the carrier’s reduced risk exposure resulting from reduced application of dental procedures to covered persons in New Jersey during the Public Health Emergency and State of Emergency declared by the Governor in Executive Order 103 of 2020] in an amount equivalent to the value of any reduced claims experience due to the limitations of dental services for the period beginning on March 27, 2020 and ending on May 26, 20201.

     b.    The credit required by subsection a. of this section shall be calculated retroactively to plans in effect on March 27, 2020. The credit may be returned to the 1[subscriber] policyholder1 in the form of a direct refund, or credit toward future premiums, and shall apply to both fully paid and monthly billed plans. A 1[subscriber] policyholder1 shall not be required to take any action to receive the refund or credit. The refund or credit shall be applied for the period beginning on March 27, 2020 and ending 1[90 days after the stay-at-home provisions of Executive Order 109 of 2020 have been rescinded] on May 26, 20201 .

     c.     A carrier writing a dental benefits plan in this State shall provide to the Department of Banking and Insurance 1, on or before December 31, 2020,1 a report containing all actions taken 1[, and contemplated future actions,]1 to reduce premiums in compliance with P.L.    , c.    (C.        ) (pending before the Legislature as this bill). The report shall include 1[New Jersey-specific]1 information 1for New Jersey policyholders1 and an explanation and justification for the amount and duration of any premium reductions 1issued by the carrier,1 based on the carrier’s claim and premium data. The report shall also provide monthly and overall totals 1for the months of March, April, and May of 20201 for the following: aggregate premium prior to, and subject to, application of refunds or adjustments; aggregate premium refunds and adjustments; the number of in-force plans, and number of 1[subscribers] policyholders1 receiving refunds or adjustments. 1[These reports shall be due on August 1, September 1, October 1, and November 1; the information provided in each report shall reflect activity through the preceding month’s end.]1

     1d.   As used in this act:

     “Carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, or dental plan organization authorized to issue dental benefits plans in this State, but shall not include any entity that:

     (1)   issued a credit or refund to policyholders in an amount of more than 50% of one month’s premium for each policyholder during the period of March through June 2020; or

     (2)   has taken any actions to assist policyholders that the Commissioner of Banking and Insurance deems sufficient to excuse the entity from the provisions of this act.1

 

     2.    This act shall take effect immediately and shall be retroactive to March 27, 2020.