[Second 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)

Senator  NELLIE POU

District 35 (Bergen and Passaic)

Senator  ANTHONY M. BUCCO

District 25 (Morris and Somerset)

 

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 Senate Commerce Committee on February 11, 2021, 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 2, regardless of whether the plan has since been terminated,2 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.  2A carrier shall not condition the issuance of the credit on the renewal of the plan by the policyholder.2

      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on March 27, 2020 and ending 1[90 days after the stay-at-home provisions of Executive Order 109 of 2020 have been rescinded] on May 26, 20201.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 2[December 31, 2020] May 31, 20212,1 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 2[of  more than] equivalent to2 50% 2or more2 of one month’s premium for each policyholder 2[during] for2 the period of March through June 2020; 2[or]2

      (2)  2waived frequency limits for the 2020 plan year;

      (3)  waived deductibles or maximum annual rollover limitations; or

      (4)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“Dental benefits plan” means a benefits plan which pays or provides dental expense benefits for covered dental services and is delivered or issued for delivery in this State by or through a carrier on a stand-alone basis.2

 

      22.   This act shall not apply to a provider network contract for dental services provided to beneficiaries of the Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), the Medicare program established pursuant to the federal Social Security Act (42 U.S.C. s.1395 et seq.), the State Health Benefits Program, the School Employees’ Health Benefits Program, or the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.).2

 

     2[2.] 3.2     This act shall take effect immediately and shall be retroactive to March 27, 2020.