ASSEMBLY, No. 2618

STATE OF NEW JERSEY

INTRODUCED DECEMBER 16, 1996

By Assemblymen MALONE, COTTRELL, Assemblywoman Heck, Assemblymen Augustine, Romano, DeSopo, Assemblywoman Wright and Assemblyman Kramer

An Act concerning the State Health Benefits Program and supplementing P.L.1961, c.49 (C.52:14-17.25 et seq.).

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

    1. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act provides that if an enrollee's or member's primary care physician's contract as a participating physician in a health maintenance organization or NJ PLUS will be terminated, the health maintenance organization or NJ PLUS, as appropriate, shall provide the enrollee or member with 90-days notice of the termination. If 90-days notice cannot be provided because the termination will occur prior to the end of the 90-day period, the health maintenance organization or NJ PLUS shall notify the enrollee or member as soon as the health maintenance organization or NJ PLUS has knowledge of the termination.

    b. Notwithstanding the provisions of any policy governing open enrollment to the contrary, an enrollee or member who has been notified by a health maintenance organization or NJ PLUS pursuant to this section may change his coverage to another health benefits plan under the State Health Benefits Program upon receiving notice that his primary care physician will no longer be a participating physician with the health maintenance organization or NJ PLUS, in which the person is currently enrolled.

    2. This act shall take effect immediately.

STATEMENT

    This bill requires the State Health Benefits Program to ensure that any person covered under the program who is enrolled in a health maintenance organization or the NJ PLUS plan, shall be provided with 90-days notice if that person's primary care physician will be terminated from the provider network. Upon receiving such notification, the covered person shall be permitted to change his coverage to another health benefits plan, even though the physician's termination may occur outside of the annual open enrollment period.

    The provisions of this bill will give public employees covered under the State Health Benefits Program who are enrollees of health maintenance organizations or participants in NJ PLUS, more flexibility in selecting a new primary care physician if their physician's participation in their current plan is terminated prior to the annual open enrollment period.

Requires State Health Benefits Program managed care plans to give 90-days notice to enrollees if primary care physician is terminated from plan.