Governor Murphy signed legislation (S-3756) that permits the State Health Benefits Program (SHBP) and School Employees Health Benefits Program (SEHBP) to award contracts for more claims administrators for each program plan and provide claims data and trend reports to participating employers. The new law took effect on December 21.
The new law requires the Department of Treasury participating employers in the State Health Benefits Program and School Employees Health Benefits Program to provide a standard report within 60 days of request that contains the requesting employer’s de-identified aggregate data relating to the use of benefits by employees, early retirees, and dependents covered under each plan. The report, at a minimum, must include premiums paid by month. If there are more than 300 employees in the plan, the report must also include claims by month for inpatient hospital, out-patient hospital, in –network medical, out-of-network medical, prescription drugs, emergency room services, and behavioral health.
In addition, the Department of Treasury is required to collect and analyze claims data within the SHBP and the SEHBP to develop, and make publicly available, a claims trend report for each program in the following categories: inpatient hospital; outpatient hospital; in-network medical; out-of-network medical; prescription drugs; medical drugs; emergency room services; and behavioral health. The claims trend report will provide the information in segments, including active, early retiree, and Medicare retiree, for each plan, within the plans, and in the aggregate for each plan in both programs. The reports must be made public on the Treasury’s website.
The new law also requires the Health Benefits Plan Design Committees to select at least two third-party administrators for the plans.
The new law took effect on December 21, 2023.
Contact: Paul Penna, Senior Legislative Analyst, ppenna@njlm.org, 609-695-3481, x110.