Senate Commerce Committee Statement to Senate, No. 3733 — State of New Jersey (June 16, 2021)

Summary

The Senate Commerce Committee of the State of New Jersey, in a statement dated June 16, 2021, reports favorably and with committee amendments Senate Bill No. 3733. As amended, the bill requires health insurance carriers to offer a clear cost share plan for individual health benefits plans, a plan design with a set of annual copayments, coinsurance and deductibles. The commissioner of the Department of Banking and Insurance is to develop at least one clear cost share plan for each of the bronze, silver and gold tiers and evaluate the plans annually, with a 60-day public comment period. A carrier may offer up to three health benefits plans that modify a clear cost share plan if the commissioner approves an actuarial certification.

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SENATE COMMERCE COMMITTEE

STATEMENT TO

SENATE, No.
3733

STATE
OF NEW JERSEY

DATED: JUNE
16, 2021

The Senate Commerce Committee reports favorably and
with committee amendments Senate Bill No. 3733.

As
amended, this bill requires health insurance carriers to offer a clear cost
share plan for individual health benefits plans.

A
clear cost share plan is a plan design that includes a set of annual
copayments, coinsurance, and deductibles for all or a designated subset of
benefits within a health benefits plan. Under this bill, the commissioner of
the Department of Banking and Insurance, in consultation with the board of
directors of the Individual Health Coverage Program, will be required to
develop a clear cost share plan for individual health benefits plans that
provide for standardized benefits and cost-sharing for covered health services.
When creating the share plan, the commissioner is to take into consideration
the following:

(1) the
ability of a health plan to conform to actuarial value ranges;

(2) focusing
consumer choice to make the process of selecting a health plan more transparent
and quality-based;

(3) limiting
out-of-pocket costs that serve as a financial barrier to accessing high-value
care; and

(4) fostering
quality improvement through the promotion of benefits with a high value and a
focus on the consumer.

The
commissioner will also be required to develop at least one clear cost share
plan for each tier of a health insurance plan designated as bronze, silver, and
gold in accordance with the federal Patient Protection and Affordable Care
Act. A carrier is to make available any clear cost share plan developed pursuant
to the bill from each metal tier in order to participate in the individual
market.

Once
created, the commissioner will evaluate annually whether to revise,
discontinue, or add any clear cost share plan for use by a carrier, which
includes, but is not limited to, considering whether a deductible or copayment
level should be changed to reflect medical inflation and actuarial values. A
60-day public comment period will be permitted as part of the evaluation
process.

Additionally,
a carrier will be able to offer up to three health benefits plans that modify
one or more parameters in a clear cost share plan created by the commissioner
if the carrier submits, and the commissioner approves, an actuarial
certification stating that the alternative share plan offers significant
consumer benefits and will not result in an adverse selection for the consumer.
The commissioner will also ensure that the exchange’s website prioritizes
unmodified clear cost share plans and that a comparison be available to display
the similarities and differences in coverage between modified and unmodified
clear cost share plans. Finally, the commissioner will require that plans
offered on the exchange conform with standardized plan designs that provide for
standardized cost-sharing for covered health services.

COMMITTEE AMENDMENTS:

The committee amended the bill to:

(1) remove language requiring the commissioner to
consult with the advisory committee on the development and evaluation of clear
cost share plans;

(2) clarify that the cost share plans may also modify
current benefits;

(3) confirm that a carrier is to make available any
clear cost share plan developed pursuant to the bill in order to participate in
the individual market rather than being required to offer at least one such
plan; and

(4) remove language requiring an annual report be
submitted by the commissioner to the Governor and Legislature on the enrollment
of consumers in cost share plans compared to other health plans.

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