Revises certain requirements for individual and small employer health benefits plans and for small employer members of multiple employer welfare arrangements.
This adjustment aligns New Jersey's health insurance regulations more closely with the ACA requirement of ensuring equitable access to health coverage without disproportionate increases based on age or gender. With the alterations introduced in S1188, one of the significant changes includes removing gender as a permissible factor for determining premiums. Consequently, this move is projected to enhance affordability for women while also ensuring compliance with the ACA’s principles.
Senate Bill S1188 addresses requirements for individual and small employer health benefits plans in New Jersey. The bill seeks to amend current statutes governing the rating factors used by health insurance carriers, aiming to bring state law into compliance with federal standards set by the Affordable Care Act (ACA). The provisions modify how rates can be determined for health benefits plans, specifically adjusting the maximum premium differential between the highest and lowest-rated individuals from 350% to 300% of the premium rate charged for any given plan within set classifications.
However, the bill has faced some contention regarding its effects on small employer members of multiple employer welfare arrangements (MEWAs). Some stakeholders argue that the adjustments could lead to higher assessments for small employers as overall premium costs may increase due to stricter regulations. Furthermore, the elimination of gender as a rating factor has raised concerns regarding potential rate increases for male employees in certain plans, and varying opinions exist on whether this might inadvertently shift the financial burden away from companies onto employees.
Moreover, this bill stipulates improved transparency in the rate-setting process and encourages the offering of health benefits that exceed current minimum requirements, ensuring that additional coverage such as pediatric services and maternity benefits remains available. These considerations are aimed at bolstering the safety net for small employers and their employees while adhering to federal expectations set forth by the ACA.