New Jersey Assembly Bill A5080

New Jersey 2024-2025 Regular Session

• Introduced: 12/12/24
• Refer: 12/12/24

Caption

Establishes special enrollment period for covered persons whose in-network health care provider leaves network of health benefits plan.

Impact

The implications of A5080 on state laws primarily revolve around consumer protections within the health insurance market. By instituting a clear protocol for enrollment following a provider's exit from the network, the bill enhances the rights of policyholders to transition to other available services seamlessly. This provision also obligates health insurance carriers to communicate effectively with affected individuals, ensuring that they are well-informed about their options. It encourages a greater level of transparency and accountability from health insurance providers.

Summary

Assembly Bill A5080 aims to establish a special enrollment period for individuals whose in-network healthcare provider leaves the network of their health benefits plan. This initiative is intended to ensure that covered persons are afforded a reasonable opportunity to seek alternative providers without facing irregularities in their health insurance coverage. The bill mandates the Department of Banking and Insurance to establish this special enrollment period, which must last at least 30 calendar days following a provider's departure from a network during the individual’s policy or contract period.

Contention

While the bill appears straightforward, potential points of contention could arise regarding how insurance carriers implement these requirements. Concerns may emerge among insurers about the administrative burden of establishing and maintaining these enrollment periods and effectively notifying all affected parties. Furthermore, differing interpretations of what constitutes the timely or adequate communication of these changes could lead to disputes between consumers and insurers, highlighting a need for careful monitoring of compliance once the bill is enacted.