S 814

Requires health insurers to limit patient cost-sharing and provide appeal process concerning certain prescription drug coverage

NJEA opposes S-814 (Weinberg, Kean) because it mandates a benefit in the School Employees Health Benefits Plan (SEHBP) without going through the Plan Design Committee. This bill would require health insurers to limit patient cost-sharing and provide an appeal process concerning certain prescription drug coverage.  We are not taking a position on the issue of the cost-sharing of certain prescription drug coverage, but rather the mechanism for this mandated coverage in the SEHBP.

P.L. 2011, Chapter 78, established the Plan Design Committee in the SEHBP.  According to the law, the committee is the body with the authority to make changes to the SEHBP.   The law states:  “The committee shall have the responsibility for and authority over the various plans and components of those plans, including for medical benefits, prescription benefits, dental, vision, and any other health care benefits, offered and administered by the program. The committee shall have the authority to create, modify, or terminate any plan or component, at its sole discretion. Any reference in law to the School Employees’ Health Benefits Commission in the context of the creation, modification, or termination of a plan or plan component shall be deemed to apply to the committee.”

While the legislature is free to regulate plan design changes in other health insurance plans, the authority to modify benefits in the SEHBP rests in the SEHBP Plan Design Committee.   

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