Makes various changes to SHBP plan offerings and governance.

A1831

ASSEMBLY, No. 1831

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblyman ANTHONY S. VERRELLI

District 15 (Hunterdon and Mercer)

Assemblywoman VERLINA REYNOLDS-JACKSON

District 15 (Hunterdon and Mercer)

Assemblyman WAYNE P. DEANGELO

District 14 (Mercer and Middlesex)

Co-Sponsored by:

Assemblymen Singh, Abdelaziz, Stanley, Freiman,
Assemblywomen Park, Drulis, Quijano, Collazos-Gill, Assemblyman Danielsen,
Assemblywoman Murphy, Assemblyman Rodriguez, Assemblywomen Donlon, Peterpaul,
Haider, Assemblyman Sampson, Assemblywomen Bagolie, Speight, Simmons, McCoy,
Assemblyman Bailey, Assemblywoman Morales, Assemblymen Egan, Guardian,
Assemblywomen Lopez, Katz, Tucker, Assemblymen Kennedy, Schaer, Miller,
Hutchison, Assemblywoman Kane, Assemblymen Calabrese, Spearman and Stewart

SYNOPSIS

���� Makes various changes to SHBP plan offerings and
governance.

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

An Act

concerning health care benefits plans provided
by the State Health Benefits Program and amending and supplementing various
parts of the statutory law.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

�����
1.�
Section 3 of P.L.1961, c.49 (C.52:14-17.27) is amended to read as follows:

���� 3.� a.� There is hereby
created a State Health Benefits Commission, consisting of
[
five
]

11

members
as follows
:

����
(1)
the State
Treasurer; the Commissioner of Banking and Insurance; the Chairperson of the
Civil Service Commission
, or their designees, who shall serve ex officio
;

[
a
State employees' representative chosen by the Public Employee Committee of the
AFL-CIO; and the fifth member of the commission shall be a local employees'
representative chosen by the Public Employee Committee of the AFL-CIO.
]

����
(2) two members who shall
be appointed by the Governor;

����
(3) a member appointed by
the Public Employee Committee of the New Jersey AFL-CIO who is a member of the
public employee organization affiliated with the New Jersey AFL-CIO with the
largest number of employees participating in the State Health Benefits Program;

����
(4) a member appointed by
the Public Employee Committee of the New Jersey AFL-CIO who is a member of the
public employee organization affiliated with the New Jersey AFL-CIO with the
second largest number of employees participating in the State Health Benefits
Program;

����
(5) a member appointed by
the Public Employee Committee of the New Jersey AFL-CIO who is a member of the
public employee organization affiliated with the New Jersey AFL-CIO with the
public employee organization with the third largest number of employees participating
in the State Health Benefits Program;

����
(6) a member appointed by
the public employee organization that is not affiliated with the New Jersey
AFL-CIO, that represents the largest number of employees in the State Health
Benefits Program who are not represented by an employee organization affiliated
with the New Jersey AFL-CIO;

����
(7) a member appointed by
the public employee organization that is not affiliated with the New Jersey
AFL-CIO, that represents the second largest number of employees in the State
Health Benefits Program who are not represented by an employee organization
affiliated with the New Jersey AFL-CIO; and

����
(8) a member, who shall
serve as chairperson, appointed by the Governor from among three persons
nominated jointly by at least eight of the members appointed pursuant to this
subsection.

����
Each of the members
appointed pursuant to paragraphs (2) through (8) of this subsection shall be a
New Jersey resident and shall be qualified by experience, education, or
training in the review, administration, and design of health insurance plans
for self-insured employers.

����
The initial terms of the
members of the commission shall be as follows: the members appointed pursuant
to paragraph (2) of this subsection shall serve for a term of three years; the
members appointed pursuant to paragraphs (3), (4), (5), (6), and (7) of this
subsection shall serve for a term of two years.� All subsequent terms of the
members appointed pursuant to paragraphs (2) through (7) of this subsection
shall be for three years.� The chairperson, appointed pursuant to paragraph (8)
of this subsection shall serve for an initial term of two years and thereafter
shall serve for a term of five years.� A member of the commission may be
reappointed to succeeding terms without limit in the same manner as the
original appointment.� A vacancy occurring on the commission shall be filled in
the same manner as the original appointment and only for the unexpired term.

����
[
The treasurer shall be chairman
of the commission and the health benefits program authorized by P.L.1961, c.49
shall be administered in the Treasury Department.
]
� The Director of the Division of
Pensions and Benefits shall be the secretary of the commission.� The commission

[
and
committee
]

shall establish a health benefits program for the employees of the State, the
cost of which shall be paid as specified in section 6 of P.L.1961, c.49
(C.52:14-17.30).� The commission
[
,
in consultation with the committee,
]

shall establish rules and regulations as may be deemed reasonable and necessary
for the administration of P.L.1961, c.49.

���� The Attorney General shall be
the legal advisor of the commission
[
and
committee
]
.�

In those instances in which the Attorney General has a conflict of interest
with the commission, a commission decision, or a commission action, the
commission shall have the right to retain independent counsel.� The fees of
such independent counsel shall be paid for by the Department of the Treasury.

���� The members of the commission
[
and committee
]
shall serve
without compensation but shall be reimbursed for any necessary expenditures.�
The public employee members shall not suffer loss of salary or wages during
service on the commission
[
or
committee
]
.

���� The commission shall publish
annually a report showing the fiscal transactions of the program for the
preceding year and stating other facts pertaining to the plan.� The commission
shall submit the report to the Governor and furnish a copy to every employer
for use of the participants and the public.

���� b.���
[
There is
established a State Health Benefits Plan Design Committee, composed of 12
members as follows:�

���� six members who shall be
appointed by the Governor as representatives of public employers whose
employees are enrolled in the program;

���� three members who shall be
appointed by the Public Employee Committee of the AFL-CIO;

���� one member who shall be
appointed by the head of the union, that is not affiliated with the AFL-CIO,
that represents the greatest number of police officers in this State;

���� one member who shall be
appointed by the head of the union, that is not affiliated with the AFL-CIO,
that represents the greatest number of firefighters in this State; and

���� one member who shall be
appointed by the head of the State Troopers Fraternal Association.

���� The members of the committee
shall serve for a term of three years and until a successor is appointed and
qualified.� Of the initial appointments by the Governor, three members shall
serve for two years and until a successor is appointed and qualified, and two
shall serve for one year and until a successor is appointed and qualified.� Of
the initial appointment by the head of the union representing the greatest
number of police officers in the State, the member shall serve for two years
and until a successor is appointed and qualified.� Of the initial appointment
by the head of the union representing the greatest number of firefighters in
the State, the member shall serve for one year and until a successor is
appointed and qualified.

���� The members of the committee
shall select a chairperson from among the members, who shall serve for a term
of one year, with no member serving more than one term as chairperson until all
the members of the committee have served a term in a manner alternating among
the employer representatives and employee representatives, unless the committee
determines otherwise with regard to this process.

���� The committee shall have the
responsibility for and authority over the various plans and components of those
plans, including for medical benefits, prescription drug 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 State 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.

���� The members of the committee
shall have the same duty and responsibility to the program as do the members of
the commission.

���� If any matter before the
committee receives at least seven votes in the affirmative, the commission
shall approve and implement the committee's decision.

���� If any matter before the
committee receives six votes in the affirmative and six votes in the negative
or the committee otherwise reaches an impasse on a decision, the provisions of
section 55 of P.L.2011, c.78 (C.52:14-17.27b) shall be followed.
]
�
(Deleted
by amendment, P.L.��� , c.��� ) (pending before the Legislature as this bill)

����
c.� (1) The commission, by
a majority vote of its full authorized membership, shall establish and modify
rules and regulations as may be deemed reasonable and necessary for the
administration of P.L.1961, c.49 (C.52:14-17.25 et seq.).

����
(2) The commission shall
have responsibility for, and authority over, the various plans and components
of those plans, including medical benefits, prescription drug benefits, dental,
vision, and any other health benefits, offered and administered by the program.�
The commission shall have the authority to create, modify, or terminate any
plan or component of any plan at its sole discretion. Any reference in law to
the State Health Benefits Plan Design Committee in the context of the creation,
modification, or termination of a plan or plan component shall be deemed to
apply to the commission.

����
(3) The commission shall
ensure that audits are performed as required by section 17 of P.L.2008, c.89
(C.52:14-17.27a), and that claims reviews are performed as specified in section
6 of P.L.1961, c.49 (C.52:14-17.30) and section 3 of P.L.��� , c.��� (C.�������
) (pending before the Legislature as this bill).� Actions of the commission
resulting from such audits and claims reviews shall require a majority vote of
the fully authorized membership of the commission to be approved.

����
(4) Members of the
commission shall have access to information, consistent with the �Health
Insurance Portability and Accountability Act of 1996,� Pub.L.104-191, necessary
to carry out the duties vested in the commission by statute, including, but not
limited to, the setting of premiums, designing of health care plans, and
entering into contracts for the provision of benefits for health services
pursuant to section 4 of P.L.1961, c.49 (C.52:14-17.28).� Commission members
shall have access to data necessary to carry out the duties vested in the
commission by statute, including, but not limited to, any available claims and
utilization data; reimbursement rates between third-party administrators,
medical service providers, and hospitals; and any documents relating to the
solicitation and award of contracts, including, but not limited to, requests
for proposals, quotations, and requests for quotations, at least 30 days prior
to the release of such contract documents.

����
The chair shall transmit a
request for information to the appropriate individual or entity. Information
requested by the commission shall be provided as soon as is practicable
and in a usable format
. In any vote before
the commission, the chair may take into account whether legitimate requests for
information have been provided as soon as is practicable and in a usable
format. The chair may also take into account whether requests for information
have been excessive or unreasonable.� Upon the commencement of binding
arbitration proceedings pursuant to the provisions of subsection b. of section
55 of P.L.2011, c.78 (C.52:14-17.27b) the arbitrator may take into account
whether legitimate requests for information have been provided as soon as is
practicable and in a usable format, or whether requests for information were
excessive or unreasonable, for the purpose of rendering a final decision on a
matter before the arbitrator.

����
(5) Except as otherwise
specified in P.L.��� , c.��� (C.������� ) (pending before the Legislature as
this bill), actions of the commission shall require the affirmative vote of a
majority of the members present at a meeting at which a majority of the full
authorized membership is present.� Six members of the commission shall
constitute a quorum for the transaction of business.

����
(6) Matters before the
commission shall be resolved within 30 days from the date such matters are
placed before the commission.� After such 30-day period, if a decision on a
matter before the commission has not been rendered, or if the commission
remains at an impasse, the provisions of subsection b. of section 55 of
P.L.2011, c.78 (C.52:14-17.27b) shall be followed.

����
(7) In consultation with
the program actuary, the State Health Benefits Commission shall develop plan
designs for the State Health Benefits Program, including the health plans as
described in section 4 of P.L.��� , c.���� (C.�������� ) (pending before the
Legislature as this bill).� Such plan designs shall apply to and remain in
effect for those employees and retirees who are covered under such plans until
the commission, in consultation with the program actuary, shall determine that
adjustments to one or more of the plans are necessary.

����
(8) Upon the advice of the
program actuary that the anticipated costs of one or more of the State Health
Benefit Program health plans, including the plans described in section 4 of
P.L. , c. (C. )
(pending before the Legislature as this bill), are likely to exceed the rate of
medical or prescription drug inflation for a given plan year, as determined by
the program actuary based upon relevant indices or information, the commission
shall undertake such actions and plan modifications as may be necessary to
appropriately manage such costs and ensure the continued viability of the
program, subject to established processes including, but not limited to,
collective negotiations agreements.

����
(9) Within 180 calendar
days after the effective date of P.L.��� , c.���� (C.������� ) (pending before
the Legislature as this bill), the State�s actuary for the State Health
Benefits Program shall issue an actuarial report concerning the State Health
Benefits Program health plans, including the plans described in section 4 of
P.L.��� , c.���� (C.������� ) (pending before the Legislature as this bill).�
The report shall include the State and public entities other than the State
that participate and do not participate in the State Health Benefits Program,
inclusive of retirees who are not Medicare-eligible paid for by the State.� The
report shall make recommendations addressing the cost of higher priced
medications, including, but not limited to, glucagon-like peptide-1 drugs
utilized for diabetes, weight loss, and cardiovascular disease.� Within 90
calendar days of the commission�s receipt of the actuary�s report and
recommendations regarding higher priced medications, including glucagon-like
peptide-1 drugs, the commission shall undertake actions and plan modifications
as may be necessary to appropriately manage the cost of higher priced
medications.

����
(10)� The commission shall
review and consider any prescription medications that have been newly approved
by the federal Food and Drug Administration on a quarterly basis and shall
review such information when considering updates to the prescription drug
formularies for each of the State Health Benefit Program health plans,
including the plans described in section 4 of
P.L. , c. (C. ) (pending
before the Legislature as this bill).� Prescription medications newly approved
by the Food and Drug Administration shall only be included on the prescription
drug formularies of the State Health Benefits Program health plans based on a
majority vote of commission members.

(cf: P.L.2011, c.78, s.45)

���� 2.� Section 55 of P.L.2011,
c.78 (C.52:14-17.27b) is amended to read as follows:

���� 55.�
a.
� Whenever the
[
State Health
Benefits Plan Design Committee of the State Health Benefits Program or the
]
School
Employees' Health Benefits Plan Design Committee of the School Employees'
Health Benefits Program fails to render a decision on a matter before the
committee because it has not received a vote of the majority of the committee
members after 60 days have passed following the initial consideration of the
matter, the committee shall utilize a super conciliator, randomly selected from
a list developed by the New Jersey Public Employment Relations Commission.� The
super conciliator shall assist the committee based upon procedures and subject
to qualifications established by the commission pursuant to regulation.

���� The super conciliator shall
promptly schedule investigatory proceedings.� The purpose of the proceedings
shall be to:

���� Investigate and acquire all
relevant information regarding the committee's failure to render a decision;

���� Discuss with the members of
the committee their differences, and utilize means and mechanisms, including
but not limited to requiring 24-hour per day negotiations, until a voluntary
settlement is reached, and provide recommendations to resolve the members'
differences; and

���� Institute any other
non-binding procedures deemed appropriate by the super conciliator.

���� If the actions taken by the
super conciliator fail to resolve the dispute, the super conciliator shall
issue a final report, which shall be provided to the committee promptly and
made available to the public within 10 days thereafter.

���� The super conciliator, while
functioning in a mediatory capacity, shall not be required to disclose any
files, records, reports, documents, or other papers classified as confidential
which are received or prepared by him or to testify with regard to mediation
conducted by him under this section.� Nothing contained herein shall exempt an
individual from disclosing information relating to the commission of a crime.

����
b.� (1) Whenever the State
Health Benefits Commission fails to render a decision on a matter before the commission
after 30 days have passed following the initial consideration of the matter, or
the commission remains at an impasse on a matter before the commission, the
commission shall select a neutral third-party arbitrator with subject matter
expertise who shall assist the commission based upon procedures and subject to
qualifications established by the commission pursuant to regulation.� If an
arbitrator ceases or is unable to act during the arbitration proceeding, a
replacement arbitrator shall be selected to continue the proceedings and
resolve the matter.

����
The arbitrator shall
promptly schedule investigatory proceedings.� The purpose of the proceedings
shall be to:

����
investigate and acquire all
relevant information regarding the commission�s failure to render a decision;

����
discuss with the members of
the commission their differences, and utilize means and mechanisms, including
but not limited to requiring 24-hour per day negotiations, until a voluntary
settlement is reached, and provide recommendations to resolve the members'
differences; and

����
institute any other
non-binding procedures deemed appropriate by the arbitrator.

����
(2) If the commission fails
to reach a resolution of the matter after 30 days of arbitration, the arbitrator
shall issue a final decision on the matter, which shall be binding.� The
decision shall be provided to the commission promptly and made available to the
public within 10 days thereafter.

����
The arbitrator shall not be
required to disclose any files, records, reports, documents, or other papers
classified as confidential which are received or prepared by the arbitrator or
to testify with regard to arbitration conducted under this section.� Nothing
contained herein shall exempt an individual from disclosing information
relating to the commission of a crime.

(cf: P.L.2011, c.78, s.55)

����� 3.�
(New section) The State Health Benefits Commission shall require the
third-party medical claims reviewer procured pursuant to section 2 of P.L.2019,
c.143 (C.52:14-17.30b), as part of the contract, to utilize appropriate data
analytics to determine the most effective methodology for conducting annual
reviews of in-network claims and out-of-network claims, as shall be determined
through the utilization of appropriate methods of data analytics, to ensure
that the State Health Benefits Program is being properly charged for in-network
and out-of-network provider services.� The claims review program shall utilize
data analytics to determine the most effective approach for reviewing claims
reimbursed to providers located in New York and Pennsylvania, with a focus on
claims resulting from higher cost services, including, but not limited to,
services provided by specialty physicians.� The State Treasurer shall adopt,
pursuant to the �Administrative Procedure Act,� P.L.1968, c.410 (C.52:14B-1 et
seq.), such rules and regulations as may be necessary to implement the
provisions of this section.� The regulations shall specify any additional
quantitative and qualitative criteria that shall apply to the claims review requirements
established by this section.

�����
4.�
(New section) a.� This section shall apply to the State Health Benefits Program
but only to employers other than the State that participate in the program,
except that the provisions of this section shall not increase the contribution
rates being paid by employees who had 20 or more years of creditable service in
one or more State or locally-administered retirement systems on the effective
date of section 77 of P.L.2011, c.78 (C.52:14-17.28e).� This section shall not
apply to State colleges or universities established pursuant to chapter 64 of
Title 18A of the New Jersey Statutes, Rutgers, The State University, New Jersey
Institute of Technology, Rowan University, Montclair State University, Kean
University and any other State college or university now or hereafter
established or authorized by law.� This section shall not apply to University
Hospital, as described under section 14 of P.L.2012, c.45 (C.18A:64G-6.1a).

���� b.� Notwithstanding the
provisions of any other law, rule, or regulation to the contrary, beginning
with the plan year that commences the year following the enactment of
P.L. , c. (C. ) (pending
before the Legislature as this bill), and for each plan year thereafter, the
State Health Benefits Program shall offer only five plans that provide medical
and prescription drug benefits for employees, and retirees who are not
Medicare-eligible, and their dependents, if any.� All other plans offered prior
to the effective date of P.L.��� , c.���� (C.������� ) (pending before the
Legislature as this bill) for employees, and retirees who are not
Medicare-eligible, and their dependents, if any, shall be terminated, unless as
otherwise specified in this section.

���� The five plans shall be:

���� (1) the SHBP Unity 2019 PPO
plan as offered by the State Health Benefits Commission effective July 1, 2019,
except that the commission and employers other than the State shall require
employee contribution rates to be those specified in subsection d. of this
section;

���� (2) the SHBP Tiered Network
plan as offered by the State Health Benefits Commission as of the effective
date of
P.L. , c. (C. )
(pending before the Legislature as this bill), except that the commission and
employers other than the State shall require employee contribution rates to
equate to 75 percent of the rates paid by employees of employers other than the
State enrolled in the SHBP Unity 2019 PPO plan pursuant to this section;

���� (3) the SHBP PPO 2030 plan as
offered by the State Health Benefits Commission as of the effective date of
P.L. , c. (C. ) (pending
before the Legislature as this bill);

���� (4) the SHBP PPO 2035 plan as
offered by the State Health Benefits Commission as of the effective date of
P.L. , c. (C. )
(pending before the Legislature as this bill); and

���� (5) the NJ Gold plan as
developed by the State Health Benefits Commission in accordance with subsection
c. of this section.

���� Employers other than the State
that participate in the State Health Benefits Program shall retain the ability
to enter the program for medical only plans and may separately purchase
pharmacy and dental benefits outside of the program without limitation or
restriction.

���� c.� Beginning the first day of
January next following the date of enactment of P.L.��� , c.���� (C.������� )
(pending before the Legislature as this bill) and for each plan year
thereafter, the program shall offer a plan to be called the NJ Gold plan.� The
NJ Gold plan shall be developed by the State Health Benefits Commission in a
manner which does not require employee contributions in the form of withholding
from the employee�s base salary, or the retirement allowance of retirees.� The
NJ Gold plan shall provide benefits that are actuarially equivalent to 80
percent of the full actuarial value of the benefits provided under the plan.

���� d.� (1) Beginning the first
day of January next following the date of enactment of P.L.��� , c.���
(C.������� ) (pending before the Legislature as this bill) and for each plan
year thereafter, the SHBP Unity 2019 PPO plan shall require each employee, and
retiree who is not Medicare-eligible and who is required by another provision
of law to contribute in retirement toward the cost of health care benefits
coverage under the State Health Benefits Program, to contribute annually toward
the cost of health care benefits coverage for the employee and retiree, and
dependents if any, under the SHBP Unity 2019 PPO plan offered by the State
Health Benefits Program pursuant to this section, an amount equal to a
percentage of the employee�s annual salary or retiree�s annual retirement
allowance, including any cost-of-living adjustments made to that allowance.�
The contribution shall be withheld by the employer from the salary of the
employee or by the retirement system from the retirement allowance, including
any cost-of-living adjustments made to that allowance, of the retiree who is
not Medicare-eligible.� The percent to be contributed shall be as follows with
the retirement allowance including any cost-of-living adjustments made to that
allowance:

���� (a) For single coverage or its
equivalent �

���� an employee whose base salary
or retirement allowance is $20,000 or more but less than $30,000 annually shall
pay 2.584 percent;

���� an employee whose base salary
or retirement allowance is $30,000 or more but less than $45,000 annually shall
pay 2.906 percent;

���� an employee whose base salary
or retirement allowance is $45,000 or more but less than $50,000 annually shall
pay 3.1 percent;

���� an employee whose base salary
or retirement allowance is $50,000 or more but less than $55,000 annually shall
pay 4.75 percent;

���� an employee whose base salary
or retirement allowance is $55,000 or more but less than $60,000 annually shall
pay 5.75 percent;

���� an employee whose base salary
or retirement allowance is $60,000 or more but less than $65,000 annually shall
pay
6.975
percent;

���� an employee whose base salary
or retirement allowance is $65,000 or more but less than $70,000 annually shall
pay 7.25 percent;

���� an employee whose base salary
or retirement allowance is $70,000 or more but less than $80,000 annually shall
pay 7.95 percent;

���� an employee whose base salary
or retirement allowance is $80,000 or more but less than $95,000 annually shall
pay $6,350; and

���� an employee whose base salary
or retirement allowance is $95,000 or more annually shall pay $6,750.

���� (b) For employee and
spouse/partner coverage or its equivalent �

���� an employee whose base salary
or retirement allowance is $20,000 or more but less than $30,000 annually shall
pay 2.584 percent;

���� an employee whose base salary
or retirement allowance is $30,000 or more but less than $36,000 annually shall
pay 3.552 percent;

���� an employee whose base salary
or retirement allowance is $36,000 or more but less than $50,000 annually shall
pay 3.875 percent;

���� an employee whose base salary
or retirement allowance is $50,000 or more but less than $55,000 annually shall
pay 5.49 percent;

���� an employee whose base salary
or retirement allowance is $55,000 or more but less than $60,000 annually shall
pay 6.5 percent;

���� an employee whose base salary
or retirement allowance is $60,000 or more but less than $65,000 annually shall
pay 8.5 percent;

���� an employee whose base salary
or retirement allowance is $65,000 or more but less than $70,000 annually shall
pay 9.25 percent;

���� an employee whose base salary
or retirement allowance is $70,000 or more but less than $75,000 annually shall
pay 10.95 percent;

���� an employee whose base salary
or retirement allowance is $75,000 or more but less than $80,000 annually shall
pay $8,950;

���� an employee whose base salary
or retirement allowance is $80,000 or more but less than $85,000 annually shall
pay $9,400;

���� an employee whose base salary
or retirement allowance is $85,000 or more but less than $100,000 annually
shall pay $10,975;
and

���� an employee whose base salary
or retirement allowance is $100,000 or more annually shall pay
$12,000.

���� (c) For family coverage or its
equivalent �

���� an employee whose base salary
or retirement allowance is $20,000 or more but less than $26,000 annually shall
pay 2.584 percent;

���� an employee whose base salary
or retirement allowance is $26,000 or more but less than $30,000 annually shall
pay 2.906 percent;

���� an employee whose base salary
or retirement allowance is $30,000 or more but less than $35,000 annually shall
pay 3.229 percent;

���� an employee whose base salary
or retirement allowance is $35,000 or more but less than $45,000 annually shall
pay 3.875 percent;

���� an employee whose base salary
or retirement allowance is $45,000 or more but less than $50,000 annually shall
pay 4.52 percent;

���� an employee whose base salary
or retirement allowance is $50,000 or more but less than $55,000 annually shall
pay 5.813 percent;

���� an employee whose base salary
or retirement allowance is $55,000 or more but less than $60,000 annually shall
pay 6.548 percent;

���� an employee whose base salary
or retirement allowance is $60,000 or more but less than $65,000 annually shall
pay 7.75 percent;

���� an employee whose base salary
or retirement allowance is $65,000 or more but less than $70,000 annually shall
pay 8.395 percent;

���� an employee whose base salary
or retirement allowance is $70,000 or more but less than $85,000 annually shall
pay
12.75
percent;

���� an employee whose base salary
or retirement allowance is $85,000 or more but less than $100,000 annually
shall pay 13.0 percent;

���� an employee whose base salary
or retirement allowance is $100,000 or more but less than $110,000 annually
shall pay $14,975;
and

���� an employee whose base salary
or retirement allowance is $110,000 or more annually shall pay $17,500.

���� (d) For parent and child
coverage or its equivalent �

���� an employee whose base salary
or retirement allowance is $20,000 or more but less than $30,000 annually shall
pay 2.584 percent;

���� an employee whose base salary
or retirement allowance is $30,000 or more but less than $36,000 annually shall
pay 3.552 percent;

���� an employee whose base salary
or retirement allowance is $36,000 or more but less than $45,000 annually shall
pay 3.875 percent;

���� an employee whose base salary
or retirement allowance is $45,000 or more but less than $50,000 annually shall
pay 4.199 percent;

���� an employee whose base salary
or retirement allowance is $50,000 or more but less than $60,000 annually shall
pay 5.813 percent;

���� an employee whose base salary
or retirement allowance is $60,000 or more but less than $65,000 annually shall
pay 8.5 percent;

���� an employee whose base salary
or retirement allowance is $65,000 or more but less than $70,000 annually shall
pay 9.25 percent;

���� an employee whose base salary
or retirement allowance is $70,000 or more but less than $75,000 annually shall
pay 10.25 percent;

���� an employee whose base salary
or retirement allowance is $75,000 or more but less than $80,000 annually shall
pay $7,850;

���� an employee whose base salary
or retirement allowance is $80,000 or more but less than $85,000 annually shall
pay $8,250;

���� an employee whose base salary
or retirement allowance is $85,000 or more but less than $100,000 annually
shall pay $8,475;
and

���� an employee whose base salary
or retirement allowance is $100,000 or more annually shall pay

$10,750.

���� (2) An employee enrolled in
the SHBP Unity 2019 PPO plan shall be required to pay only the contribution
specified in this subsection, notwithstanding any other provision of law, rule,
or regulation to the contrary requiring contributions by employees toward the
cost of health care benefits coverage under the program.� No other contribution
may be required by collective negotiations agreement, unless the parties to a
collective negotiations agreement agree to negotiate different contributions
than are specified in this subsection.

���� (3) Only those retirees who
are not Medicare-eligible and who are required by another provision of law to
contribute in retirement toward the cost of health care coverage under the
State Health Benefits Program shall be required to pay the contribution specified
in this subsection.

���� A retiree who is not
Medicare-eligible, who is enrolled in the SHBP Unity 2019 PPO plan, and who is
required by another provision of law to contribute in retirement toward the
cost of health care coverage under the program shall be required to pay only the
contribution specified in this subsection, notwithstanding the provisions of
section 77 of P.L.2011, c.78 (C.52:14-17.28e) to the contrary requiring
contributions by retirees toward the cost of health care benefits coverage
under the program.

���� (4) For an employee, the
annual base salary paid by the employer for the position held by the employee
shall be used to identify the percentage to be used to calculate the annual
contribution required under this subsection.� For a retiree who is not Medicare-eligible,
the annual retirement allowance, including any cost of living adjustments to
that allowance, received by the retiree shall be used to identify the
percentage to be used to calculate the annual contribution required under this
subsection.

���� (5) The annual contribution by
an employee or a retiree who is not Medicare-eligible as calculated in
accordance with this subsection shall not exceed the amount as calculated in
accordance with section 5 of P.L.1961, c.49 (C.52:14-17.29).

���� (6) The contributions required
by this subsection shall apply to employees for whom the employer has assumed a
health care benefits payment obligation, to require that such employees pay the
amount of contribution specified in this subsection for health care benefits
coverage.� The contributions required by this subsection shall apply to
retirees for whom a local government employer has assumed a health care
benefits payment obligation but who are required by law to contribute toward
the cost of health care benefits coverage under the program, to require that
such retirees pay the amount of contribution specified in this subsection for
health care benefits coverage.

���� (7) For the plan year that
commences next following the date of enactment of P.L.��� , c.���� (C.������� )
(pending before the Legislature as this bill) and for each plan year
thereafter, the contributions required pursuant to this subsection may be
modified through collective negotiations agreements entered into between the
employers who participate in the State Health Benefits Program and their
employees.� The contributions required pursuant to this subsection shall become
part of the parties' collective negotiations agreement and shall then be
subject to collective negotiations in a manner similar to other negotiable
items between the parties.� Negotiations concerning contributions for health
care benefits shall be conducted as if the contributions required pursuant to
this subsection were included in the prior contract.� The contribution
calculation based on the percentage of base salary set forth in this subsection
may be modified or a new method of contribution calculation other than a
percentage of salary may be provided for in accordance with a collective
negotiations agreement, provided that the parties to the collective
negotiations agreement agree on the new or modified method of contribution
calculation.

���� e.� Prior to the first day of
January next following the date of enactment of P.L.��� , c.���� (C.������� )
(pending before the Legislature as this bill), the program, through the
Division of Pensions and Benefits in the Department of the Treasury, shall
provide for an enrollment period during which all employees who commenced
employment prior to the effective date of P.L.��� , c.���� (C.������� )
(pending before the Legislature as this bill) shall be required to
affirmatively select one of the plans specified in subsection b. of this
section.� If an employee fails to affirmatively select a plan during this
enrollment period, the program shall enroll the employee, and the employee�s
dependents, if any, in the SHBP Unity 2019 PPO plan for the plan year beginning
on the first day of January next following the effective date of P.L.��� ,
c.���� (C.������� ) (pending before the Legislature as this bill).

���� During the enrollment period,
any person who is enrolled in a plan offered by the program and who is paying
the full cost of health care benefits coverage shall also be required to
affirmatively select one of the plans specified in subsection b. of this section.�
If a person fails to affirmatively select a plan during this enrollment period,
the program shall enroll the person, and the person�s dependents, if any, in
the SHBP Unity 2019 PPO plan for the plan year beginning on the first day of
January next following the effective date of P.L.��� , c.���� (C.������� )
(pending before the Legislature as this bill).

���� f.� (1) Beginning on the first
day of January next following the date of enactment of P.L.��� , c.����
(C.������� ) (pending before the Legislature as this bill), an employee
commencing employment on or after the effective date P.L.��� , c.���� (C.�������
) (pending before the Legislature as this bill) who does not waive coverage
shall be required to affirmatively select one of the plans specified in
subsection b. of this section.� If the employee fails to affirmatively select a
plan during this enrollment period, the program shall enroll the employee, and
the employee�s dependents, if any, in the SHBP Unity 2019 PPO plan for the plan
year beginning on the first day of January next following the effective date of
P.L.��� , c.���� (C.������� ) (pending before the Legislature as this bill).

���� The employee shall remain
enrolled in the plan selected by the employee at the annual open enrollment for
each plan year, provided that the employee during this period may waive
coverage as an employee and select and change the type of coverage received under
the plan following a qualifying life event, in accordance with the program
regulations.

���� (2) For the plan year
beginning on the first day of January next following the date of enactment of
P.L.��� , c.���� (C.������� ) (pending before the Legislature as this bill), a
retiree who is not Medicare-eligible, shall be required to affirmatively select
one of the plans specified in subsection b. of this section.� If the retiree
fails to affirmatively select a plan during this enrollment period, the program
shall enroll the retiree, and the retiree�s dependents, if any, in the SHBP
Unity 2019 PPO plan for the plan year beginning on the first day of January
next following the effective date of P.L. , c. (C. )
(pending before the Legislature as this bill) as a retiree, if the retiree does
not waive coverage.� The retiree shall remain enrolled in that plan for each
plan year until the retiree becomes eligible for Medicare.� The retiree who
becomes eligible for Medicare shall no longer be eligible for enrollment in the
plan, except that any dependent of the retiree who is not eligible for Medicare
may remain eligible for coverage.

���� (3) Except as otherwise
provided in this subsection or subsection e. of this section, selection of a
plan shall be at the sole discretion of the employee or retiree who is not
Medicare-eligible.

���� g.� Parties to a collective
negotiations agreement shall be permitted to enter into binding agreements to
provide employees with access to health care reimbursement arrangements, health
care savings accounts, and flexible spending accounts to the full extent
permitted by federal law including statutes, regulations, and policy guidance
of the Internal Revenue Service.

���� h.� (1) Notwithstanding the
provisions of this section, or any other law, rule, or regulation to the
contrary, for each plan year, the State Health Benefits Commission shall
annually track and calculate the actual premium costs of each plan offered,
inclusive of medical and prescription drug costs, following each plan�s initial
offering after the effective date of this act, P.L.��� , c.��� (C.������� )
(pending before the Legislature as this bill).� In addition, the commission
shall compare such costs to trends of health care costs at the national,
regional, and State levels.� After the commission�s review of any mid-year
report the commission shall meet annually between March 1 and April 15 to
discuss actual and projected utilization and costs for plans in which active
and retiree members are enrolled.� Such meeting may also include
representatives from the New Jersey Division of Pensions and Benefits.� Any
cost sharing of any increases or decreases in the premium costs of the health
plans offered in each plan year shall be subject to adjustment, pursuant to the
escalator and de-escalator provisions provided in this section.

���� (2) As used in this section:

���� �Baseline premium� means the
blended premium for the current plan year plus one percent.

���� �Blended premium� means and
includes the premiums for medical and prescription drug rates for all levels of
coverage.

���� "Consumer Price
Index" means the Consumer Price Index for All Urban Consumers, New
York-Northern New Jersey-Long Island Metropolitan Area, All Items
(1982-84=100), as published by the Bureau of Labor Statistics in the United
States Department of Labor.

���� (3) Every year prior to the
renewal of each plan, the commission shall determine whether the blended
premium of a plan in a plan year exceeds the baseline premium.� If so, the
commission shall determine how to manage the plan to lower the premium, reduce
the rate of premium increases, or both.� If the commission cannot agree upon
plan design changes or other cost saving measures that would reduce the
actuary�s recommendations for premiums for the upcoming plan year to the
preliminary baseline premium by the September 1 preceding the start of the next
plan year, then an escalator shall be applied to employee contribution rates,
pursuant to paragraph (4) of this subsection.

���� (4) If the renewal premium is
six percent or more above the preliminary baseline premium, the escalator to be
applied to employee contribution rates shall be equal to the rate of inflation
as determined by the Consumer Price Index.� Any increase in employee
contributions shall be effective the first pay period of the new plan year.

���� (5) If the renewal premium is
six percent or more below the preliminary baseline premium, the commission
shall determine how to manage the plan to share the savings in reduced costs or
to improve the quality of the plan through design changes or other measures.�
If the commission cannot agree to either reduce costs or improve the quality of
the plan, or agree upon a reduction in the employee contribution rates by
September 1 preceding the start of the plan year, then contribution rates shall
be reduced by the application of a de-escalator.� The de-escalator shall be the
amount of the decrease in the renewal premium. Any decrease in employee
contributions shall be effective the first pay period of the new plan year.

���� (6) The commission�s actions
undertaken pursuant to paragraphs (3), (4), and (5) of this subsection shall
not be subject to the dispute resolution procedures set forth in subsection b.
of section 55 of P.L.2011, c.78 (C.52:14-17.27b).

�����
5.�
(New section) a.� Within 180 days following the enactment of P.L.��� , c.����
(C.������� ) (pending before the Legislature as this bill), when a public
employer other than the State does not participate in the State Health Benefits
Program
, if the public employer does not offer
a plan substantially similar in design to the SHBP Unity 2019 PPO Plan

and its employees are enrolled in medical and prescription drug plans with
higher annual premiums than the SHBP Unity 2019 PPO plan, upon request of the
collective negotiations representative who represents those employees, the
public employer other than the State and the collective negotiations
representative shall negotiate over offering employees a health care plan
substantially similar in design to the SHBP 2019 Unity PPO at substantially
similar contribution rates
and annual premiums
,
offering employees incentives to select plans with lower costs, or, in the
alternative, enrolling in the State Health Benefits Program.� Modifications to
the health benefit provisions of collective negotiations agreements or to
health benefit plans, including prescription drug plans, offered to employees,
shall only be by mutual agreement between the collective negotiations
representative and the local employer.� Upon request of the parties, the Public
Employment Relations Commission shall assign a mediator to assist in the
resolution of a dispute.� If mediation is unsuccessful and the parties are
unable to reach a mutual agreement, there shall be no changes to health benefits
provided pursuant to a collective negotiations agreement, practice, or policy.

���� b.� Notwithstanding any law,
rule, or regulation to the contrary, local government entities that do not
participate in the State Health Benefits Program shall be permitted to provide
employees with access to health care reimbursement arrangements, health care
savings accounts, and flexible spending accounts pursuant to collective
negotiations agreements to offset Internal Revenue Service eligible employee
out-of-pocket costs related to eligible medical and prescription drug services,
to the full extent permitted by federal law including statutes, regulations,
and policy guidance of the Internal Revenue Service.�

���� c.� The provisions of P.L.���
, c.���� (C.������� ) (pending before the Legislature as this bill) shall not
be construed to interfere with or require changes to the health plans offered
by a public employer other than the State that does not participate in the
State Health Benefits Program.

���� 6.� (New section) Notwithstanding
the provisions of any other law, rule, or regulation to the contrary, within
one year from the effective date of P.L.��� , c.���� (C.������� ) (pending
before the Legislature as this bill), any employer other than the State shall
be required to make a determination as to whether to participate in the State
Health Benefits Program.� Any employer other than the State which elects to
participate in the State Health Benefits Program shall be required to remain
enrolled in the program for a minimum period of two consecutive plan years
following the election to participate in the program.� Any employer other than
the State that elects not to participate in the State health Benefits Program
shall be prohibited from enrolling in the program for a minimum of two
consecutive plan years.

���� 7.� This act shall take effect
immediately.

STATEMENT

���� This bill makes various
changes to the State Health Benefits Program (SHBP).

State Health Benefits Commission

���� The bill revises the structure
of the State Health Benefits Commission (SHBC) to include 11 members as
follows:

���� (1) the State Treasurer; the
Commissioner of Banking and Insurance; the Chairperson of the Civil Service
Commission, or their designees, who will serve ex officio;

���� (2) two members appointed by
the Governor;

���� (3) a member appointed by the
Public Employee Committee of the New Jersey AFL-CIO who is a member of the
public employee organization affiliated with the New Jersey AFL-CIO with the
largest number of employees participating in the State Health Benefits Program;

���� (4) a member appointed by the
Public Employee Committee of the New Jersey AFL-CIO who is a member of the
public employee organization affiliated with the New Jersey AFL-CIO with the
second largest number of employees participating in the State Health Benefits
Program;

���� (5) a member appointed by the
Public Employee Committee of the New Jersey AFL-CIO who is a member of the
public employee organization affiliated with the New Jersey AFL-CIO with the
public employee organization with the third largest number of employees participating
in the State Health Benefits Program;

���� (6) a member appointed by the
public employee organization that is not affiliated with the New Jersey
AFL-CIO, that represents the largest number of employees in the State Health
Benefits Program who are not represented by an employee organization affiliated
with the New Jersey AFL-CIO;

���� (7) a member appointed by the
public employee organization that is not affiliated with the New Jersey
AFL-CIO, that represents the second largest number of employees in the State
Health Benefits Program who are not represented by an employee organization
affiliated with the New Jersey AFL-CIO; and

���� (8) a member, who will serve
as chairperson, appointed by the Governor from among three persons nominated
jointly by at least eight of the members appointed.

���� The bill specifies that the
SHBC will establish the health benefits program and, with respect to plan
design, the SHBC will have responsibility for, and authority over, the various
health care benefits plans and components of those plans, including medical
benefits, prescription drug benefits, dental, vision, and any other health
benefits, offered and administered by the SHBP and will have the authority to
create, modify, or terminate any plan or component of any health care benefits
plan, at its sole discretion.� The bill empowers the SHBC to obtain certain
information necessary to make informed decisions and to enter into contracts
with third-party administrators and consultants.

���� The SHBC will also be required
to follow the advice and guidance of the program actuary when developing plan
designs for the health plans provided by the program.� Whenever the program
actuary advises that the anticipated costs of one or more of the plans under
the program is likely to exceed the rate of medical or prescription drug
inflation for a given plan year, as determined by the program actuary based
upon relevant indices and information, the commission will be required to take
such actions as may be necessary to appropriately mange such costs and ensure
the continued viability of the program, subject to established processes
including, but not limited to, collective negotiations agreements.

Actuarial Report

���� Additionally, the bill, requires
that within 180 calendar days after the effective date of the bill, the State�s
actuary for the SHBP will issue an actuarial report concerning the SHBP health
plans.� The report must include the State and public entities other than the
State that participate and do not participate in the State Health Benefits
Program, inclusive of retirees who are not Medicare-eligible paid for by the
State.� The report must make recommendations addressing the cost of higher
priced medications, including, but not limited to, glucagon-like peptide-1
drugs utilized for diabetes, weight loss, and cardiovascular disease.� Within 90
calendar days of the commission�s receipt of the actuary�s report and
recommendations regarding higher priced medications, including glucagon-like
peptide-1 drugs, the commission will undertake actions and plan modifications
as may be necessary to appropriately manage the cost of higher priced
medications.

���� The bill requires the
commission to review and consider any prescription medications that have been
newly approved by the federal Food and Drug Administration on a quarterly basis
and must review such information when considering updates to the prescription
drug formularies for each of the plans in the SHBP and those described in the
bill.� The bill provides that prescription medications newly approved by the
Food and Drug Administration will only be included on the prescription drug
formularies of the SHBP health plans based on a majority vote of commission
members.

Plan Design Committee and
Arbitration Process

���� This bill eliminates the SHBP
Plan Design Committee and transfers the powers and functions of the Plan Design
Committee to the newly organized SHBC.� With the elimination of the SHBP Plan
Design Committee, the bill ends the use of a super conciliator by the SHBP to
resolve deadlocked matters before the SHBP Plan Design Committee.� Instead, the
bill requires all decisions before the commission to be resolved within 30 days
from the date such decisions are placed before the commission.� After the 30
day period, if a decision on a matter before the commission is not reached, or
if the commission remains at an impasse, the commission will select a neutral
third-party arbitrator with subject matter expertise who will attempt to assist
the commission in reaching a voluntary resolution on the matter.

���� The bill requires the
arbitrator to promptly schedule investigatory proceedings to investigate and
acquire all relevant information regarding the committee�s failure to render a
decision; discuss with the members of the committee their differences, and utilize
means and mechanisms, including but not limited to requiring 24-hour per day
negotiations, until a voluntary settlement is reached, and provide
recommendations to resolve the members� differences; and institute any other
non-binding procedures deemed appropriate by the arbitrator.� If the actions
taken by the arbitrator fail to resolve the dispute after 30 days, the
arbitrator will issue a final binding decision, which will be provided to the
commission promptly and made available to the public within 10 days thereafter.

Medical Claims Review

���� This bill also requires SHBC
to require that the third-party medical claims reviewer will utilize
appropriate data analytics to determine the most effective methodology for
conducting annual reviews of in-network claims and out-of-network claims, as
must be determined through the utilization of appropriate methods of data
analytics, to ensure that the SHBP is being properly charged for in-network and
out-of-network provider services.� The claims review program will utilize data
analytics to determine the most effective approach for reviewing claims
reimbursed to providers located in New York and Pennsylvania, with a focus on
claims resulting from higher cost services, including, but not limited to,
services provided by specialty physicians.� The State Treasurer is required to
adopt, pursuant to the �Administrative Procedure Act,� such rules and
regulations as may be necessary to implement the provisions of this section.�
The regulations must specify any additional quantitative and qualitative
criteria that will apply to the claims review requirements established by this
section.

SHBP-Local Plans

���� The bill requires that the
SHBP offer five plans that provide medical and prescription drug benefits for
local government employees of employers other than the State that participate
in the SHBP and retirees who are not Medicare-eligible, and their dependents,
if any.� However, under the bill, these provisions will not increase the
contribution rates of employees who had 20 or more years of creditable service
in one or more State or locally-administered retirement systems on the
effective date of section 77 of P.L.2011, c.78 (C.52:14-17.28e). Under the
bill, this section will not apply to State colleges or universities, Rutgers,
The State University, New Jersey Institute of Technology, Rowan University,
Montclair State University, Kean University and any other State college or
university now or hereafter established or authorized by law, or to University
Hospital.

���� The five plans will be:

���� (1) the SHBP Unity 2019 PPO
plan as offered by the State Health Benefits Commission effective July 1, 2019,
except that the commission and employers other than the State will require
employee contribution rates as set forth in the bill which will be the default
plan for employees and retirees who fail to affirmatively select a plan during
the open enrollment period;

���� (2) the SHBP Tiered Network
plan as offered by the State Health Benefits Commission as of the effective
date of this bill, except that the commission and employers other than the
State will require employee contribution rates to equate to 75 percent of the
rates paid by employees of employers other than the State enrolled in the SHBP
Unity 2019 PPO plan pursuant to the bill;

���� (3) the SHBP PPO 2030 plan as
offered by the State Health Benefits Commission as of the effective date of
this bill;

���� (4) the SHBP PPO 2035 plan
offered by the State Health Benefits Commission as of the effective date this
bill; and

���� (5) the NJ Gold plan.

���� The NJ Gold plan will be
developed by the SHBC in a manner which does not require employee contributions
in the form of withholding from the employee�s base salary, or the retirement
allowance of retirees.� The NJ Gold plan will provide benefits that are
actuarially equivalent to 80 percent of the full actuarial value of the
benefits provided under the plan.

���� The bill provides for the
escalation or de-escalation of employee contribution rates depending on the
anticipated increase or decrease in premium costs, as applicable. The bill
directs the State Health Benefits Commission to annually track and calculate
the actual premium costs of each plan offered, inclusive of medical and
prescription drug costs, following each plan�s initial offering after the
effective date of the bill, and to compare such costs to trends of health care
costs at the national, regional, and State levels.� After the commission�s
review of any mid-year report the commission will meet annually between March 1
and April 15 to discuss actual and projected utilization and costs for plans in
which active and retiree members are enrolled.� Such meeting may also include
representatives from the New Jersey Division of Pensions and Benefits.� Any
cost sharing of any increases or decreases in the premium costs of the health
plans offered in each plan year will be subject to adjustment, pursuant to the
escalator and de-escalator provisions provided in the bill.

���� Under the bill, every year
prior to the renewal of each plan, the commission will determine whether the
blended premium, defined in the bill as the premiums for medical and
prescription drug rates for all levels of coverage, of a plan in a plan year
exceeds the baseline premium, defined in the bill as the blended premium for
the current plan year plus one percent. If so, the commission will determine
how to manage the plan to lower the premium, reduce the rate of premium
increases, or both.� If the commission cannot agree upon plan design changes or
other cost saving measures that would reduce the actuary�s recommendations for
premiums for the upcoming plan year to the preliminary baseline premium by the
September 1 preceding the start of the next plan year, then an escalator will
be applied to employee contribution rates.

���� If the renewal premium is six
percent or more above the preliminary baseline premium, the escalator to be
applied to employee contribution rates will be equal to the rate of inflation
as determined by the Consumer Price Index.� Any increase in employee contributions
will be effective the first pay period of the new plan year.

���� If the renewal premium is six
percent or more below the preliminary baseline premium, the commission will
determine how to manage the plan to share the savings in reduced costs or to
improve the quality of the plan through design changes or other measures.� If
the commission cannot agree to either reduce costs or improve the quality of
the plan, or agree upon a reduction in the employee contribution rates by
September 1 preceding the start of the plan year, then contribution rates will
be reduced by the application of a de-escalator.� The de-escalator will be the
amount of the decrease in the renewal premium. Any decrease in employee
contributions will be effective the first pay period of the new plan year.

���� The commission�s actions
undertaken pursuant to the escalator and de-escalator provisions will not be
subject to the commission�s dispute resolution procedures.

Non-SHBP-Local Employers

���� The bill also requires that
within 180 days following the enactment this bill, when a public employer other
than the State does not participate in the SHBP, if the public employer does
not offer a plan substantially similar in design to the SHBP Unity 2019 PPO
Plan and its employees are enrolled in medical and prescription drug plans
substantially similar in design to the SHBP Unity 2019 PPO plan but with higher
annual premiums than the SHBP Unity 2019 PPO plan, upon request of the
collective negotiations representative who represents those employees, the
public employer other than the State and the collective negotiations
representative will negotiate over offering employees a health care plan
substantially similar in design to the 2019 Unity PPO at substantially similar
contribution rates and annual premiums, offering employees incentives to select
plans with lower costs, or, in the alternative, enrolling in the SHBP.�
Modifications to the health benefit provisions of collective negotiations
agreements or to health benefit plans, including prescription drug plans,
offered to employees, will only be by mutual agreement between the collective
negotiations representative and the local employer.� Upon request of the
parties, the Public Employment Relations Commission will assign a mediator to
assist in the resolution of a dispute.� If mediation is unsuccessful and the
parties are unable to reach a mutual agreement, there will be no changes to
health benefits provided pursuant to a collective negotiations agreement, practice,
or policy.

���� The bill clarifies that local
government entities that do not participate in the SHBP will be permitted to
utilize health reimbursement arrangements pursuant to collective negotiations
agreements to offset IRS eligible employee out-of-pocket costs related to eligible
medical and prescription drug services.� The bill also specifies that its
provisions will not be construed to interfere with or require changes to the
health plans offered by a public employer other than the State that does not
participate in the State Health Benefits Program.

Local Participation in SHBP

���� The bill also requires that,
within one year from the effective date of this bill, any employer other than
the State will be required to make a determination as to whether or not to
participate in the SHBP.� Any employer other than the State which elects to
participate in the SHBP will be required to remain enrolled in the program for
a minimum period of two consecutive plan years following the election to
participate in the program.� Any employer other than the State that elects not
to participate in the SHBP will be prohibited from enrolling in the program for
a minimum of two consecutive plan years.