"Property Tax Relief Act"; makes various changes to SHBP and SEHBP administration and limits reimbursement for certain medical procedures.

A5086

ASSEMBLY, No. 5086

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED MAY 14, 2026

Sponsored by:

Assemblyman� ANDREW MACURDY

District 21 (Middlesex, Morris, Somerset and Union)

SYNOPSIS

���� �Property Tax Relief Act�; makes various changes to
SHBP and SEHBP administration and limits reimbursement for certain medical
procedures.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act
concerning plan administration and reimbursement for
certain procedures covered under the State Health Benefits Program and the
School Employees� Health Benefits Program, amending and supplementing various
parts of the statutory law
, and repealing section 55 of P.L.2011, c.78
.

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

���� 1.� This act shall be known
and may be cited as the �Property Tax Relief Act.�

���� 2.��� (New Section)� a.�
Notwithstanding any law, rule, or regulation to the contrary, on or after the
effective date of P.L.��� , c.���� (pending before the Legislature as this
bill), any contract purchased or renewed by the State Health Benefits
Commission, or its designee, pursuant to section 4 of P.L.1961, c.49 (C.52:14-17.28),
shall limit reimbursement for knee replacements, hip replacements, magnetic
resonance imaging (MRI) scans, computed tomography (CT) scans, colonoscopies,
cataracts, arthroscopy, and diagnostic lab tests performed in an inpatient or
outpatient hospital setting to the lesser of the contract price, the billed
price, or the reference price as defined under subsection f. of this section.

���� b.� A carrier, hospital, or
State-managed care plan shall not collect any money from a covered employee,
retiree, dependent thereof, or the State Health Benefits Program in excess of
the amount determined in accordance with subsection a. of this section for the
listed procedures.

���� c.� (1) The provisions of this
section shall not apply when a procedure listed under subsection a. of this
section is performed in:

���� (a) a rural hospital that is
certified by the U.S. Centers for Medicare and Medicaid Services as a sole
community hospital, as defined in 42 U.S.C. s.1395ww(d)(5)(D)(iii);

���� (b) a critical access hospital
that is certified by the U.S. Centers for Medicare and Medicaid Services, as
defined in 42 U.S.C. s.1395x(mm)(1); or

���� (c) a hospital with a monitor
appointed by the New Jersey Department of Health pursuant to subsection c. of
section 2 of P.L.2008, c.58 (C.26:2H-5.1a).

���� (2) The provisions of this
section shall not apply when a procedure listed under subsection a. of this
section is performed in an emergency.

���� d. �The provisions of this
section shall not be construed to require a health benefits plan offered by the
State Health Benefits Program to provide reimbursement for claims using a
fee-for-service payment method.

���� e.� Not later than two years
after the effective date of P.L.��� , c.����� (pending before the Legislature
as this bill), the Department of the Treasury shall evaluate the list of
procedures specified in subsection a. of this section.� The evaluation shall
assess the amount of money the program has saved on those procedures and
recommend changes to the list of procedures for consideration by the
Legislature.

���� f.� As used in this section,
�reference price� means 165 percent of the amount paid by Medicare for the same
or a similar procedure for in-network providers and 150 percent for
out-of-network providers.

���� 3.��� (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.����� (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 upon the conclusion of that
year shall be required to remain enrolled in the program for a period of three
consecutive plan years.� Any employer other than the State that elects to leave
the program upon the conclusion of that year shall be prohibited from
reenrolling in the program for three consecutive plan years.� Any employer
other than the State that is not enrolled in the program and does not elect to
participate within that year shall be permitted to join at any time, but shall
be required to remain enrolled in the program for three consecutive plan years
following new enrollment.

�����
4.�
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 members: the State
Treasurer; the Commissioner of Banking and Insurance; the Chairperson of the
Civil Service Commission; 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.

����� 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.

����� 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
]

commission

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
]

commission

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.
]

�
On or after the effective date of P.L.��� , c.���� (pending before the
Legislature as this bill), any reference in law to the State Health Benefits
Program Plan Design Committee shall be deemed to apply to the commission.

�����
[
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.
]

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

���� 5.� Section 5 of P.L.1961, c.49
(C.52:14-17.29) is amended to read as follows:

���� 5.� (A)� The contract or
contracts purchased by the commission pursuant to subsection b. of section 4 of
P.L.1961, c.49 (C.52:14-17.28) shall provide separate coverages or policies as
follows:

���� (1)�� Basic benefits which
shall include:

���� (a)�� Hospital benefits,
including outpatient;

���� (b)�� Surgical benefits;

���� (c)�� Inpatient medical
benefits;

���� (d)�� Obstetrical benefits;
and

���� (e)�� Services rendered by an
extended care facility or by a home health agency and for specified medical
care visits by a physician during an eligible period of such services, without
regard to whether the patient has been hospitalized, to the extent and subject
to the conditions and limitations agreed to by the commission and the carrier
or carriers.

���� Basic benefits shall be
substantially equivalent to those available on a group remittance basis to
employees of the State and their dependents under the subscription contracts of
the New Jersey "Blue Cross" and "Blue Shield" Plans. Such
basic benefits shall include benefits for:

���� (i)��� Additional days of
inpatient medical service;

���� (ii)�� Surgery elsewhere than
in a hospital;

���� (iii) X-ray, radioactive
isotope therapy and pathology services;

���� (iv)� Physical therapy
services;

���� (v)�� Radium or radon therapy
services;

and the extended basic benefits
shall be subject to the same conditions and limitations, applicable to such
benefits, as are set forth in "Extended Outpatient Hospital Benefits
Rider," Form 1500, 71(9-66), and in "Extended Benefit Rider" (as
amended), Form MS 7050J(9-66) issued by the New Jersey "Blue Cross"
and "Blue Shield" Plans, respectively, and as the same may be amended
or superseded, subject to filing by the Commissioner of Banking and Insurance;
and

���� (2)�� Major medical expense
benefits which shall provide benefit payments for reasonable and necessary
eligible medical expenses for hospitalization, surgery, medical treatment and
other related services and supplies to the extent they are not covered by basic
benefits. The commission may, by regulation, determine what types of services
and supplies shall be included as "eligible medical services" under
the major medical expense benefits coverage as well as those which shall be
excluded from or limited under such coverage. Benefit payments for major
medical expense benefits shall be equal to a percentage of the reasonable
charges for eligible medical services incurred by a covered employee or an
employee's covered dependent, during a calendar year as exceed a deductible for
such calendar year of $100.00 subject to the maximums hereinafter provided and
to the other terms and conditions authorized by this act. The percentage shall
be 80 percent of the first $2,000.00 of charges for eligible medical services
incurred subsequent to satisfaction of the deductible and 100 percent
thereafter. There shall be a separate deductible for each calendar year for (a)
each enrolled employee and (b) all enrolled dependents of such employee. Not
more than $1,000,000.00 shall be paid for major medical expense benefits with
respect to any one person for the entire period of such person's coverage under
the plan, whether continuous or interrupted except that this maximum may be
reapplied to a covered person in amounts not to exceed $2,000.00 a year.
Maximums of $10,000.00 per calendar year and $20,000.00 for the entire period
of the person's coverage under the plan shall apply to eligible expenses
incurred because of mental illness or functional nervous disorders, and such
may be reapplied to a covered person, except as provided in P.L.1999, c.441
(C.52:14-17.29d et al.). The same provisions shall apply for retired employees
and their dependents. Under the conditions agreed upon by the commission and
the carriers as set forth in the contract, the deductible for a calendar year
may be satisfied in whole or in part by eligible charges incurred during the
last three months of the prior calendar year.

���� Any service determined by
regulation of the commission to be an "eligible medical service"
under the major medical expense benefits coverage which is performed by a duly
licensed practicing psychologist within the lawful scope of psychologist practice
shall be recognized for reimbursement under the same conditions as would apply
were such service performed by a physician.

���� (B)� The contract or contracts
purchased by the commission pursuant to subsection c. of section 4 of P.L.1961,
c.49 (C.52:14-17.28) shall include coverage for services and benefits that are
at a level that is equal to or exceeds the level of services and benefits set
forth in this subsection, provided that such services and benefits shall
include only those that are eligible medical services and not those deemed
experimental, investigative or otherwise not eligible medical services. The
determination of whether services or benefits are eligible medical services
shall be made by the commission consistent with the best interests of the State
and participating employers, employees, and dependents. The following list of
services is not intended to be exclusive or to require that any limits or
exclusions be exceeded.

���� Covered services shall
include:

���� (1)�� Physician services,
including:

���� (a)�� Inpatient services,
including:

���� (i)��� medical care including
consultations;

���� (ii)�� surgical services and
services related thereto; and

���� (iii) obstetrical services
including normal delivery, cesarean section, and abortion.

���� (b)�� Outpatient/out-of-hospital
services, including:

���� (i)��� office visits for
covered services and care;

���� (ii)�� allergy testing and
related diagnostic/therapy services;

���� (iii) dialysis center care;

���� (iv)� maternity care;

���� (v)�� well child care;

���� (vi)� child immunizations/lead
screening;

���� (vii) routine adult physicals
including pap, mammography, and prostate examinations; and

���� (viii) annual routine
obstetrical/gynecological exam.

���� (2)�� Hospital services, both
inpatient and outpatient, including:

���� (a)�� room and board;

���� (b)�� intensive care and other
required levels of care;

���� (c)�� semi-private room;

���� (d)�� therapy and diagnostic
services;

���� (e)�� surgical services or
facilities and treatment related thereto;

���� (f)�� nursing care;

���� (g)�� necessary supplies,
medicines, and equipment for care; and

���� (h)�� maternity care and
related services.

���� (3)�� Other facility and
services, including:

���� (a)�� approved treatment
centers for medical emergency/accidental injury;

���� (b)�� approved surgical
center;

���� (c)�� hospice;

���� (d)�� chemotherapy;

���� (e)�� diagnostic x-ray and lab
tests;

���� (f)�� ambulance;

���� (g)�� durable medical
equipment;

���� (h)�� prosthetic devices;

���� (i)��� foot orthotics;

���� (j)��� diabetic supplies and
education; and

���� (k)�� oxygen and oxygen
administration.

���� (4)�� All services for which
coverage is required pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.), as
amended and supplemented. Benefits under the contract or contracts purchased as
authorized by the State Health Benefits Program shall include those for mental
health services subject to limits and exclusions consistent with the provisions
of the New Jersey State Health Benefits Program Act.

���� (C)� The contract or contracts
purchased by the commission pursuant to subsection c. of section 4 of P.L.1961,
c.49 (C.52:14-17.28) shall include the following provisions regarding
reimbursements and payments:

���� (1)�� In the successor plan,
the co-payment for doctor's office visits shall be $10 per visit with a maximum
out-of-pocket of $400 per individual and $1,000 per family for in-network
services for each calendar year. The out-of-network deductible shall be $100 per
individual and $250 per family for each calendar year, and the participant
shall receive reimbursement for out-of-network charges at the rate of 80
percent of reasonable and customary charges, provided that the out-of-pocket
maximum shall not exceed $2,000 per individual and $5,000 per family for each
calendar year.

���� (2)�� In the State managed
care plan that is required to be included in a contract entered into pursuant
to subsection c. of section 4 of P.L.1961, c.49 (C.52:14-17.28), the co-payment
for doctor's office visits shall be $15 per visit. The participant shall receive
reimbursement for out-of-network charges at the rate of 70% of reasonable and
customary charges. The in-network and out-of-network limits, exclusions,
maximums, and deductibles shall be substantially equivalent to those in the NJ
PLUS plan in effect on June 30, 2007, with adjustments to that plan pursuant to
a binding collective negotiations agreement or pursuant to action by the
commission, in its sole discretion, to apply such adjustments to State
employees for whom there is no majority representative for collective
negotiations purposes.

���� (3)�� "Reasonable and
customary charges" means charges based upon the 90th percentile of the
usual, customary, and reasonable (UCR) fee schedule determined by the Health
Insurance Association of America or a similar nationally recognized database of
prevailing health care charges.

���� (D)� Benefits under the
contract or contracts purchased as authorized by this act may be subject to
such limitations, exclusions, or waiting periods as the commission finds to be
necessary or desirable to avoid inequity, unnecessary utilization, duplication
of services or benefits otherwise available, including coverage afforded under
the laws of the United States, such as the federal Medicare program, or for
other reasons.

���� Benefits under the contract or
contracts purchased as authorized by this act shall include those for the
treatment of alcohol use disorder where such treatment is prescribed by a
physician and shall also include treatment while confined in or as an outpatient
of a licensed hospital or residential treatment program which meets minimum
standards of care equivalent to those prescribed by the Joint Commission on
Hospital Accreditation. No benefits shall be provided beyond those stipulated
in the contracts held by the State Health Benefits Commission.

���� (E)� The rates charged for any
contract purchased under the authority of this act shall reasonably and
equitably reflect the cost of the benefits provided based on principles which
in the judgment of the commission are actuarially sound. The rates charged shall
be determined by the carrier on accepted group rating principles with due
regard to the experience, both past and contemplated, under the contract. The
commission shall have the right to particularize subgroups for experience
purposes and rates. No increase in rates shall be retroactive.

���� (F)�� The initial term of any
contract purchased by the commission under the authority of this act shall be
for such period to which the commission and the carrier may agree, but
permission may be made for automatic renewal in the absence of notice of
termination by the commission. Subsequent terms for which any contract may be
renewed as herein provided shall each be limited to a period not to exceed one
year.

���� (G)� A contract purchased by
the commission pursuant to subsection b. of section 4 of P.L.1961, c.49
(C.52:14-17.28) shall contain a provision that if basic benefits or major
medical expense benefits of an employee or of an eligible dependent under the
contract, after having been in effect for at least one month in the case of
basic benefits or at least three months in the case of major medical expense
benefits, is terminated, other than by voluntary cancellation of enrollment,
there shall be a 31-day period following the effective date of termination
during which such employee or dependent may exercise the option to convert,
without evidence of good health, to converted coverage issued by the carriers
on a direct payment basis. Such converted coverage shall include benefits of
the type classified as "basic benefits" or "major medical
expense benefits" in subsection (A) hereof and shall be equivalent to the
benefits which had been provided when the person was covered as an employee.
The provision shall further stipulate that the employee or dependent exercising
the option to convert shall pay the full periodic charges for the converted
coverage which shall be subject to such terms and conditions as are normally
prescribed by the carrier for this type of coverage.

���� (H)� The commission may
purchase a contract or contracts to provide drug prescription and other health
care benefits or authorize the purchase of a contract or contracts to provide
drug prescription and other health care benefits as may be required to implement
a duly executed collective negotiations agreement or as may be required to
implement a determination by a public employer to provide such benefit or
benefits to employees not included in collective negotiations units.

���� (I)�� The commission shall
take action as necessary, in cooperation with the School Employees' Health
Benefits Commission established pursuant to section 33 of P.L.2007, c.103
(C.52:14-17.46.3), to effectuate the purposes of the School Employees' Health
Benefits Program Act as provided in sections 31 through 41 of P.L.2007, c.103
(C.52:14-17.46.1 through C.52:14-17.46.11) and to enable the School Employees'
Health Benefits Commission to begin providing coverage to participants pursuant
to the School Employees' Health Benefits Program Act as of July 1, 2008.

���� (J)�� Beginning January 1,
2012, the State Health Benefits Plan Design Committee shall provide to
employees the option to select one of at least three levels of coverage each
for family, individual, individual and spouse, and individual and dependent, or
equivalent categories, for each plan offered by the program differentiated by
out of pocket costs to employees including co-payments and deductibles.�
Notwithstanding any other provision of law to the contrary, the committee shall
have the sole discretion to set the amounts for maximums, co-pays, deductibles,
and other such participant costs for all plans in the program.� The committee
shall also provide for a high deductible health plan that conforms with
Internal Revenue Code Section 223.�
�

���� There shall be appropriated
annually for each State fiscal year, through the annual appropriations act,
such amounts as shall be necessary as funding by the State as an employer, or
as otherwise required, with regard to employees or retirees who have enrolled
in a high deductible health plan that conforms with Internal Revenue Code
Section 223.

����
(K) Notwithstanding the
provisions of this section, or any other law, rule, or regulation to the
contrary, on or after the effective date of P.L.��� , c.����� (pending before
the Legislature as this bill), the commission, in consultation with the program
actuary, shall ensure that the actuarial value of any plan offered to employees
and non-Medicare eligible retirees shall not be less than 85 percent.�

(cf: P.L.2023, c.177, s.139)

���� 6.��� (New section)� a.�
Notwithstanding any law, rule, or regulation to the contrary, on or after the
effective date of P.L.��� , c.���� (pending before the Legislature as this
bill), any contract purchased or renewed by the School Employees� Health
Benefits Commission, or its designee, pursuant to section 35 of P.L.2007, c.103
(C.52:14-17.46.5), shall limit reimbursement for knee replacements, hip
replacements, magnetic resonance imaging (MRI) scans, computed tomography (CT)
scans, colonoscopies, cataracts, arthroscopy, and diagnostic lab tests
performed in an inpatient or outpatient hospital setting to the lesser of the
contract price, the billed price, or the reference price as defined under
subsection f. of this section.

b.� A carrier,
hospital, or State-managed care plan shall not collect any money from a covered
employee, retiree, dependent or the School Employees� Health Benefits Program
in excess of the amount determined in accordance with subsection a. of this
section for the listed procedures.

���� c.� (1) The provisions of this
section shall not apply when a procedure listed under subsection a. of this
section is performed in:

���� (a) a rural hospital that is
certified by the U.S. Centers for Medicare and Medicaid Services as a sole
community hospital, as defined in 42 U.S.C. s.1395ww(d)(5)(D)(iii);

���� (b) a critical access hospital
that is certified by the U.S. Centers for Medicare and Medicaid Services, as
defined in 42 U.S.C. s.1395x(mm)(1); or

���� (c) a hospital with a monitor
appointed by the New Jersey Department of Health pursuant to subsection c. of
section 2 of P.L.2008, c.58 (C.26:2H-5.1a).

���� (2) The provisions of this
section shall not apply when a procedure listed under subsection a. of this
section is performed in an emergency.

���� d. �The provisions of this
section shall not be construed to require a health benefits plan offered by the
School Employees� Health Benefits Program to provide reimbursement for claims
using a fee-for-service payment method.

���� e.� Not later than two years
after the effective date of P.L.��� , c.����� (pending before the Legislature
as this bill), the Department of the Treasury shall evaluate the list of
procedures specified in subsection a. of this section.� The evaluation shall
assess the amount of money the program has saved on those procedures and
recommend changes to the list of procedures for consideration by the
Legislature.

���� f.� As used in this section,
�reference price� means 165 percent of the amount paid by Medicare for the same
or a similar procedure for in-network providers and 150 percent for
out-of-network providers.

���� 7.��� (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.����� (pending before the
Legislature as this bill), any employer as that term is defined under section
32 of P.L.2007, c.103 (C.52:14-17.46.2) shall be required to make a
determination as to whether to participate in the School Employees� Health
Benefits Program.� Any employer which elects to participate in the School
Employees� Health Benefits Program upon the conclusion of that year shall be
required to remain enrolled in the program for three consecutive plan years.� Any
employer that elects to leave the program upon the conclusion of that year shall
be prohibited from reenrolling in the program for three consecutive plan years.�
Any employer that is not enrolled in the program and does not elect to
participate within that year shall be permitted to join at any time, but shall
be required to remain enrolled in the program for three consecutive plan years
following new enrollment.

�����
8.�
Section 33 of P.L.2007, c.103 (C.52:14-17.46.3) is amended to read as follows:

���� 33. a. There is hereby created
a School Employees' Health Benefits Commission, consisting of nine members:

���� (1)�� the State Treasurer and
the Commissioner of the Department of Banking and Insurance serving ex officio;

���� (2)�� a member appointed by
the Governor who is a New Jersey resident and is qualified by experience,
education, or training in the review, administration, or design of health
insurance plans for self-insured employers;

���� (3)�� a member appointed by
the Governor from among three persons nominated by the New Jersey School
Boards' Association, which member shall be qualified by experience, education,
or training in the review, administration, or design of health insurance plans
for self-insured employers;

���� (4)�� three members appointed
by the Governor from among five persons nominated by the New Jersey Education
Association, of whom two shall be qualified by experience, education, or
training in the review, administration, or design of health insurance plans for
self-insured employers;

���� (5)�� a member appointed by
the Governor from among three persons nominated by the education section of the
New Jersey State AFL-CIO, which member shall be qualified by experience,
education, or training in the review, administration, or design of health insurance
plans for self-insured employers; and

���� (6)�� a member appointed
pursuant to subsection b. of this section who shall be the chairperson.

���� b.��� The Governor shall
appoint the chairperson from among three persons nominated jointly by at least
six of the eight members appointed pursuant to subsection a. of this section.

���� c.���� If the Governor
declines to make an appointment from among the persons nominated for
membership, the Governor shall request that a new list of nominees be provided
in compliance with subsection a. of this section. If the Governor declines to
make an appointment from the new list, the process set forth in this subsection
shall be repeated until the Governor makes an appointment from a list of
nominees. Except with respect to the appointment of the chairperson, if a new
list of nominees is not submitted within 45 days of the Governor's request, the
Governor shall make the appointment without the need to select from any list of
nominees.

���� d.��� The initial terms of the
members of the commission shall be as follows:

���� (1)�� the member appointed
pursuant to paragraph (3) of subsection a. of this section and the two members
appointed pursuant to paragraph (4) of subsection a. of this section who are
required to be qualified by experience, education, or training shall serve for
a term of three years;

���� (2)�� the member appointed
pursuant to paragraph (2) of subsection a. of this section, the member
appointed pursuant to paragraph (4) of subsection a. of this section who is not
required to be qualified by experience, education, or training, and the member
appointed pursuant to paragraph (5) of subsection a. of this section shall
serve for a term of two years; and

���� (3)�� the chairperson shall
serve for a term of six years.

���� All subsequent terms shall be
for three years, except that the term of the chairperson shall be 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.

���� e.����
[
There is
established a School Employees' Health Benefits Plan Design Committee, composed
of six members as follows:�

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

���� two members who shall be
appointed by the New Jersey Education Association; and

���� one member who shall be
appointed by the education section of the New Jersey State AFL-CIO.

���� 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, two members shall
serve for two years and until a successor is appointed and qualified, and one
shall serve for one year and until a successor is appointed and qualified.� Of
the initial appointments by the New Jersey Education Association, one 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
]

commission

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
]

commission

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.
]
�
On or after the effective
date of P.L.��� , c.���� (pending before the Legislature as this bill), any
reference in law to the School Employees� Health Benefits Plan Design Committee
shall be deemed to apply to the commission.

����
[
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 four votes in the affirmative, the commission shall
approve and implement the committee's decision.

���� If any matter before the
committee receives three votes in the affirmative and three 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.
]

(cf: P.L.2011, c.78, s.46)

�����
9.�
Section 34 of P.L.2007, c.103 (C.52:14-17.46.4) is amended to read as follows:

���� 34.� The School Employees'
Health Benefits Program, authorized by sections 31 through 41 of P.L.2007,
c.103 (C.52:14-17.46.1 through C.52:14-17.46.11), shall be administered in the
Department of the Treasury. Administrative services required by the commission
shall be provided through the Division of Pensions and Benefits, and the
Director of the Division of Pensions and Benefits shall be the secretary of the
commission. The commission
[
and
the committee
]

shall establish a health benefits program for the school employees of the
State, the cost of which shall be paid as specified in this act. The commission
shall, by a majority vote of its full authorized membership, establish and
change rules and regulations as may be deemed reasonable and necessary for the
administration of this act by the commission
[
and
committee
]
.
Until such rules and regulations are established, the rules and regulations of
the State Health Benefits Commission shall be deemed to apply to the School
Employees' Health Benefits Program.

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

���� The members of the commission
[
and committee
]
shall serve
without compensation but shall be reimbursed for any necessary expenditure.

���� The commission shall ensure
that audits and reviews are performed as required by section 40 of P.L.2007,
c.103 (C.52:14-17.46.10). Actions of the commission related to such audits and
reviews shall require a majority vote of the full authorized membership of the
commission to be approved.

���� Except as otherwise specified
in this act, 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.

(cf: P.L.2011, c.78, s.36)

�����
10.�
Section 1 of P.L.2020, c.44 (C.52:14-17.46.13) is amended to read as follows:

���� 1.��� This section shall apply
to the School Employees' Health Benefits Program (SEHBP) and to those employers
defined pursuant to section 32 of P.L.2007, c.103 (C.52:14-17.46.2) that
participate in the program.

���� a. (1) Notwithstanding the
provisions of any other law, rule, or regulation to the contrary, beginning
with the plan year that commences January 1, 2021 and for each plan year
thereafter, the School Employees' Health Benefits Program shall offer only three
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 January 1, 2021 for employees, and retirees who are not
Medicare-eligible, and their dependents if any, shall be terminated.

���� The three plans shall be the
New Jersey Educators Health Plan as developed by the School Employees' Health
Benefits Plan Design Committee in accordance with subsection f. of this section
which sets forth the plan design of the New Jersey Educators Health Plan; the
SEHBP NJ Direct 10 plan as adopted and implemented by the School Employees'
Health Benefits Commission for the plan year that began January 1, 2020; and
the SEHBP NJ Direct 15 plan as adopted and implemented by the School Employees'
Health Benefits Commission for the plan year that began January 1, 2020.

���� Employers that participate in
the School Employees' 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.

���� (2)�� Only the plans set forth
in this section shall be offered by the program regardless of any collective
negotiations agreement between a participating employer and its employees in
effect on the effective date of this act, P.L.2020, c.44, that provides for
enrollment in other plans that were offered by the program prior to January 1,
2021.

���� b.��� Prior to January 1,
2021, 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 this act
shall be required to select affirmatively one of the three plans specified in
subsection a. of this section. If an employee fails to select affirmatively a
plan during this enrollment period, the program shall enroll the employee, and
the employee's dependents if any, in the New Jersey Educators Health Plan for
the plan year beginning January 1, 2021 and ending December 31, 2021.

���� 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 select
affirmatively one of the three plans specified in subsection a. of this
section. If a person fails to select affirmatively a plan during this
enrollment period, the program shall enroll the person, and the person's
dependents if any, in the New Jersey Educators Health Plan for the plan year
beginning January 1, 2021 and ending December 31, 2021. Any such person shall
continue to pay the full cost of coverage and shall not be subject to the
contribution schedule or any mandatory enrollment period as set forth in this
section.

���� c. (1) Beginning on January 1,
2021, an employee commencing employment on or after the effective date of this
act but before January 1, 2028 who does not waive coverage shall be enrolled by
the program, with the employee's dependents if any, in the New Jersey Educators
Health Plan, or the Garden State Health Plan if selected by the employee. The
employee shall remain enrolled in either the New Jersey Educators Health Plan
or the Garden State Health Plan selected by the employee at the annual open
enrollment for each plan year through the plan year that ends December 31,
2027, 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.

���� The enrollment required by
this paragraph shall not include an employee who commenced employment prior to
the effective date of P.L.2020, c.44 and who did not enroll, who waived
enrollment, or who was not eligible to enroll prior to that effective date for
health care coverage provided by the employer, including, but not limited to,
an employee who commenced employment as a part-time employee prior to the
effective date of P.L.2020, c.44.� If such an employee was required to enroll
prior to the effective date of P.L.2021, c.163 in accordance with this
paragraph, the employee shall be notified promptly in writing that enrollment
is not mandatory and shall be provided promptly with an opportunity to select
enrollment in another health care benefits plan. For the plan year beginning
January 1, 2028, the employee may select, during any open enrollment period or
at such other times or under such conditions as the program may provide, any
plan offered by the program.

���� (2)�� For the plan year
beginning January 1, 2021, the program shall enroll a retiree who is not
Medicare-eligible, and the retiree's dependents if any, in the New Jersey
Educators Health Plan for health care benefits coverage as a retiree, if the
retiree does not waive coverage. The retiree shall remain enrolled in that plan
for each plan year through the plan year that ends December 31, 2027 or until
the retiree becomes eligible for Medicare, whichever comes first. The retiree
who becomes eligible for Medicare shall no longer be eligible for enrollment in
the New Jersey Educators Health Plan, except that any dependent of the retiree
who is not eligible for Medicare may remain eligible for coverage under the New
Jersey Educators Health Plan. For the plan year beginning January 1, 2028, that
retiree who is not Medicare-eligible may select, during any open enrollment
period or at such other times or under such conditions as the program may
provide, any plan offered by the program.

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

���� d.��� Beginning January 1,
2022 and for each plan year thereafter, the program shall offer a fourth plan
to be called the Garden State Health Plan. The plan shall be developed by the
School Employees' Health Benefits Plan Design Committee. If the committee does
not adopt a design for the Garden State Health Plan by December 31, 2020, the
Division of Pensions and Benefits in the Department of the Treasury may develop
the Garden State Health Plan.� The program shall provide an enrollment period
prior to January 1, 2022.

���� The Garden State Health Plan
shall provide medical and prescription drug benefits that are equivalent to the
level of medical and prescription drug benefits provided by the New Jersey
Educators Health Plan, except that the benefits under the Garden State Health
Plan shall be available only from providers located in the State of New Jersey.

���� Access to a service provider
that is located outside of the State shall be available only under such terms,
conditions, restrictions, and limitations as the plan design committee or the
division, as appropriate, shall provide in the plan governing documents.

���� Employers that participate in
the School Employees' 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.

���� e.���� The plan design of the
New Jersey Educators Health Plan, the Garden State Health Plan, the NJ Direct
10 plan, and the NJ Direct 15 plan as those plan designs are specified in
subsections a., d., and f. of this section shall remain unchanged until December
31, 2027. No change in the plan design of those plans shall be made before that
date unless such a change in plan design is required by federal or State law to
governmental health care benefits plans or to both governmental and
non-governmental health care benefits plans, except as provided in subparagraph
2 of this subsection.����

���� For the plan year that
commences January 1, 2028 and for each plan year thereafter, the plan design of
the New Jersey Educators Health Plan, the Garden State Health Plan, the NJ
Direct 10 plan, and the NJ Direct 15 plan as those plan designs are specified
in subsections a., d., and f. of this section may be modified by the
[
School
Employees' Health Benefits Plan Design Committee
]

commission pursuant to this subsection.

���� Modifications to plan design
of the plans set forth in this section made by the School Employees' Health
Benefits Plan Design Committee or the State Treasurer pursuant to section 7 of
this act shall be implemented by the program for the purposes of this section
commencing January 1, 2024.

���� f.���� The plan design of the
New Jersey Educators Health Plan shall be the following:

In Network Benefits

Coverage

Member Coinsurance:10%, Applies
Only to Emergency Transportation Care and Durable Medical Equipment

Deductible:N/A

Out-of-Pocket Maximum:$500 Single/
$1,000 Family (covers all in network copayments, coinsurance, and deductible)

Emergency Room Copayment:$125 (To
be Waived if Admitted)

PCP Office Visit Copayment:$10

Specialist Office Visit
Copayment$15Out-of-Network Benefits

Coverage

Member Coinsurance:30% of the
Out-of-Network Fee Schedule

Deductible:$350 / $700

Out-of-Pocket Maximum:$2,000 Single
/ $5,000 Family Routine Lab:Paid at Out-of-Network Benefit Level

Out-of-Network Fee Schedule:200% of
CMS - MedicarePharmacy

Out-of-Pocket Maximum:$1,600 Single
/ $3,200 Family (Indexed Annually Pursuant to Federal Law)Generic Copayment:$5
Retail 30 Day Supply / $10 Mail 90 Day SupplyBrand Copayment:$10 Retail 30 Day
Supply/ $20 Mail 90 Day SupplyMandatory Generic:Member Pays Difference in Cost
Between Generic and Brand, Plus Brand CopaymentFormulary: Closed Formulary as
contracted with the Pharmacy Benefit Manager and the School Employees' Health
Benefits CommissionOther

Chiropractic, Physical Therapy, and
Acupuncture:

Subject to the same Out-of-Network
Limits as for the State Health Benefits Program as were in effect on June 1,
2020 to take effect as of July 1, 2020, or as soon thereafter as reasonably
practicable.

���� Under a patient centered
medical home model, there shall be no office visit copay for primary care for
participants who select and commit to a patient centered medical home for
primary care in accordance with plan rules and regulations.

���� g.��� Any plan offered by the
School Employees' Health Benefits Program shall require that chiropractic,
physical therapy, and acupuncture benefits shall be subject to the same
out-of-network limits as for the State Health Benefits Program that were in
effect on June 1, 2020 to take effect as of July 1, 2020 or as soon thereafter
as reasonably practicable.

���� h.��� Notwithstanding any
provision of law, rule, or regulation to the contrary, for any period of time
during which the employer does not have to pay a premium or periodic charge for
any health care benefits plan or program provided to its employees through the
School Employees' Health Benefits Program, an employee enrolled in such plan or
program shall not be required to make the employee's contribution toward that
premium or periodic charge during that period of time.� In the event that a
collective negotiations agreement specifically addresses a premium holiday the
collective negotiations agreement shall be controlling.

����
i. Notwithstanding the
provisions of this section, or any other law, rule, or regulation to the
contrary, on or after the effective date of P.L.��� , c.����� (pending before
the Legislature as this bill), the commission, in consultation with the program
actuary, shall ensure that the actuarial value of any plan offered to employees
and non-Medicare eligible retirees shall not be less than 85 percent.� ��

(cf: P.L.2021, c.163, s.2)

���� 11. �Section 55 of P.L.2011,
c.78 (C.52:14-17.27b) is repealed.

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

STATEMENT

���� This bill, designated as the �Property
Tax Relief Act,� makes various changes to State Health Benefits Program and
(SHBP) and School Employees� Health Benefits Program (SEHBP) administration and
reimbursement levels.

Reimbursement Level for Certain
Procedures

����
The bill limits reimbursement
for certain medical procedures covered under SHBP and the SEHBP.� Under the
bill, reimbursement for knee replacements, hip replacements, magnetic resonance
imaging (MRI) scans, computed tomography (CT) scans, colonoscopies, cataracts,
arthroscopy, and diagnostic lab tests performed in an inpatient or outpatient
hospital setting will be limited to the lesser of the contract price, the
billed price, or the reference price defined as 165 percent of the amount paid
by Medicare for the same or a similar procedure for in-network providers and
150 percent for out-of-network providers.

���� The bill prohibits a carrier,
hospital, or State-managed care plan from collecting any money from a covered
employee, retiree, dependent, or either program in excess of this amount for
the procedures covered under the bill.

���� The reimbursement limitations
established by the bill will not apply when a procedure listed under the bill
is performed in a rural hospital certified by the U.S. Centers for Medicare and
Medicaid Services as a sole community hospital; a critical access hospital
certified by the U.S. Centers for Medicare and Medicaid Services; or a hospital
with a monitor appointed by the New Jersey Department of Health. The limitation
also excludes any service or procedure that is performed in an emergency.

���� The bill will not be
interpreted to require a health benefit plan offered by the SHBP or the SEHBP
to reimburse claims using a fee-for-service payment method.

���� The bill requires the
Department of the Treasury to evaluate the listed procedures covered under the
bill within two years of the effective date.� The evaluations will assess the
amount of money each program saved on those procedures and recommend changes to
the list of procedures for consideration by the Legislature.

Responsibility for Plan Design

���� This bill eliminates the SHBP
Plan Design Committee and the SEHBP Plan Design Committee and transfers the
powers and functions of each committee to the respective commission.� With the
elimination of the SHBP Plan Design Committee and SEHBP Plan Design Committee,
the bill ends the use of a super conciliator by the SHBP and the SEHBP to
resolve deadlocked matters before the committees, and repeals that statute from
the current law.�

Plan Value

���� In addition, this bill
requires any plan offered on or after the bill�s effective date by the SHBP or
the SEHBP to have an actuarial value of at least 85 percent.

Local and Education Participation
in SHBP and SEHBP

���� 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, and any employer as defined under current law will �be
required to make a determination as to whether to participate in the SEHBP.�
Any employer other than the State which elects to participate in the SHBP and
any employer that elects to participate in the SEHBP upon the conclusion of
that year will be required to remain enrolled in the program for three
consecutive plan years.� Any employer that elects to leave either program upon
the conclusion of that year will be prohibited from reenrolling for three
consecutive plan years.� Any employer that is not enrolled in the program and
does not elect to participate within that year shall be permitted to join at
any time, but shall be required to remain enrolled in the program for three
consecutive plan years following new enrollment. �