Requires employees who do not select or waive coverage to be enrolled in lowest cost SHBP or SEHBP health plan.

A5226

ASSEMBLY, No. 5226

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED JUNE 8, 2026

Sponsored by:

Assemblywoman� MARGIE DONLON, M.D.

District 11 (Monmouth)

SYNOPSIS

���� Requires employees who do not select or waive
coverage to be enrolled in lowest cost SHBP or SEHBP health plan.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act

concerning the enrollment of certain employees
in the State Health Benefits Program and School Employees� Health Benefits
Program and supplementing Title 52 of the Revised Statutes.

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

���� 1.� a.� Notwithstanding any
law, rule, or regulation to the contrary, any employee of the State who is
eligible to participate in the State Health Benefits Program, and does not
affirmatively select a health care plan or waive health care coverage, shall be
enrolled, along with their dependents, if any, into the health care plan with
the lowest overall costs for members and the State as determined by the
Evaluation Committee with oversight from the Division of Purchase and Property
in the Department of the Treasury, and the State Health Benefits Commission.�
If it is determined that no plan has the lowest overall costs for both members
and the State, the commission shall require the enrollment of such employees,
and their dependents, if any, into the health care plan with the lowest overall
costs for the State.

���� b.� The Evaluation Committee
with oversight from the Division of Purchase and Property in the Department of
the Treasury, and the State Health Benefits Commission, in consultation with
the program actuary, shall determine the health care plan which has the lowest
anticipated overall costs for members and for the State prior to the start of
each new plan year and may adjust such determinations as may be appropriate at
any time during the plan year.

���� 2.� a.� Notwithstanding any
law, rule, or regulation to the contrary, any employee who is eligible to
participate in the School Employees� Health Benefits Program, and does not
affirmatively select a health care plan or waive health care coverage, shall be
enrolled, along with their dependents, if any, into the health care plan with
the lowest overall costs for members and the employer as determined by the
Evaluation Committee with oversight from the Division of Purchase and Property
in the Department of the Treasury, and the School Employees� Health Benefits
Commission.� If it is determined that no plan has the lowest overall costs for
both members and the employer, the commission shall require the enrollment of
such employees, and their dependents, if any, into the health care plan with
the lowest overall costs for the employer.

���� b.� The Evaluation Committee
with oversight from the Division of Purchase and Property in the Department of
the Treasury, and the School Employees� Health Benefits Commission, in
consultation with the program actuary, shall determine the health care plan
which has the lowest anticipated overall costs for members and for the employer
prior to the start of each new plan year and may adjust such determinations as
may be appropriate at any time during the plan year.

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

STATEMENT

���� This bill requires employees
who are eligible to participate in the State Health Benefits Program or School
Employees� Health Benefits Program, and who do not affirmatively select a
health care plan or waive coverage, to be enrolled, along with their dependents,
if any, into the health care plan with the lowest overall costs to members and
to the employer, as determined by the Evaluation Committee with oversight from
the Division of Purchase and Property in the Department of the Treasury, and
the State Health Benefits Commission (SHBC) or School Employees� Health
Benefits Commission (SEHBC), as appropriate.� If a determination is made that
no plan can be considered to provide the lowest overall cost to both members
and the employer, then the SHBC or SEHBC will enroll such employees, along with
their dependents, if any, into the plan with the lowest overall costs for the
employer.

���� The bill requires the
Evaluation Committee with oversight from the Division of Purchase and Property,
and the SHBC or SEHBC, as appropriate, in consultation with their respective
program actuaries, to determine the health care plan which has the lowest anticipated
overall costs for members and for the employer prior to the start of each new
plan year.� The bill permits the SHBC and the SEHBC to adjust such
determinations as may be appropriate at any time during the plan year.