Permits greater diversity in creation of new health sharing ministries and establishes and exempts certain mandates and reporting requirements.

S3634

SENATE, No. 3634

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED FEBRUARY 24, 2026

Sponsored by:

Senator� ANGELA V. MCKNIGHT

District 31 (Hudson)

SYNOPSIS

���� Permits greater diversity in creation of new health
sharing ministries and establishes and exempts certain mandates and reporting
requirements.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act

concerning health care sharing ministries and
reporting requirements; amending and supplementing P.L.2018, c.31.

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

���� 1.��� (New section) The
Legislature finds and declares that:

���� a.���� Health care sharing
ministries are organizations whose members share a common set of ethical or
religious beliefs and voluntarily share medical expenses among members in
accordance with those beliefs.

���� b.��� Members of qualified
health care sharing ministries are exempt from the required health insurance
coverage in this State.

���� c.���� The term �health care
sharing ministry� in this State is defined solely by the federal definition as
incorporated under the federal �Patient Protection and Affordable Care Act,� 26
U.S.C. s.5000A et seq., which includes the requirement that a ministry, or a
predecessor thereof, be in continuous operation since December 31, 1999.

���� d.��� There is no statement of
intent in the Affordable Care Act explaining any benefit to a consumer or
governmental entity for including the requirement that a health care sharing
ministry must be in continuous operation since December 31, 1999.

���� e.���� In the years since the
enactment of the Affordable Care Act, the term �health care sharing ministry�
has proven unworkable as a consumer protection mechanism, with several new
organizations using the �predecessor� loophole in the Affordable Care Act�s definition
to take unfair advantage of consumers in this State.

���� f.���� Therefore, to increase
transparency, the law should update who health care mandates apply to and
establish certain disclosures to enhance transparency.

���� 2.��� Section 2 of P.L.2018,
c.31(C.54A:11-2) is amended to read as follows:

���� 2.��� As used in this act:

���� "Affordable Care
Act" means the federal "Patient Protection and Affordable Care
Act," Pub.L.111-148, as amended by the federal "Health Care and
Education Reconciliation Act of 2010," Pub.L.111-152, and any federal
rules and regulations adopted pursuant thereto.

���� "Applicable
individual" means the same as defined in 26 U.S.C. s.5000A(d)(1
),
except that, for purposes of P.L.2018, c.31 (C.54A:11-1 et seq.)
s.5000A(d)(2)(B) shall not apply. �For purposes of P.L.2018, c.31 (C.54A:11-1
et seq.), �applicable individual� shall not include any individual for any
month if that individual is a member of a health care sharing ministry for the
month
.

���� "Carrier" means any
entity that contracts or offers to contract to provide, deliver, arrange for,
pay for, or reimburse any of the costs of health care services, including a
sickness and accident insurance company, a health maintenance organization, a
hospital or health service corporation, a multiple employer welfare
arrangement, an entity under contract with the State Health Benefits Program or
the School Employees' Health Benefits Program to administer a health benefits
plan, or any other entity providing a health benefits plan.�

����
�Director� means the Director
of Consumer Affairs in the Department of Law and Public Safety.

����
�Health care sharing
ministry� means a not-for-profit organization pursuant to 26 U.S.C. s.501(c)(3)
that is exempt from federal income taxes under 26 U.S.C. s.501(a), whose
members: (1) share a common set of ethical or religious beliefs and share
medical expenses among members in accordance with those beliefs, without regard
to the state in which a member resides or is employed; and (2) retain
membership even after developing a medical condition.�

����
The term �health care
sharing ministry� shall exclude ministries that do not conduct an annual audit
that: (1) is performed by an independent certified public accounting firm; (2)
follows generally accepted accounting principles; and (3) is made available to
the public upon request.

���� "Minimum essential
coverage" means the same as defined in 26 U.S.C. s.5000A(f)(1).

(cf: P.L.2018, c.31, s.2)

���� 3.��� (New section) a.� A health
care sharing ministry or other organization that offers or intends to offer a
plan or arrangement to facilitate payment or reimbursement of health care costs
or services for residents of this State, regardless of whether the ministry or
organization is domiciled in this State or another state, shall post on its Internet
website 30 days following the effective date of
P.L. , c. (C. )
(pending before the Legislature as this bill), and by March 1 each year
thereafter the following information:

���� (1)�� the total number of
individuals and households that participated in the plan or arrangement in this
State in the immediately preceding calendar year;

���� (2)�� the total number of
employer groups that participated in the plan or arrangement in this State in
the immediately preceding calendar year, specifying the total number of
participating individuals in each participating employer group;

���� (3)�� the total number of
participants in the plan or arrangement nationally, if the organization or
ministry offers a plan or arrangement in other states;

���� (4)�� any contracts the
ministry or organization has entered into with providers in this State that
provide health-care services to plan or arrangement participants;

���� (5)�� the total amount of
fees, dues, or other payments collected by the ministry or organization in the
immediately preceding calendar year from individuals, employer groups, or
others who participated in the plan or arrangement in this State, specifying:

���� �(a)� the percentage of fees,
dues, or other payments retained by the ministry or organization for
administrative expenses;

���� �(b)� the total dollar amount
of requests for reimbursement of health care costs or services submitted in
this State in the immediately preceding calendar year by participants in the
plan or arrangement or providers that provided health care services to plan or
arrangement participants;

���� �(c)� the total dollar amount
of requests for reimbursement of health care costs or services that were
submitted in this State and were determined to qualify for reimbursement under
the plan or arrangement in the immediately preceding calendar year;

���� �(d)� the total amount of payments
made to in-State providers in the immediately preceding calendar year for
health care services provided to or received by a plan or arrangement
participant; and

���� �(e)� the total amount of
reimbursements made to plan or arrangement participants in this State in the
immediately preceding calendar year for health care services provided to or
received by a plan or arrangement participant;

���� (6)�� the total number of
requests for reimbursement of health care costs or services submitted in this State
in the immediately preceding calendar year that were denied, expressed as a
percentage of total reimbursement requests submitted in that calendar year, and
the total number of reimbursement request denials that were appealed;

���� (7)�� the total amount of
health care expenses submitted in this State by a plan or arrangement
participant or provider in the immediately preceding calendar year that qualify
for reimbursement pursuant to the plan or arrangement criteria but that, as of
the end of that calendar year, have not been reimbursed, excluding any amounts
that the plan or arrangement participants incurring the health care costs must
pay before receiving reimbursement under the plan or arrangement;

���� (8)�� the estimated number of
plan or arrangement participants the ministry or organization is anticipating
in this State in the following calendar year, specifying the estimated number
of individuals, households, employer groups, and employees;

���� (9)�� the specific counties in
this State in which the ministry or organization:

���� (a)�� offered a plan or
arrangement in the immediately preceding calendar year; and

���� (b)�� intends to offer a plan
or arrangement in the next calendar year;

���� (10) other states in which the
ministry or organization offers a plan or arrangement;

���� (11) a list of any third parties,
not including insurance producers, that are associated with or assist the ministry
or organization in offering or enrolling participants in the plan or
arrangement in this State, copies of any training materials provided to a third
party, and a detailed accounting of any commissions or other fees or
remuneration paid to a third party in the immediately preceding calendar year
for:

���� (a)�� marketing, promoting, or
enrolling participants in a plan or arrangement offered by the ministry or
organization in this State; or

���� (b)�� operating, managing, or
administering a plan or arrangement offered by the ministry or organization in
this State;

���� (12) the total number of
insurance producers that are associated with or assist the ministry or organization
in offering or enrolling participants in this State in the plan or arrangement,
the total number of participants enrolled in the plan or arrangement through an
insurance producer, copies of any training materials provided to an insurance
producer, and a detailed accounting of any commissions or other fees or
remuneration paid to an insurance producer in the immediately preceding
calendar year for marketing, promoting, or enrolling participants in a plan or
arrangement offered by the ministry or organization in this State;

���� (13) copies of any
consumer-facing and marketing materials used in this State in promoting the
ministry or organization's plan or arrangement, including plan or arrangement
and benefit descriptions and other materials that explain the plan or
arrangement;

���� (14) the name, mailing
address, e-mail address, and telephone number of individuals serving as a
contact organization for the ministry or organization in this State;

���� (15) a list of any parent
companies, subsidiaries, and other names that the ministry or organization has
operated under at any time within the immediately preceding five calendar
years;

���� (16) an organizational chart
for the ministry or organization that, to the best of the ministry or
organization�s good faith knowledge and belief, is accurate and satisfies the
requirements of this subsection; and

���� (17) a certification by an
officer of the ministry or organization that, to the best of the ministry or
organization�s good faith knowledge and belief, the information submitted is
accurate and satisfies the requirements of this subsection.

���� b.��� In addition to the
disclosures required pursuant to subsection a. of this section, a health care
sharing ministry or organization offering a plan or arrangement to facilitate
payment or reimbursement of health-care costs or services to residents of this
State shall post on its Internet website a conspicuous notice stating that the
plans or arrangements that it offers to its participants are not health
insurance plans.� A health care sharing ministry or organization shall also
notify its participants, on its Internet website, that any personal information
collected by the ministry or organization of its participants is protected.

���� 4.��� (New section) a.� A
health care sharing ministry or organization operating in this State shall
notify the Director of Consumer Affairs in the Department of Law and Public
Safety if legal action is taken against the ministry or organization in another
state.

���� b.��� The Director may issue a
notice of noncompliance to a health care sharing ministry or organization that
fails to comply with the requirements of P.L.��� , c.��� (C.������� ) (pending
before the Legislature as this bill).� If a ministry or organization fails to
comply with the provisions of P.L.��� , c.��� (C.������� ) (pending before the
Legislature as this bill) for more than 45 calendar days after a notice of
noncompliance has been issued, the Director shall file an injunction in a court
of competent jurisdiction or issue a monetary penalty, to be determined by the
Director.

���� 5.��� (New section) The
Director shall adopt, pursuant to the �Administrative Procedure Act,� P.L.1968,
c.410 (C.52:14B-1 et seq.), rules or regulations as shall be necessary to
effectuate the provisions of P.L.��� , c.��� (C.������� ) (pending before the
Legislature as this bill).

���� 6.��� This act shall take
effect on the 60th day next following enactment, except that the Director may
take any anticipatory administrative action in advance as shall be necessary
for the implementation of this act.

STATEMENT

���� This bill permits greater
diversity in the creation of new health sharing ministries and establishes and
exempts certain mandates and reporting requirements.

���� Under the bill, a participant
in a health care sharing ministry established after December 31, 1999 will not
be considered an applicable individual subject to the State�s minimum essential
coverage requirement, which requires that every applicable individual maintain
health insurance coverage.� Currently, a participant in a health care sharing
ministry established after December 31, 1999 is considered an applicable
individual subject to the State�s minimum essential coverage requirements and
must maintain health insurance coverage or pay a State-imposed tax.��

���� Additionally, the bill
establishes certain reporting requirements for health care sharing ministries
and organizations that offer or intend to offer a plan or arrangement to
facilitate payment or reimbursement of health care costs or services for
residents of this State.� The reporting requirements include the total number
of individuals and households that participated in the plan or arrangement in
the immediately preceding calendar year and the total amount of fees, dues, or
other payments collected by the ministry or organization in the immediately
preceding calendar year, among other requirements.� Ministries or organizations
that fail to comply with the reporting requirements under the bill may be
subject to certain monetary penalties or other administrative or legal actions.

���� As used in this bill, �health
care sharing ministry� means a not-for-profit organization pursuant to 26
U.S.C. s.501(c)(3) that is exempt from federal income taxes under 26 U.S.C.
s.501(a), whose members: (1) share a common set of ethical or religious beliefs
and share medical expenses among members in accordance with those beliefs,
without regard to the state in which a member resides or is employed; and (2)
retain membership even after they develop a medical condition.� The term
�health care sharing ministry� excludes ministries that do not conduct an
annual audit that: (1) is performed by an independent certified public
accounting firm; (2) follows generally accepted accounting principles; and (3)
is made available to the public upon request.