As we previously reported A-5903, which makes changes to the State Health Benefits Program (SHBP) plan offering and governance, was amended and released by the Assembly State and Local Government Committee.
The amendments to A-5903 include a new contribution chart for SHBP Unity 2019 PPO:
Single Coverage
Salary/Retirement Allowance Range | Percent or Flat Rate |
$20,000 to $29,999 | 2.584% |
$30,000 to $44,999 | 2.906% |
$45,000 to $49,999 | 3.1% |
$50,000 to $54,999 | 4.75% |
$55,000 to $59,999 | 5.75% |
$60,000 to $64,999 | 6.975% |
$65,000 to $69,999 | 7.25% |
$70,000 to $79,999 | 7.95% |
$80,000 to $94,999 | $6,350 |
$95,000 or more | $6,750 |
Employee and Spouse/Partner Coverage
Salary/Retirement Allowance Range | Percent or Flat Rate |
$20,000 to $29,999 | 2.584% |
$30,000 to $35,999 | 3.552% |
$36,000 to $49,999 | 3.875% |
$50,000 to $54,999 | 5.49% |
$55,000 to $59,999 | 6.5% |
$60,000 to $64,999 | 8.5% |
$65,000 to $69,999 | 9.25% |
$70,000 to $74,999 | 10.95% |
$75,000 to $79,999 | $8,950 |
$80,000 to $84,999 | $9400 |
$85,000 to $99,999 | $10,975 |
$100,000 or more | $12,000 |
Family Coverage
Salary/Retirement Allowance Range | Percent or Flat Rate |
$20,000 to $25,999 | 2.584% |
$26,000 to $29,999 | 2.906% |
$30,000 to $34,999 | 3.229% |
$35,000 to $44,999 | 3.875% |
$45,000 to $49,999 | 4.52% |
$50,000 to $54,999 | 5.813% |
$55,000 to $59,999 | 6.548% |
$60,000 to $64,999 | 7.75% |
$65,000 to $69,999 | 8.395% |
$70,000 to $84,999 | 12.75% |
$85,000 to $99,999 | 13.0% |
$100,000 to $109,999 | $14,975 |
$110,000 to more | $17,500 |
Parent and Child Coverage
Salary/Retirement Allowance Range | Percent or Flat Rate |
$20,000 to $29,999 | 2.584% |
$30,000 to $35,999 | 3.552% |
$36,000 to $44,999 | 3.875% |
$45,000 to $49,999 | 4.199% |
$50,000 to $59,999 | 5.813% |
$60,000 to $64,999 | 6.458% |
$65,000 to $69,999 | 6.781% |
$70,000 to $74,999 | 10.25% |
$75,000 to $79,999 | $7,850 |
$80,000 to $84,999 | $8,250 |
$85,000 to $99,999 | $8,475 |
$100,000 or more | $10,750 |
In addition to the contribution rate changes, the amendments include:
- Added language to the requirement that non-SHBP municipalities with medical and prescription drug plan premiums higher than the SHBP Unity 2019 plan to negotiate upon request from unions a plan substantially similar in design and contribution rates to SHBP Unity 2019. The amendments only require such negotiations if the employer does not offer a plan substantially similarly in design to SHBP Unity 2019, removes the benchmark of higher employee contributions rates than SHBP Unity 2019 plan, and adds the requirement that the plan be similar to SHBP Unity 2019 with substantially similar contribution rates and annual premiums.
- Removed the language that would have permitted three members of the State Health Benefits Commission (SHBC) to request information through the Chair.
- Requires the SHBC Chair to transmit a request for information to the appropriate individual or entity with the information requested to be provided as soon as practicable and in a usable format.
- Added language that permits the chair to consider whether legitimate requests for information have been excessive or unreasonable prior to a vote. In binding arbitration, for the purpose of rendering a final decision, the arbitrator may take into account whether legitimate requests for information have been provided as soon as practicable and in a usable format or whether requests for information were excessive or unreasonable.
- Changes the timeframe for the actuarial report on GLP-1 and higher priced medications from 30 calendar days after the first full plan year to 180 calendar days after the bill’s effective date.
- Adds language to require the Commission within 90 calendar days of receiving the actuary report on prescription drug costs to undertake actions and plan modifications as necessary to appropriately manage the cost of higher-priced medications.
- Adds language that prescription medications newly approved by the Food and Drug Administration (FDA) can only be added to the SHBP prescription drug formularies upon a majority vote of the SHBC.
- Changes the annual review of the in-network and out-of-network claims from a benchmark of 33% to a general review utilizing appropriate data analytics to determine the most effective methodology for conducting annual reviews.
- Exempts from the bill’s provisions State colleges and universities established by N.J.S.A. 52:14-17.28e, Rutgers, NJIT, Rowan, Montclair, and Kean.
In addition, the Office of Legislative Services (OLS) issued a legislative fiscal estimate on A-5903. OLS estimates that the changes “may result in an indeterminate net fiscal impact to the State and participating local government employers.” OLS also anticipates “that certain changes in the governance and operation of the program may also result in potential indeterminate annual expenditure increases for the State and participating local government employers.”
No Senate companion bill has been introduced. A-5903 awaits consideration by the Assembly Appropriation Committee.
Contact: Lori Buckelew, Deputy Executive Director, lbuckelew@njlm.org, 609-695-3481, x112.