Bill Text: NJ S2626 | 2024-2025 | Regular Session | Introduced
Bill Title: Permits State employees not covered by collective negotiations agreements to enroll in certain negotiated health care plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-02-08 - Introduced in the Senate, Referred to Senate State Government, Wagering, Tourism & Historic Preservation Committee [S2626 Detail]
Download: New_Jersey-2024-S2626-Introduced.html
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
SYNOPSIS
Permits State employees not covered by collective negotiations agreements to enroll in certain negotiated health care plans.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning access to certain health care plans in the State Health Benefits Program and amending P.L.1996, c.8 and P.L.1961, c.49.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 6 of P.L.1996, c.8 (C.52:14-17.28b) is amended to read as follows:
6. a. Notwithstanding the provisions of any other law to the contrary, the obligations of the State or an independent State authority, board, commission, corporation, agency, or organization to pay the premium or periodic charges for health benefits coverage provided under P.L.1961, c.49 (C.52:14-17.25 et seq.) may be determined by means of a binding collective negotiations agreement, including any agreements in force at the time of the adoption of P.L.1996, c.8.
With respect to State employees for whom there is no majority representative for collective negotiations purposes, the commission may, in its sole discretion, modify the respective payment obligations set forth in P.L.1961, c.49 for the State and such employees in a manner consistent with the terms of any collective negotiations agreement binding on the State. However, beginning January 1, 2025, the payment obligations of State employees for whom there is no majority representative for collective negotiations purposes shall be determined in the manner consistent with the terms set forth for the Preferred Provider Organization (PPO) plan CWA Unity DIRECT or CWA Unity DIRECT2019, or their successor, depending on the date of hire of the employee, if the State employee enrolls in coverage under the Preferred Provider Organization (PPO) plan CWA Unity DIRECT or CWA Unity DIRECT2019, or their successor.
With respect to employees of an independent State authority, board, commission, corporation, agency, or organization for whom there is no majority representative for collective negotiations purposes, the employer may, in its sole discretion, modify the respective payment obligations set forth in P.L.1961, c.49 for such employer and such employees in a manner consistent with the terms of any collective negotiations agreement binding on such employer. The provisions of this subsection shall also apply to employees deemed or considered to be employees of the State pursuant to subsection (c) of section 2 of P.L.1961, c.49 (C.52:14-17.26).
b. (1) Notwithstanding the provisions of any other law to the contrary, for each State employee who accrues 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems before July 1, 1997, excepting the employee who elects deferred retirement, the State, upon the employee's retirement, shall pay the full cost of the premium or periodic charges for the health benefits provided to a retired State employee and dependents covered under the State Health Benefits Program, but not including survivors, and shall also reimburse the retired employee for premium charges under Part B of Medicare covering the retired employee and the employee's spouse.
(2) Notwithstanding the provisions of any other law to the contrary, and except as otherwise provided by section 8 of P.L.1961, c.49 (C.52:14-17.32) as amended by P.L.2005, c.341, and by subsection c. of this section, for each State employee who accrues 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems on or after July 1, 1997, excepting the employee who elects deferred retirement, the State, upon the employee's retirement, shall pay the premium or periodic charges for the health benefits provided to a retired State employee and dependents covered under the State Health Benefits Program, but not including survivors, and shall reimburse the retired employee for premium charges under Part B of Medicare covering the retired employee and the employee's spouse: (a) in accordance with the provisions, if any, concerning health benefits coverage in retirement which are in the collective negotiations agreement applicable to the employee at the time of the employee's accrual of 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems, or (b) if the employee has no majority representative for collective negotiations purposes, in a manner consistent with the terms, if any, concerning health benefits coverage in retirement which are in any collective negotiations agreement deemed applicable by the State Health Benefits Commission to that employee at the time of the employee's accrual of 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems. The terms for the payment of premiums or periodic charges established pursuant to this paragraph for the traditional plan shall apply to the successor plan, and the terms for the payment of premiums or periodic charges established pursuant to this paragraph for the NJ PLUS plan shall apply to the State managed care plan 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).
c. (1) Effective July 1, 2007, but, with respect to employees to whom this subsection applies who are paid through the State centralized payroll, effective with the first pay period beginning after July 1, 2007, the cost of benefits provided pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.) shall be shared by employees through the withholding of a contribution in an amount as determined in accordance with paragraph (2) of this subsection.
(2) The amount of the contribution required pursuant to paragraph (1) of this subsection as to State employees and employees of an independent State authority, board, commission, corporation, agency, or organization for whom there is a majority representative for collective negotiations purposes shall be determined by means of a binding collective negotiations agreement. Commencing on the effective date of P.L.2010, c.2 and upon the expiration of any applicable binding collective negotiations agreement in force on that effective date, the amount of the contribution required pursuant to paragraph (1) of this subsection by State employees and employees of an independent State authority, board, commission, corporation, agency, or organization for whom there is a majority representative for collective negotiations purposes shall be 1.5% of base salary, notwithstanding any other amount that may be required additionally pursuant to this paragraph by means of a binding collective negotiations agreement.
The amount of the contribution required pursuant to paragraph (1) of this subsection as to State employees for whom there is no majority representative for collective negotiations purposes shall be determined in a manner consistent with the terms, if any, concerning health benefits coverage which are in a collective negotiations agreement deemed applicable by the commission to the employee. The amount of the contribution required pursuant to paragraph (1) of this subsection as to employees of an independent State authority, board, commission, corporation, agency, or organization for whom there is no majority representative for collective negotiations purposes shall be determined in a manner consistent with the terms, if any, concerning health benefits coverage which are in a collective negotiations agreement deemed applicable by the employer to the employee. The amount of the contribution required pursuant to paragraph (1) of this subsection as to State employees or employees of an independent State authority, board, commission, corporation, agency, or organization for whom there is no majority representative for collective negotiations purposes shall be 1.5 percent of base salary, notwithstanding any other amount that may be required additionally pursuant to this paragraph by means of the application of the terms of a binding collective negotiations agreement.
(3) Except as provided in paragraph (5) of this subsection, the cost of benefits provided pursuant to P.L.1961, c.49 (C.52:14-17.25 et seq.) shall be shared by retirees to whom this subsection applies through the withholding of a contribution in an amount as determined in accordance with paragraph (4) of this subsection.
(4) The amount of the contribution required pursuant to paragraph (3) of this subsection as to State employees and employees of an independent State authority, board, commission, corporation, agency, or organization for whom there is a majority representative for collective negotiations purposes who accrue 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems on or after July 1, 2007, and who retire on or after July, 1, 2007, excepting employees who elect deferred retirement, but including those who retire on a disability pension after July 1, 2007, shall be determined by means of a binding collective negotiations agreement applicable at the time of the employee's accrual of 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems. The amount of the contribution required pursuant to paragraph (3) of this subsection as to State employees or employees of an independent State authority, board, commission, corporation, agency, or organization for whom there is no majority representative for collective negotiations purposes who accrue 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems on or after July 1, 2007, and who retire on or after July 1, 2007, excepting employees who elect deferred retirement, but including those who retire on a disability pension after July 1, 2007, shall be determined in a manner consistent with the terms, if any, concerning health benefits coverage in retirement which are in any collective negotiations agreement deemed applicable by the commission to that employee at the time of the employee's accrual of 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems, except that for employees who accrue 25 years of nonconcurrent service credit in one or more State or locally-administered retirement systems in the period beginning July 1, 2007, and ending June 30, 2011, the contribution shall be 1.5 percent of the monthly retirement allowance, including any future cost-of-living adjustments, or, with respect to retirees for whom there is no majority representative and who are members of the alternate benefit program, an amount determined pursuant to a formula developed by the commission that shall be designed to result in a contribution that is comparable to the contribution that applies to retirees who are not members of the alternate benefit program.
(5) The contribution required pursuant to paragraph (3) of this subsection shall not take effect until the New Jersey Retirees' Wellness Program is open for enrollment and thereafter the contribution shall be waived for a retiree who participates in the New Jersey Retirees' Wellness Program. The Division of Pensions and Benefits shall issue a report on the New Jersey Retirees' Wellness Program. The report shall include, but need not be limited to, the claims experience with regard to retirees in the program, and the costs and savings realized. The report shall be issued at the end of the third year after the program's implementation or by December 30, 2010, whichever is earlier. The report shall be submitted to the Governor, the Legislature, and the State Treasurer.
(6) Any employee or retiree
from whom withholding of a contribution is required pursuant to this subsection
shall not be required to pay any percentage of the premiums or periodic charges
for health care benefits provided under P.L.1961, c.49
(C.52:14-17.25 et seq.), other than dental benefits.
(7) The contribution required pursuant to this subsection may be terminated only upon withdrawal from all health care benefits coverage as an employee or retiree, other than coverage for dental benefits, and the submission to the commission of written certification by the employee that the employee is covered by other health care benefits and that those benefits are in force. The commission shall not apply the written certification requirement to retirees or to employees to whom Article VI, Section VI, paragraph 6 of the New Jersey Constitution applies.
d. The amount of contribution required pursuant to paragraph (3) of subsection c. of this section in retirement as to a State employee and employee of an independent State authority, board, commission, corporation, agency, or organization who becomes a member of a State or locally-administered retirement system on or after the effective date of P.L.2010, c.2, for whom there is a majority representative for collective negotiations purposes and for whom there is no such representative, shall be 1.5 percent of the retiree's monthly retirement allowance, including any future cost-of-living adjustments, or with respect to members of the alternate benefit program, an amount determined pursuant to the formula specified in paragraph (4) of subsection c. of this section, notwithstanding any other amount that may be required additionally pursuant to paragraph (4) of subsection c. of this section by means of a binding collective negotiations agreement or by means of the application of the terms of such an agreement. The contribution required by this subsection or pursuant to paragraph (4) of subsection c. of this section for officers or employees specified in this subsection shall not be waived for a retiree who participates in the New Jersey Retirees' Wellness Program.
(cf: P.L.2010, c.2, s.1)
2. 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% of the first $2,000.00 of charges for eligible medical services incurred
subsequent to satisfaction of the deductible and 100% 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 his 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% 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 alcoholism 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) A State employee for
whom there is no majority representative for collective negotiations purposes shall
be permitted to select coverage under the Preferred Provider Organization (PPO)
plan CWA Unity DIRECT or CWA Unity DIRECT2019, or their successor, depending on
the date of hire of the employee, commencing with the open enrollment period
next following the effective date of
P.L. , c. (pending before the Legislature as this bill),
and the payment schedule of percentage of salary applicable to those State
employees represented by the Communications Workers of America who select coverage
under those plans shall be applicable to those who select coverage under this
subsection to determine their annual contributions to the cost of health care
benefits coverage.
(cf: P.L.2011, c.78, s.47)
3. This act shall take effect immediately.
STATEMENT
Under current law, the State Health Benefits Program provides to State employees covered by collective negotiations agreements the health care and prescription drug plans required by the terms of those collective negotiations. Those agreements may also specify the annual contributions that the State employees must make toward the cost of the plans if they enroll for coverage in those plans.
This bill permits State employees who are not covered by collective negotiations agreements to enroll in certain plans and to make the same contributions negotiated by the Communication Workers of America.
