Public entities would get health claims data from plan providers

Health plan data custodians would send claims data to public entity plan sponsors automatically and without charge. The duty would cover carriers, claims administrators, health and joint insurance fund administrators, stop-loss carriers, and the Division of Pensions and Benefits when they hold data for a New Jersey public entity plan sponsor. The package would include medical and pharmacy claims, costs, plan details, and summary information. For groups with fewer than 50 covered people, custodians would provide summaries and comparisons instead of individual claim records. A group with fewer than 50 people in any one year could request pooled, de-identified claim data if its three-year total reaches at least 150 covered person-years. For groups with 50 to 99 covered people, custodians would suppress data cells representing fewer than 11 people. The data could be used only for plan-related purposes, not sold or used for unrelated marketing. Within 30 days after the act takes effect, custodians would send data for the latest completed plan or fund year and, if available, the two preceding years. After that, they would send updated data within 30 days after each year ends. Sponsors could also request data, generally due within 15 business days.