New JerseyInsurers could not penalize in-network facilities for certain out-of-network services
New Jersey insurers would face state penalties for charging in-network facilities administrative fees or penalties for certain covered out-of-network care.
What it does
Insurers could not charge in-network facilities administrative fees or penalties for covered out-of-network care when in-network services are unavailable at that facility, or for certain outside lab tests.
Argument forIn-network facilities could avoid added insurer charges when covered patients need care that in-network providers cannot supply at that facility.
Argument againstInsurers could lose a financial tool for influencing how in-network facilities arrange covered out-of-network care, since administrative fees and penalties would be barred.
More detail
Insurers could not charge in-network facilities administrative fees or penalties for the covered out-of-network services. Services must be covered by a managed care plan with a network. The ban would also cover outside lab testing ordered by an in-network provider. Insurers that violate the ban would face penalties under state insurance law. The ban would take effect on the 90th day after enactment and apply to policies and contracts issued, executed, delivered, or renewed on or after enactment.
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Where it stands
- Introduced
- Passed 1st Chamber
- Passed 2nd Chamber
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Oct 19Introduced, Referred to Assembly Financial Institutions and Insurance CommitteeIntroduced
Healthcare