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A 5903

Creates an exemption to the presumption that a child born in wedlock is the child of the birth parent's legal spouse

2025 Regular Session Introduced by Chantel Jackson

Reorganizes SHBP governance, narrows plan options for local employers, updates contribution rules with escalator/de-escalator, and adds arbitration for disputes.

REFERRED TO JUDICIARY
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Bill Summary · A 5903

Bill summary — A5903 (Introduced June 27, 2025; reported with amendments July 24, 2025)

Note: Although the bill caption in some sources differs, the attached committee documents and fiscal notes show A5903 makes broad changes to the State Health Benefits Program (SHBP) — governance, plan offerings, prescription drug review, and employer/employee contribution rules.

Main purpose

To reorganize governance of the SHBP, centralize plan-design authority in a reconstituted State Health Benefits Commission (SHBC), change the range of plans offered (especially for participating local employers), revise how local employee contributions are calculated (including automatic escalator/de-escalator rules), strengthen actuarial oversight and prescription drug cost review, and replace the existing deadlock-resolution (super-conciliator) process with a specified arbitration procedure.

Key provisions and changes

  • SHBC composition and powers

    • Expands the Commission from 5 to 11 members: ex officio State Treasurer, Commissioner of Banking & Insurance, Chair of Civil Service Commission (or designees); two gubernatorial appointees; three appointees chosen by the Public Employee Committee of the NJ AFL‑CIO (representing the three largest AFL‑CIO public-employee organizations in SHBP); two appointees from the largest non‑AFL‑CIO public-employee organizations; and a chairperson appointed by the Governor from three nominees.
    • SHBC (not a separate Plan Design Committee) will have authority to create, modify, or terminate SHBP plans and components and to enter into contracts with administrators/consultants.
    • Director of the Division of Pensions and Benefits serves as SHBC secretary.

  • Actuarial oversight and drug cost management

    • SHBP actuary must issue an actuarial report within 180 days of the bill’s effective date covering State and participating public entities (including non‑Medicare retirees).
    • The actuary must make recommendations addressing high‑priced medications (explicitly including GLP‑1 class drugs). The commission must act within 90 days of receiving those recommendations to manage costs.
    • SHBC must follow the program actuary’s guidance in developing plan designs and must take specified actions if projected plan costs exceed medical/prescription inflation rates.

  • Prescription drug formulary and new drug review

    • The commission must review FDA‑approved medications quarterly when considering formulary updates.
    • Newly FDA‑approved drugs are added to SHBP formularies only by majority vote of commission members.

  • Elimination of Plan Design Committee / new arbitration process

    • Abolishes the Plan Design Committee and the super‑conciliator process.
    • Commission decisions must be resolved within 30 days; if impasse remains, the commission selects a neutral arbitrator with subject expertise.
    • Arbitrator conducts expedited investigation and negotiation; if unresolved after 30 days, arbitrator issues a final binding decision which must be made public within 10 days.

  • Plan offerings and contribution mechanics (affecting local employers)

    • Reduces plan options for local government participating employers from 13 choices to 5 specified plans: Unity 2019 PPO, Tiered Network, PPO 2030, PPO 2035, and a new “NJ Gold” plan to be developed by the commission.
    • Specifies how local employee contributions are calculated for certain plans (e.g., Unity 2019 local plan contribution becomes compensation‑based; Tiered Network contribution = 75% of Unity 2019 rate; NJ Gold requires no employee contribution).
    • Establishes an escalator: if renewal premiums rise ≥6% above baseline and the commission cannot agree on cost‑saving plan changes, employee contribution rates increase by the Consumer Price Index; conversely, a de‑escalator reduces contributions if renewal premiums fall ≥6% below baseline.
    • Introduces a two‑year waiting period for local employers to re‑enter or exit the SHBP.

  • Medical claims review

    • Requires third‑party medical claims reviewer to use data analytics to design annual reviews of in‑network and out‑of‑network claims, with special attention to services provided by specialty physicians and providers in New York and Pennsylvania.

Who is affected

  • State employees and retirees (non‑Medicare) covered by SHBP.
  • Participating local government employers and their employees (changes to plan choices and contribution formulas).
  • Public‑employee organizations/unions (representation on the SHBC and bargaining implications).
  • SHBP contractors (third‑party administrators, actuaries, claims reviewers).
  • Potential implications for patients regarding access/costs of newly added prescription drugs and plan benefit design.

Fiscal and administrative impact

  • Office of Legislative Services (OLS) estimate: net fiscal impact to the State and participating local governments is indeterminate. The bill could produce both expenditure decreases (through plan consolidation, actuary‑led cost management, and lower‑cost plan options) and expenditure increases (additional auditing, claims‑review operations, arbitration, reporting, and implementation costs).
  • OLS analysis shows Plan Year 2026 projected premiums for several specified plans may be 8.8% to 31.5% lower than the most expensive current plan (PPO 10), but overall net effect depends on employer/employee choices, collective bargaining limitations, and implementation actions by the commission.

Procedural status & sponsor

  • Introduced in Assembly: June 27, 2025 (sponsor listed as Chantel Jackson).
  • July 24, 2025: Reported by Assembly State & Local Government Committee with amendments and referred to Assembly Appropriations Committee.
  • Fiscal notes dated August 21 and 26, 2025 (OLS analyses).
  • Further committee hearings and floor action pending.

If you want, I can: (1) extract the specific statutory text changes, (2) produce a one‑page handout focused on impacts for local employers, or (3) compare this version to current SHBP governance and contribution law.

Compiled from official sources — confirm details with the bill’s official record.

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