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Bill

S 3416

Establishes additional health insurance carrier network adequacy standards with respect to certain physician specialists.

2024-2025 Regular Session Introduced by Jon Bramnick and 2 co-sponsors

Strengthens health plan network rules to ensure timely in-network access to specified hospital- and emergency-based specialists.

Reported out of Senate Committee, 2nd Reading
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Bill Summary · S 3416

Summary — S3416 (P.L.2025, c.546)

Status: Enacted — Delivered to Governor 11/17/2025; Signed into law (Chapter 546) 11/21/2025.
Introduced: 01/27/2025.
Subject: Health insurance — network adequacy standards for managed care plans.

Purpose

S3416 strengthens network adequacy rules for health insurance carriers that offer managed care plans by requiring the Commissioner of Banking and Insurance to adopt regulations ensuring covered persons have reasonable and timely in‑network access to specified physician specialists at in‑network hospitals and facilities.

Key provisions

  • Amends Section 19 of P.L.1997, c.192 (C.26:2S‑18) to expand required regulatory standards for carriers that offer managed care plans or use utilization management systems.
  • Requires the Commissioner to adopt rules, under the Administrative Procedure Act, that include standards to ensure covered persons have reasonable and timely in‑network access to physician specialists at in‑network hospitals and facilities.
  • Specifies listed specialists and services to be covered by the access requirement: anesthesiologists, radiologists, pathologists, emergency medicine physicians, and services under their supervision.
  • Retains and consolidates other required regulatory elements, including:
    • Quality management program standards;
    • Provider participation and network adequacy with respect to scope of benefits and geographic service area;
    • Utilization management standards;
    • Covered person complaint and patient appeals systems;
    • Consumer rights and carrier disclosure requirements;
    • Outcomes and data reporting requirements.
  • Effective date: the act takes effect immediately upon enactment.

Who is affected

  • Health insurance carriers offering managed care plans in New Jersey — required to comply with new network adequacy regulations adopted by the Commissioner.
  • Covered persons (enrollees) in those plans — expected to gain stronger, explicit protections for timely in‑network access to specified hospital‑based and emergency specialists.
  • Hospitals, facilities, and the named specialist physician groups (anesthesiologists, radiologists, pathologists, emergency medicine physicians) — may be implicated in network contracting and access standards.
  • The Department of Banking and Insurance — responsible for rulemaking and enforcement.

Procedural history

  • Introduced in Senate 01/27/2025; referred to Health Committee and amended multiple times.
  • Reported out of Senate Commerce Committee 03/24/2025.
  • Passed both houses in June 2025; delivered to Governor 11/17/2025; signed into law 11/21/2025 (Ch. 546).
  • Companion assembly measures: A5892 and A5218.

Potential impact

  • Strengthens consumer protections by explicitly requiring timely in‑network access to hospital‑based and emergency specialists.
  • May prompt carriers to revise network composition, contracting, reimbursement, and administrative practices to meet new regulatory standards.
  • Implementation and operational effects will depend on the regulations the Commissioner adopts pursuant to this law.

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

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