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Bill

Bill

S 4251

Establishes procedure for removal of health care facility from provider network and certain circumstances to allow for special enrollment period.

2024-2025 Regular Session Introduced by Patrick Diegnan and 1 co-sponsor

New Jersey bill creates removal procedures for healthcare facilities in insurance networks and allows special enrollment periods when facilities are removed from coverage.

Introduced in the Senate, Referred to Senate Commerce Committee
#healthfac #healthinsur
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WeVote Research Nonpartisan
Bill Summary · S 4251

Legislative bill overview

S 4251 establishes formal procedures for health insurers to remove healthcare facilities from their provider networks and creates circumstances that trigger special enrollment periods (allowing people to change plans outside normal enrollment windows) when facilities are removed. The bill aims to protect patients from unexpected loss of access to their preferred providers and facilities.

Why is this important

When insurers remove hospitals or major healthcare facilities from networks, patients may face disrupted care, higher out-of-pocket costs, or forced switches to unfamiliar providers. This bill addresses consumer protection by creating a structured removal process and giving affected patients enrollment flexibility—critical issues in states where network changes can significantly impact healthcare access and affordability.

Potential points of contention

  • Insurer flexibility vs. consumer protection: Requiring formal procedures and special enrollment periods may increase insurer administrative costs and potentially limit their ability to negotiate network changes, which could affect premium pricing
  • Definition ambiguity: The bill doesn't specify which facility removals trigger special enrollment (major hospitals vs. smaller clinics), potentially creating disputes over applicability
  • Timing and notification: Unclear how much advance notice insurers must provide before removal takes effect or how quickly special enrollment must be offered, affecting practical implementation

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

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