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Bill

A 5337

Makes various changes to SHBP governance and administration.

2026-2027 Regular Session Introduced by Verlina Reynolds-Jackson and 1 co-sponsor

The bill creates a revamped State Health Benefits Commission to govern SHBP design, pricing, and contracting with strengthened fiduciary duties and transparency.

Introduced, Referred to Assembly Budget Committee
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Bill Summary · A 5337

Overview

A-5337 (Session 222, New Jersey) makes comprehensive changes to the governance and administration of the State Health Benefits Program (SHBP). The bill restructures the governing body, reassigns the plan-design functions, hardens fiduciary duties, and enhances price transparency and cost-management practices. It takes effect immediately.

Main purpose and intent

  • Streamline and strengthen SHBP decision-making, governance, and oversight.
  • Consolidate plan design authority under a revamped State Health Benefits Commission (SHBC).
  • Improve cost management and transparency for health benefits negotiated on behalf of state and participating employers/employees.
  • Provide a clear, timely dispute resolution framework for plan design decisions and impasses.

Key provisions and changes

  • State Health Benefits Commission (SHBC) redesign

    • Expands to 13 voting members plus a non-voting expert member.
    • Composition includes ex officio members (State Treasurer, Commissioner of Banking and Insurance, Chair of Civil Service Commission, Commissioner of Health) and eight additional appointees representing local government, higher education, and various public employee groups, plus a non-AFL-CIO police/firefighter representative and a non-voting expert.
    • Initial term structure: 2–3 year staggered terms; co-chairs designated by subgroups; vacancy rules unchanged for unexpired terms.
    • SHBC will govern the SHBP plan design, benefits, premium setting, and contracting, with authority to create, modify, or terminate plans and set provider reimbursement rates.
    • Requires fiduciary duties akin to ERISA standards; emphasizes prudent management, transparency, and participant interests.
    • Access to information: members may obtain data necessary for plan design, contracting, and premium setting, with processes to request and receive information in a timely, usable format.

  • Plan design and administration reforms

    • Eliminates the prior SHBP Plan Design Committee; its responsibilities and authority transfer to the SHBC.
    • Establishes a mandatory 30-day decision window for the SHBC to resolve matters before it; if unresolved, an arbitrator with subject-matter expertise may be engaged to produce a binding final decision after a defined arbitration process (30 days to resolve, 60 days to issue a final decision, with possible extensions by majority vote).
    • In the event of an impasse, the arbitrator’s decision becomes binding if unresolved within the specified timeframe.

  • Contracting and benefits provisions (highlights)

    • Maintains basic and major medical benefits with specified cost-sharing rules, including deductibles, coinsurance, and annual/total limits.
    • Reimbursement formulas for in-network and out-of-network services are outlined, with references to standardized price data and roles for the program actuary in designing plans.
    • Provides for required coverages including mental health, alcohol use disorder treatments, and other standard health services, subject to negotiated contracts.

  • Price transparency and data reporting

    • Third-party administrators must file data on negotiated reimbursement rates and actual payments.
    • Establishes an Internet-based price transparency dashboard to allow sorting by location, provider, and procedure, including data on out-of-state claims.

  • Miscellaneous

    • The act clarifies procedural rulemaking, audits, claims reviews, and flexibility to manage costs, including actions beyond collective bargaining provisions when necessary to maintain program viability.

Who is affected

  • State and local government employers participating in the SHBP.
  • SHBP participants and their dependents (active employees and retirees).
  • SHBC members, beneficiaries, and contractors (third-party administrators, actuaries, legal counsel).
  • Public employee organizations representing police, firefighters, and other public employees, plus non-AFL-CIO unions involved in SHBP governance.
  • Providers and health care facilities affected by reimbursement rules and plan designs.

Procedural and timeline aspects

  • Effective date: immediate upon enactment.
  • Decision timeline: 30 days for SHBC to resolve matters before it; unresolved matters may go to binding arbitration with defined 60-day arbitration timeline (extendable by majority vote).
  • Annual reporting: SHBC must publish fiscal and plan-related information; maintain price-transparency data.

If you’d like, I can provide a side-by-side comparison with current SHBP governance and a brief summary of potential fiscal impacts.

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

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