Requires employees who do not select or waive coverage to be enrolled in lowest cost SHBP or SEHBP health plan.

2026-2027 Regular Session

Automatically enroll non-selecting SHBP/SEHBP employees in the lowest-cost plan available, with coverage and notices managed by administrators.

Summary of Bill A-5226 (Session 222, New Jersey)

Purpose and intent

This bill focuses on how health insurance is offered and assigned to state or school employee benefit programs (SHBP and SEHBP). It aims to ensure that employees who do not actively select or waive coverage are enrolled in a health plan that is the lowest-cost option available within SHBP or SEHBP.

Key provisions and changes

Automatic enrollment for non-selecting employees:

Employees who do not affirmatively choose to enroll in SHBP/SEHBP coverage or who do not submit a waiver form must be enrolled in the lowest-cost health plan offered by SHBP or SEHBP.

Plan selection criteria:

The enrollment must be in the lowest-cost plan available to the employee within the respective program (SHBP or SEHBP). The bill specifies that the selection is based on the pricing and coverage offered by the plans at the time of enrollment.

Coverage and benefits:

The enrolled employee would receive the benefits and coverage associated with the lowest-cost plan, subject to the standard terms, conditions, and network requirements applicable to that plan.

Documentation and notices:

Agencies or administrators administering SHBP/SEHBP would be required to implement processes to identify non-selecting employees and execute automatic enrollment into the lowest-cost plan. This includes appropriate notices and record-keeping to reflect the enrollment action.

Who is affected

Employees covered under the SHBP (State Health Benefits Program) and SEHBP (School Employee Health Benefits Program) who do not actively select or waive coverage.

State and school district employers responsible for administering SHBP/SEHBP enrollments and ensuring compliance with the automatic enrollment requirement.

Plan administrators within SHBP/SEHBP who manage enrollment and pricing for available health plans.

Procedural and timeline considerations

Implementation mechanics:

The bill requires administrative procedures to identify non-selecting individuals, determine the lowest-cost eligible plan, and complete automatic enrollment.

Effective date:

The bill would specify an effective date for the automatic enrollment provisions once enacted; details such as phase-in periods or transition timelines would be defined in the enacted text.

Waivers and opt-out:

While not explicitly detailed in this summary, the bill centers on individuals who do not select or waive coverage; implications for opt-out rights or alternative coverage details would be defined in the final text.

Potential impact

Cost containment for SHBP/SEHBP:

By enrolling non-selecting employees into the lowest-cost plan, the programs may better manage overall premium costs.

Employee choice considerations:

Employees who do not actively choose coverage would still receive health benefits, but their plan would be the lowest-cost option, which may differ in deductibles, co-pays, and network access from plans an employee might have preferred.

Administrative workload:

Increased administrative processes to identify non-participants and perform automatic enrollments, with required record-keeping and notices.

Notes

Specific dollar amounts, exact plan names, eligibility criteria, opt-out provisions, and transition timelines will be detailed in the enacted bill text. This summary reflects the core aims and structural changes proposed by A-5226 as described.