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Bill

Bill

A 3150

"The New Jersey Healthcare Choice Act"; permits health insurers licensed in other states to provide coverage in New Jersey under certain circumstances.

2026-2027 Regular Session Introduced by John DiMaio and 3 co-sponsors

Allows foreign health insurers to offer individual and small employer plans in New Jersey under state oversight and consumer protections.

Introduced, Referred to Assembly Financial Institutions and Insurance Committee
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WeVote Research Nonpartisan
Bill Summary · A 3150

Overview

  • Bill: A 3150
  • Session: 222
  • Jurisdiction: New Jersey
  • Title: The New Jersey Healthcare Choice Act
  • Purpose: Allow foreign (out-of-state) health insurers to offer individual and small employer health benefit plans to New Jersey residents and employers under specified conditions, with state-level oversight by the Commissioner of Banking and Insurance.

Main purpose and intent

  • Expand the range of health insurance options available to New Jersey residents and small employers by permitting health insurers licensed in other states to provide coverage in New Jersey.
  • Maintain consumer protections and regulatory oversight to ensure plans offered by foreign insurers meet New Jersey standards and are backed by guaranty associations and fair marketing practices.

Key provisions and changes

  • Definitions (Section 2)

    • Establishes terms for the act, including “foreign health insurer,” “foreign individual health insurer,” “foreign small employer health insurer,” “hazardous financial condition,” and consumer-facing terms such as “resident,” “individual health benefits plan,” and “small employer health benefits plan.”

  • Authorization for foreign insurers to offer coverage (Section 3)

    • Foreign individual health insurers may offer and provide individual health benefits plans to New Jersey residents if: 1) They offer the same plans in their domiciliary state and comply with its laws. 2) They obtain a certificate of authority to operate as a foreign health insurer in New Jersey. 3) They participate, on a nondiscriminatory basis, in the New Jersey Life and Health Guaranty Association (NJLHGA).
    • Foreign small employer health insurers may offer and provide small employer plans to New Jersey employers if they: 1) Offer the same plans in their domiciliary state and comply with its laws. 2) Obtain the certificate of authority. 3) Participate, on a nondiscriminatory basis, in the NJLHGA.

  • Certificate of authority process (Section 4)

    • Foreign health insurers may apply for a New Jersey certificate of authority using a commissioner-prescribed form.
    • The commissioner must grant the certificate unless it is determined that the insurer:
    • Will not provide compliant health insurance services,
    • Is in a hazardous financial condition (per NAIC standards),
    • Has not adopted procedures to ensure compliance with federal and New Jersey confidentiality laws.
    • Certificate validity: 3 years.
    • The commissioner will regulate renewal procedures and set application/renewal fees (not to exceed what is reasonably necessary to administer the act).

  • Consumer disclosures (Section 5)

    • Individual plans: Must disclose, in plain language (14-point bold type), how the foreign plan differs from New Jersey’s existing programs (underwriting, premiums, preexisting conditions, renewability, portability, cancellation) and which state’s laws govern issuance and requirements.
    • Small employer plans: Similar disclosures comparing the foreign plan to New Jersey’s Small Employer Health Benefits Program and identifying governing laws.

  • Compliance, oversight, and consumer protections (Section 6)

    • The commissioner may deny, revoke, or suspend a foreign insurer’s certificate for violations, with a right to appeal.
    • Establishes grievance and independent claims review procedures for claims by providers or covered persons (aligning with existing Independent Health Care Appeals Program rules).
    • Sets fair marketing standards for:
    • Individual plans (consistent with standards for NJ’s Individual Health Coverage Program).
    • Small employer plans (consistent with NJ’s Small Employer Health Benefits Program).
    • These standards must be applied nondiscriminatorily relative to other carriers.

  • Additional consumer and financial protections (Section 7)

    • Foreign insurers must comply with:
    • Unfair claims or trade practices protections (N.J. trade practices law).
    • New Jersey Life and Health Guaranty Association requirements.
    • Capital and surplus requirements as determined applicable by the commissioner (per state law).

  • Regulatory framework (Section 8)

    • The Department of Banking and Insurance will adopt regulations to implement the act.
    • Regulations must not:
    • Force foreign insurers to modify coverage, benefits, underwriting, or premium ratings in ways that conflict with their domiciliary state laws.
    • Expand the commissioner’s authority beyond the act’s provisions compared to existing law.
    • Require foreign plans to be countersigned by New Jersey agents/brokers.

  • Effective date (Section 9)

    • The act takes effect on the 180th day after enactment.

Who and what is affected

  • Affected entities:
    • Foreign health insurers (both individual and small employer) seeking authority to operate in New Jersey.
    • New Jersey residents seeking individual health coverage.
    • New Jersey employers seeking small employer health benefits plans.
    • New Jersey Life and Health Guaranty Association and related complaint/grievance processes.
    • New Jersey Department of Banking and Insurance (regulator and rulemaker).
  • Affected consumers:
    • Increased plan options from out-of-state insurers, subject to disclosures and protections.
    • Protections include access to NJ grievance processes, adherence to NJ guaranty association, and fair marketing standards.

Procedural and timeline aspects

  • Application and certification:
    • Foreign insurers must apply for a certificate of authority; certificate valid for three years with renewal procedures and fees to be established by regulation.
  • Oversight and enforcement:
    • Commissioner can deny, suspend, or revoke certificates for noncompliance, with appeal rights.
    • Grievance and independent claims review procedures are required.
  • Regulatory adoption:
    • The Department must adopt implementing regulations under the Administrative Procedure Act.
  • Effective date:
    • 180 days after enactment.

Potential impact and considerations

  • Access and competition: Likely broadened access to more health plan options for New Jersey residents and small employers, potentially increasing competition and influencing pricing.
  • Consumer protections: Maintains state protections through disclosures, guaranty association participation, and established complaint/review processes.
  • Regulatory balance: Seeks to balance allowing out-of-state insurers to operate with New Jersey’s regulatory standards, while limiting overreach by the state regulator and preserving domiciliary-state compliance.

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

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