A 3972 New Jersey General Assembly · 2024-2025 Regular Session

Makes certain changes to calculation of minimum loss ratio requirements for health benefits plans in individual and small employer markets.

This bill changes how health insurers in New Jersey calculate their minimum loss ratio requirement for individual and small employer health plans. It requires insurers to maintain at least 80% of premiums spent on claims and quality improvements, calculated using a three-year rolling average instead of annual figures. The law specifies that the numerator must include claims paid plus quality improvement spending, excludes new taxes from the calculation, and mandates that insurers issue rebates if the loss ratio falls below 80%. This applies to all health insurance carriers selling plans in New Jersey's individual and small-group markets.
Sub-Topics: Insurance
Bill status in committee 1 of 4 stages cleared
Introduction
Mar 2024
Committee Review
Floor Vote
Governor
Introduced Mar 4, 2024 Last action Jun 28, 2024
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What changed between versions

Reprint AHE 3/14/24 → Reprint AFI 6/13/24 2R · 4 edits
MODERATE
The bill moved from the Assembly Health Committee to the Assembly Financial Institutions and Insurance Committee, signaling a shift in jurisdictional focus from health policy to insurance regulation. The most substantive amendment removes a reference to a specific pending companion bill (P.L. , c. ) from the tax exclusion provision in subsection (e), making that provision no longer tied to a particular legislative act. Additional co-sponsors were added and minor structural edits were made to the list of requirements.
SCOPE

The bill was reassigned from the Assembly Health Committee to the Assembly Financial Institutions and Insurance Committee, shifting its primary jurisdictional focus from health policy to insurance regulation.

Assemblywomen Sumter and Bagolie were added as co-sponsors, expanding the bill's legislative support base.

REQUIREMENT

In subsection (e), the specific reference to a pending companion bill ('P.L. , c. (C. ) (pending before the Legislature as this bill)') was removed from the provision excluding new or increased state and federal taxes from premium calculations for minimum loss ratio purposes. The provision now reads 'enactment of shall be excluded,' removing the tie to a specific legislative act.

TECHNICAL

Structural edits to the list of requirements: an 'and' was added at the end of subsection (a), and bracketed punctuation changes were made in subsections (b) and (e), suggesting reorganization of how the enumerated requirements connect to each other.

Floor votes

How they voted

No floor votes recorded yet.
Full legislative history

Actions timeline

Total actions
5
Key actions
1
Committee
3
Jun 13, 2024
Lower · Passed
Reported out of Assembly Committee with Amendments, 2nd Reading
lower
Mar 14, 2024
Committee
Reported out of Assembly Committee with Amendments and Referred to Assembly Financial Institutions and Insurance Committee
lower
Mar 14, 2024
Committee
Transferred to Assembly Health Committee
lower
Mar 4, 2024
Introduced
Introduced in the Assembly, Referred to Assembly Financial Institutions and Insurance Committee
lower
3 primary · 3 co-sponsors

Sponsors