LEGISLATIVE FISCAL ESTIMATE

SENATE, No. 4660

STATE OF NEW JERSEY

221st LEGISLATURE

DATED: JUNE 30, 2025

SUMMARY

Synopsis:	Promotes equity in health insurance appeal process.
Type of Impact:	Annual reduction in State revenue.
Agencies Affected:	Department of Banking and Insurance.

Office of Legislative Services Estimate
Fiscal Impact	Annual
State Revenue Reduction	Indeterminate

· The Office of Legislative Services (OLS) determines that the bill result in an indeterminate annual decrease in State revenues based on the elimination of the $25 fee related to appeals against insurance carriers.

· Existing regulations provide fee waivers for any successful appeal.  In additional, participants in Pharmaceutical Assistance to the Aged and Disabled, Medicaid/NJ FamilyCare, General Assistance, Supplemental Security Income, or New Jersey Unemployment Assistance are also granted fee waivers.  The revenue decrease could be estimated as the average annual number of unsuccessful appeals, adjusted for membership in excluded programs, multiplied by $25.  The OLS does not have access to the historical appeals data required to make an accurate estimate.

BILL DESCRIPTION

      This bill eliminates fees for appeals against health insurance carriers pursuant to the Independent Health Care Appeals Program.  This bill is in response to the Governor’s Fiscal Year 2026 budget recommendations to enact legislation to permanently eliminate fees for consumer appeals against insurance carriers that deny, reduce, or terminate benefits.

FISCAL ANALYSIS

EXECUTIVE BRANCH

      None received.

OFFICE OF LEGISLATIVE SERVICES

      The OLS determines that the bill will result in an indeterminate annual decrease in State revenues based on the elimination of the $25 fee related to appeals against insurance carriers. 

      Existing regulations provide for a fee waiver for any successful appeal.  The fee is also waived for any participant in Pharmaceutical Assistance to the Aged and Disabled, Medicaid/NJ FamilyCare, General Assistance, Supplemental Security Income, or New Jersey Unemployment Assistance.  Given these exceptions, the potential reduction to State revenue is limited to a subset of unsuccessful appeals.  The revenue decrease could be estimated as the average annual number of unsuccessful appeals, adjusted for membership in excluded programs, multiplied by $25.  The OLS does not have access to the historical appeals data required to make an accurate estimate.

Section:	Commerce, Labor and Industry
Analyst:	John Gaudioso Associate Fiscal Analyst
Approved:	Thomas Koenig Legislative Budget and Finance Officer

This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.

This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).