STATE OF NEW JERSEY
222nd LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Senator VINCENT J. POLISTINA
District 2 (Atlantic)
Co-Sponsored by:
Senator Tiver
SYNOPSIS
Establishes special enrollment period for individual health plan enrollees and dependents when health care providers become out-of-network.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning special enrollment periods and amending P.L.2019, c.357.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.2019, c.357 (C.17B:27A-6.1) is amended to read as follows:
1. a. Notwithstanding the provisions of any other law, rule or regulation to the contrary, the board of the New Jersey Individual Health Coverage Program established pursuant to section 9 of P.L.1992, c.161 (C.17B:27A-10) shall establish, by regulation, an annual open enrollment period during which time individuals are permitted to enroll in an individual health benefits plan and individuals who already have coverage may replace current coverage. During any plan year in which the State is on the federally-facilitated exchange, the annual open enrollment period shall conform to federal requirements, unless the State is permitted to offer a longer open enrollment period. During any plan year in which the State operates a State-based exchange, the open enrollment period shall be set by New Jersey's State-based exchange and shall not be less than 90 days.
b. (1) The board shall establish a special enrollment period for an enrollee if a health care provider of an enrollee or a dependent becomes out-of-network during the enrollee’s current plan period.
(2) The enrollment period described pursuant to paragraph (1) of this subsection shall be determined by the board and shall not be less than 30 calendar days.
(3) Information about the enrollment period described pursuant to this subsection, including the start and end dates, shall be communicated to enrollees by the carrier.
(cf: P.L.2019, c.357, s.1)
2. This act shall take effect on the 90th day next following enactment and shall apply to plans that are delivered, issued, executed, or renewed on or after that date.
STATEMENT
This bill establishes a special enrollment period for individual health plan enrollees when their health care providers become out-of-network.
Under the bill, the board of the New Jersey Individual Health Coverage Program is required to establish a special enrollment period for a covered person whose health care provider, after participating in the covered person’s health benefits plan network, becomes out-of-network during the covered person’s policy or contract period. The special enrollment period is to last for a certain period of time to be determined by the board, not to be shorter than 30 days. Finally, the carrier is required to provide information about the enrollment period to affected individuals.