New Jersey § 52:14-17

§ 52:14-17.

a. For each active covered employee and for the eligible dependents the employee may

have enrolled at the employee's option, from funds appropriated therefor, the employer

shall pay to the commission the premium or periodic charges for the benefits provided

under the contract in amounts equal to the premium or periodic charges for the benefits

provided under such a contract covering the employee and the employee's enrolled dependents. b. The obligations of any employer to pay the premium or periodic charges for health

benefits coverage provided under the School Employees' Health Benefits Program Act,

sections 31 through 41 of P.L.2007, c. 103 ( C.52:14-17.46.1 through C.52:14-17.46.11 ), may be determined by means of a binding collective negotiations agreement, including

any agreement in force at the time the employer commences participation in the School

Employees' Health Benefits Program. With respect to employees for whom there is no majority representative for collective

negotiations purposes, the employer may, in its sole discretion, modify the respective

payment obligations set forth in law for the employer and such employees in a manner

consistent with the terms of any collective negotiations agreement binding on the

employer. Commencing on the effective date of P.L.2010, c. 2 and upon the expiration of any applicable binding collective negotiations agreement

in force on that effective date, employees shall pay 1.5 percent of base salary, through

the withholding of the contribution, for health benefits coverage provided under P.L.2007, c. 103 ( C.52:14-17.46.1 et seq. ), notwithstanding any other amount that may be required additionally pursuant to

this subsection by means of a binding collective negotiations agreement or the modification

of payment obligations. c. There is hereby established a School Employee Health Benefits Program fund consisting

of all contributions to premiums and periodic charges remitted to the State treasury

by participating employers for employee coverage. All such contributions shall be deposited in the fund and the fund shall be used

to pay the portion of the premium and periodic charges attributable to employee and

dependent coverage. d. The fund shall contain a dedicated subaccount reserved for payment of claims and other

health services fees for covered health services and prescription drug benefits provided

to covered employees and their enrolled eligible dependents. No person shall use or authorize the use of the assets in the subaccount, or the

investment earnings thereon, for any purpose other than for the provision of benefits

in accordance with the terms of the School Employees' Health Benefits Program and

for defraying the reasonable costs of administering the subaccount. A third-party medical claims reviewer, procured pursuant to section 2 of P.L.2019, c. 143 ( C.52:14-17.30b ), shall, in the performance of services for the program, act in the best interests

of the State, participating employers, and covered employees and their enrolled eligible

dependents. Nothing in this subsection shall be construed as subjecting the program, its plans,

the State, or any participating employer to the provisions of the “Employee Retirement

Income Security Act of 1974” ( 29 U.S.C. s.1001 et seq. ). The third-party medical claims reviewer shall collect, store and maintain a secure

archive of medical and prescription drug claims data and other health services payment

information and provide such data and other reports in compliance with applicable

State and federal laws, including the “Health Insurance Portability and Accountability

Act of 1996,” Pub.L.104-191 , to document the cost and nature of claims incurred, demographic information on the

covered population, emerging utilization and demographic trends, and such other information

as may be available to assist in the governance of the program and in timely response

to any requests from the Governor, the State Treasurer, the Division of Pensions and

Benefits, the School Employees' Health Benefits Commission, the School Employees'

Health Benefits Plan Design Committee, the President of the Senate, and the Speaker

of the General Assembly. Such claims data shall include, but not be limited to, for each claim, the claim

number, provider information, amount charged, amount paid, and the Current Procedural

Terminology (CPT) code. The School Employees' Health Benefits Commission, the School Employees' Health Benefits

Plan Design Committee, the State Treasurer, or the Division of Pensions and Benefits

may direct the third-party medical claims reviewer to provide appropriate medical

and prescription drug claims and other health services payment data to a health care

services provider or other authorized entity, in compliance with applicable State

and federal laws, including the “Health Insurance Portability and Accountability Act

of 1996,” Pub.L.104-191 , for the specific purpose of improving the quality and value of health care services

delivered to program participants. The State Treasurer shall deposit into the subaccount the moneys necessary to accomplish

the purposes of this subsection, including moneys paid by employers participating

in the program, and contributed by covered employees and retirees. Deposits and contributions to the subaccount shall be applied to the distribution

of payments for the costs of health care services and prescription drug benefits and

to fund the reasonable costs of administering the subaccount. Assets in the subaccount shall be expended or withdrawn, and deposits and withdrawals

shall be reconciled, in accordance with regulations and procedures adopted pursuant

to this subsection. Moneys in the subaccount shall be invested in permitted investments or shall be held

in interest-bearing accounts in such depositories as the State Treasurer may select,

and may be invested and reinvested in permitted investments or invested and reinvested

in the same manner as other accounts in the custody of the State Treasurer as provided

by law. All interest or other income or earnings derived from the investment or reinvestment

of moneys in the subaccount shall be credited thereto and shall be determined on an

aggregate basis for all participating employers. The State Treasurer shall adopt, pursuant to the “Administrative Procedure Act,” P.L.1968,

c. 410 ( C.52:14B-1 et seq. ), such rules and regulations as may be necessary to implement the provisions of this

act, P.L.2019, c. 143 ( C.52:14-17.30a et al.). e. Notwithstanding any law to the contrary and except as provided by amendment by P.L.2010, c. 2 , and by P.L.2011, c. 78, the payment in full of premium or periodic charges for eligible retirees and their

dependents pursuant to section 3 of P.L.1987, c. 384 ( C.52:14-17.32f ), section 2 of P.L.1992, c. 126 ( C.52:14-17.32f1 ), or section 1 of P.L.1995, c. 357 ( C.52:14-17.32f2 ) shall be continued without alteration or interruption and there shall be no premium

sharing or periodic charges for certain school employees in retirement once they have

met the criteria for vesting for pension benefits, which criteria for purposes of

this subsection only shall mean the criteria for vesting in the Teachers' Pension

and Annuity Fund. For purposes of this subsection, “ premium sharing or periodic charges ” shall mean payments by eligible retirees based upon a proportion of the premiums

for health care benefits.