New Jersey § 52:14-17

§ 52:14-17.

a. The School Employees' Health Benefits Commission shall publish annually, at least

30 days prior to the commencement of the open enrollment period for that year, a report

showing the fiscal transactions of the program for the preceding calendar year and

stating other facts pertinent to the program and all participating employers. b. At the same time as the annual report is published, the commission shall publish

an audit report of the program's costs and the aggregate usage of plan participants

during the preceding calendar year, which audit shall be prepared by a qualified independent

auditor selected by the commission in accordance with applicable laws regarding selection

of auditing services. The independent auditor shall include in its report specific recommendations that

are projected to result in cost savings to the State and to participating employers. The specific recommendations to be submitted in the annual audit report shall include,

but not be limited to, savings achievable through disease management, prescription

benefit management, and elimination of administrative and program inefficiencies. In addition, the annual audit may recommend changes to the benefits provided under

the School Employees' Health Benefits Program that improve the overall ability to

retain and attract eligible employees. c. The commission shall submit the annual report and annual audit report to the Governor

and the Legislature, and shall make these reports available to every participating

employer. d. At the start of the fifth year following the initial appointment of all of its

members, and at the start of every fifth year thereafter, the commission shall contract

with an independent, qualified auditor, separate from the person performing the annual

audit described in subsection b. of this section, for a comprehensive review and audit

of all elements of the program, as well as the plan design and structure for each

plan offered by the commission. The auditor shall be qualified by experience, training, resources, and education

to perform intensive audits of public health insurance plans that are of a similar

size and scope and shall be familiar with benefit designs of employers that are eligible

but do not participate in the commission. The auditor shall be selected in accordance with applicable law. e. Each fifth year review and audit shall be the annual audit for that year and the

review shall include all of the elements contained in the annual audit plus the additional

reviews set forth in this subsection. In addition to performing the tasks of the annual audit, the auditor selected for

a fifth year review shall review the program costs, plan design, and plan structure

and may issue recommendations for cost sharing measures, including modifications of

co-payments, deductibles, out-of-pocket maximums, limits, exclusions, and other measures

to be considered for implementation by the commission. The commission is authorized to implement such recommendations pursuant to majority

vote of the full authorized membership of the commission. The commission shall submit the five-year review and audit report to the Governor

and the Legislature and shall make the report available to every participating employer.