New Jersey § 52:14-17

§ 52:14-17.

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

may have enrolled at the employee's option , the State, from funds appropriated therefor, shall pay its share of the premium or periodic charges for the benefits provided under the contract purchased by the commission pursuant to subsection a. of section 4 of P.L.1961, c.

49 ( C.52:14-17.28 ) . An employee may, on an optional basis, enroll the employee's dependents for coverage

under the contract subject to such regulations and conditions as the commission and

the carrier may prescribe. b. There is hereby created a health benefits fund. Said fund shall be used to pay the premiums or periodic charges for which the State

is responsible under this act. c. 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 State 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 State 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 State 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 State Health Benefits Commission, the State 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 State Health Benefits Commission, the State 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 employees and retirees of the State and employees

and retirees of employers other than the State participating in the program. 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.).