NJ S1278

Public employers participating in the State Health Benefits Program (SHBP) or School Employees' Health Benefits Program (SEHBP) may request complete claims experience data once per calendar year, changed from the previous 24-month period

Majority representatives of public employees may request and receive the claims data within 15 days if the public employer has already requested it

Claims data must include 26 specific categories of information, including medical loss ratio reports, group census data, top 20 diagnoses by amount paid, network utilization reports, and detailed prescription claims information

Prescription data requirements include top 50 drugs by number dispensed and by total dollars paid, rebate reports, utilization summaries, and trend performance summaries for each plan design

All data releases must comply with HIPAA privacy requirements and cannot be released in any form that would identify individuals or adversely affect personal privacy rights