NJ S2993

Requires health insurance carriers offering plans on New Jersey's State-based exchange ("Get Covered NJ") to follow the ACA's single-risk-pool rule, pricing each plan based on projected utilization by the entire market risk pool.

Mandates carriers offering individual or small employer health plans at either gold or silver level in a geographic area to offer both gold and silver level plans with the same provider network in that area.

Establishes silver plan pricing requirements: for 2026 rates, carriers must base prices on the statewide distribution of silver-tier enrollees among cost sharing reduction variants from 2022; for rates after 2026, carriers must assume enrollees will have plans with 90 percent actuarial value.

Permits carriers to transfer members from silver to gold level plans without affirmative member choice if the gold plan has the same network, higher actuarial value, lower premium, and proper notice is provided with opt-out options.

Takes effect immediately and applies to health benefits plans delivered, issued, or renewed on or after January 1, 2026.