OON Implementation Toolkit


The New Jersey Hospital Association’s (NJHA) Out-of-Network Implementation Toolkit (hereinafter “materials”) are intended to be tools that hospitals may use to implement and comply with the “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act.” The information provided in these materials should not be relied upon or regarded as legal advice. No specific representation is made, nor should be implied, nor shall NJHA or any other party involved in creating, producing or delivering this material be liable in any manner whatsoever for any direct, incidental, consequential, indirect or punitive damages arising out of your use of these materials. NJHA makes no warranties or representations, express or implied, as to the accuracy or completeness of the information contained or referenced herein. This publication is provided “AS IS” WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT. Some jurisdictions do not allow the exclusion of implied warranties, so the above exclusion may not apply to you. All images and information contained in these materials are copyrighted and otherwise proprietary. No use of this information is permitted without the prior written consent of NJHA. If you have other questions or concerns, please contact NJHA’s Legal Affairs at 609.275.4089.

NJHA Out-of-Network Implementation Toolkit

Governor Murphy signed the “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” (“OON”) June 1, 2018. The law is effective Aug. 29 and requires general acute care hospitals, satellite emergency departments, hospital-based off-site ambulatory facilities that perform ambulatory surgical procedures and ambulatory surgery facilities to provide certain information to consumers, including making available to the public a listing of the facility’s standard charges for items and services provided, in a form that is consistent with federal guidelines.

While the law provides consumer protections that the New Jersey Hospital Association (NJHA) has long supported, it is important to recognize that the law impacts consumers differently based on the type of insurance they have. The only plans definitively covered by the law are health plans that are fully insured and issued in New Jersey as well as the State Health Benefits Plan and the School Employees’ Health Benefits Plan. In the case of a self-funded plan, the plan sponsor may opt in and elect to subject itself to the law; however, it is not required to opt in. Therefore, the only provisions of the law that apply to members of self-funded plans that have elected not to opt-in are disclosure and arbitration requirements.

This toolkit contains: