This bill requires New Jersey automobile insurers to reimburse ambulatory surgical centers (ASCs) for certain services at 300% of the Medicare Part B payment rate - instead of current rates - if the service isn't already listed in the state's medical fee schedule. It also mandates that unlisted medical supplies used with these services be reimbursed at invoice cost plus 20%. The policy directly affects ASCs and insurers by establishing a standardized, higher reimbursement rate for uncovered ASC services, aligning with Medicare guidelines. This change aims to ensure ASCs receive fair compensation for services not previously covered under insurer fee schedules.
This bill requires all health insurance plans in New Jersey - including employer-sponsored plans (SHBP/SEHBP) and state programs (NJ FamilyCare) - to cover qualified sign language interpreter services during medical appointments for individuals who are deaf or hard of hearing. It mandates coverage for in-person interpreters or video remote services when in-person options are unavailable, with specific safety exceptions (e.g., prohibiting family interpreters in suspected domestic violence or child abuse cases). Insurers must cover these services at the same level as other medical expenses, and interpreters must be certified by New Jersey’s Registry of Interpreters for the Deaf or an approved organization. The bill directly affects deaf and hard of hearing residents seeking medical care by ensuring access to communication support during health encounters.
This bill requires health insurance plans covering groups of 50+ people to cover preimplantation genetic testing (PGT) when performed alongside in vitro fertilization (IVF) to prevent serious genetic conditions from being passed to offspring. It applies only when specific medical criteria are met, such as both partners being carriers of certain genetic disorders or a history of a child with a genetic condition. Insurance plans must cover these services at the same level as other pregnancy-related care, but religious employers can opt out if coverage conflicts with their beliefs. The law directly affects insurance providers and individuals seeking IVF with PGT for defined genetic prevention purposes.
This bill (S 2871) requires most health insurance plans sold in New Jersey to cover screening for Alzheimer's disease and related disorders for people aged 65 or older. It applies to hospital service corporations, medical service corporations, health service corporations, individual health insurance policies, group health plans, health benefits plans, and health maintenance organizations (HMOs) issued or renewed in the state. The coverage must be provided at the same level as other medical conditions, without additional cost-sharing, and defines "Alzheimer's and related disorders" as dementia impairing daily functioning. This policy change directly affects seniors enrolled in these insurance plans and aims to improve early detection access.
This bill (S 963) requires New Jersey health insurance carriers to provide policyholders with simplified "explanation of benefits" (EOB) forms for every claim. The first page of each form must clearly list the insured's name, provider, service date, claim amount, payments made by the insurer and the patient, and plain-language explanations for payment decisions or denials. It mandates all information be in 12-point font using simple, understandable language - avoiding jargon - consistent with New Jersey's existing insurance policy simplification law. The bill directly affects health insurers (who must implement the changes) and policyholders (who receive clearer, more transparent billing information). If passed, it would take effect 90 days after enactment.
This bill requires New Jersey health insurers to collect and publicly report detailed data on claims processed through automated systems, directly affecting insurers and their covered patients. Insurers must annually disclose statistics on claim denials (including appeals outcomes and specialty-specific denial patterns), rejection rates by medical reviewers, and average review times on their websites. A key provision penalizes insurers that deny 20% or more of claims without justification by requiring them to refund denied service costs to affected patients. The bill also mandates that medical directors reviewing claims include denial rates and consumer assistance instructions on all denial notices. These requirements aim to increase transparency in automated claim review processes.
This bill (S 2672) requires all health insurance plans in New Jersey - including hospital service corporations, medical service corporations, individual policies, group plans, and health maintenance organizations - to cover planned home childbirth costs. It mandates coverage for services provided by healthcare providers (like midwives, nurses, and doctors), doulas, and necessary medical equipment, at the same level as other covered medical services. The law applies to all insurance contracts issued or renewed in New Jersey after its effective date, regardless of whether premiums can be adjusted. This directly affects insurance companies and Medicaid by expanding coverage options for individuals choosing home births.
S 855, "Michelle's Law," requires all health insurance plans in New Jersey to cover mammograms when recommended by a healthcare provider. It mandates coverage for a baseline mammogram at age 40, annual mammograms for women 40 and older, and mammograms for women under 40 with specific risk factors (like family history or dense breast tissue) as determined by their doctor. The law also requires coverage for additional tests like ultrasounds or MRIs after a mammogram if medically necessary due to breast density, abnormal results, or other risk factors. Insurance companies may review the medical necessity of these additional tests but cannot deny coverage for recommended screenings. This applies to all group and individual health insurance plans sold in New Jersey.
This bill requires health insurance plans covering groups of 50+ people in New Jersey to include infertility treatment coverage. It mandates coverage for specific services like IVF, embryo transfer, medications, and up to four egg retrievals per person, with limitations for certain procedures (e.g., IVF only after trying less expensive options and under age 45). Religious employers may opt out of covering some procedures (like IVF) if it conflicts with their beliefs, but must provide clear written notice in 10-point font. The law applies to hospital and medical service corporation contracts but excludes Medicaid programs like NJ FamilyCare. It aims to standardize infertility coverage under existing pregnancy-related benefit rules.
S 959, the "New Jersey Respect for Physicians Act," requires health insurance companies to respond to doctors' and hospitals' requests for prior authorization of medical services within strict timeframes. For most cases (inpatient or outpatient care), insurers must approve or deny requests within 48 hours - reducing the previous 15-day deadline - and must contact providers by phone within 4 hours to discuss the request. If insurers miss these deadlines, the service is automatically approved, and insurers must pay for the care. The bill directly affects healthcare providers seeking authorization and insurance companies handling those requests, aiming to reduce delays in patient care.
