Bill Text: NJ A2214 | 2012-2013 | Regular Session | Introduced
Bill Title: Requires dental benefits coverage for dental composite restorations.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2013-09-20 - Reviewed by the Pension and Health Benefits Commission Recommend not to enact [A2214 Detail]
Download: New_Jersey-2012-A2214-Introduced.html
Sponsored by:
Assemblyman REED GUSCIORA
District 15 (Hunterdon and Mercer)
SYNOPSIS
Requires dental benefits coverage for dental composite restorations.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning coverage for certain dental services and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Every dental service corporation contract that is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance pursuant to P.L.1968, c.305 (C.17:48C-1 et seq.), on or after the effective date of this act, shall provide coverage to any covered person for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
2. Every certificate of authority to establish and operate a dental plan organization pursuant to P.L.1979, c.473 (C.17:48D-1 et seq.), issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage to any covered person for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
3. Every health service corporation contract providing dental expense benefits that is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), on or after the effective date of this act, shall provide coverage to any covered person for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
4. Every individual health insurance policy providing dental expense benefits that is delivered, issued, executed or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage to any covered person for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
5. Every group health insurance policy providing dental expense benefits that is delivered, issued, executed or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage to any covered person for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
6. Every certificate of authority to establish and operate a health maintenance organization in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act, which provides coverage to any covered person for dental expense benefits shall provide coverage for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
7. The Commissioner of Human Services shall ensure that every contract for health care services under the Medicaid program pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the NJ FamilyCare Program pursuant to P.L.2005, c.156 (C.30:4J-8 et seq.), entered into on or after the effective date of this act, and that the fee-for-service Medicaid program on or after the effective date of this act, provide benefits to any recipient or other covered person for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
8. a. Every policy of private passenger automobile insurance delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, which includes medical expense benefits as part of personal injury protection coverage pursuant to section 4 of P.L.1972, c.70 (C.39:6A-4) or section 4 of P.L.1998, c. 21 (C. 39:6A-3.1), shall provide coverage to any covered person for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
b. In establishing by regulation the basic medical expense benefits which shall be included in a policy of private passenger automobile insurance pursuant to section 4 of P.L.1972, c.70 (C.39:6A-4) or section 4 of P.L.1998, c.21 (C.39:6A-3.1), the commissioner shall include coverage for any covered person for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
9. The State Health Benefits Commission shall ensure that every contract purchased or renewed by the commission, on or after the effective date of this act that provides benefits to any covered person for dental services, shall provide coverage for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
10. The School Employees' Health Benefits Commission shall ensure that every contract purchased or renewed by the commission, on or after the effective date of this act that provides benefits to any covered person for dental services, shall provide coverage for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee.
11. This act shall take effect on the 180th day next following enactment.
STATEMENT
This bill requires coverage for dental composite restorations at the basic service percentage level of the usual, customary and reasonable fee under dental service corporation and dental plan organization contracts approved for issuance or renewal in this State by the Commissioner of Banking and Insurance. The same coverage would be required under all health benefits plans providing dental expense benefits issued by health insurance carriers, such as health service corporations, individual and group health insurer, health maintenance organizations, the State Health Benefits Plan, and the School Employees' Health Benefits Plan. It would also require the same coverage under the medical expense benefits portion of basic and standard private passenger automobile insurance policies, and, finally, under contracts for health care services under the Medicaid and NJ FamilyCare Programs and the fee-for-service Medicaid program.
While dental amalgam is a safe and effective dental restorative material that has been used for more than 150 years, the reduction of products that contain mercury, including dental amalgam, is beneficial to the environment. Certain dental composite restorative materials exist in the marketplace today which do not contain mercury; however, the costs are greater than those of dental amalgam. Because of this, in most instances, dental plans and health insurance carriers have chosen not to cover the additional costs associated with dental composite restorative materials, which in turn promotes the continued use of dental amalgam. In order to ensure greater use of dental composite restorative materials among the citizens of the State, this bill requires dental and health benefits plan coverage of dental restorative materials whenever dental expense benefits are provided.
