Bill Text: NJ A4654 | 2024-2025 | Regular Session | Amended
Bill Title: Requires health benefits coverage for family planning and reproductive health care services, including early infancy care, without cost sharing.
Spectrum: Partisan Bill (Democrat 7-0)
Status: (Engrossed) 2024-09-19 - Received in the Senate, Referred to Senate State Government, Wagering, Tourism & Historic Preservation Committee [A4654 Detail]
Download: New_Jersey-2024-A4654-Amended.html
Sponsored by:
Assemblywoman LISA SWAIN
District 38 (Bergen)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
SYNOPSIS
Requires health benefits coverage for family planning and reproductive health care services, including early infancy care, without cost sharing.
CURRENT VERSION OF TEXT
As reported by the Assembly Budget Committee on June 26, 2024, with amendments.
An Act concerning health benefits coverage and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A contract that provides hospital or medical expense benefits and is delivered, issued, executed, or renewed in this State by a carrier or is 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 for family planning and reproductive health care services as set forth in this section, when the services are provided by in-network health care providers.
b. A contract subject to this section shall not impose a deductible, coinsurance, copayment, or any other cost sharing requirement on the coverage required under this section. For a qualifying high-deductible health plan for a health savings account, the carrier shall establish the plan's cost sharing for the coverage provided pursuant to this section at the minimum level necessary to preserve the covered person's ability to claim tax-exempt contributions and withdrawals from the covered person's health savings account under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223).
c. Notwithstanding the provisions of subsections a. and b. of this section to the contrary, if the Commissioner of Banking and Insurance concludes that enforcement of this section may adversely affect the allocation of federal funds to this State, the commissioner may grant an exemption to the requirements of this section, but only to the minimum extent necessary to ensure the continued receipt of federal funds.
d. This section shall not apply to any coverage subject to an exclusion granted to a religious employer pursuant to section 3 of P.L.2021, c.375 (C.26:2S-39).
e. As used in this section:
"Abortion" means any medical treatment intended to induce the termination of a pregnancy and services rendered to facilitate the termination which may include follow-up care, except for the purpose of producing a live birth. "Abortion" includes, but is not limited to, "aspiration abortion" and "medication abortion," as defined in this subsection.
"Aspiration abortion" means a procedure that terminates a pregnancy utilizing manual or electric suction to empty the uterus.
"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State.
"Family planning and reproductive health care services" means essential health benefits for maternity and newborn care pursuant to P.L.2019, c.354 (C.17B:27A-7.26 et al.) and shall include the following services:
(1) abortion;
(2) emergency services, which shall mean medical screening, examination, and evaluation for mothers and newborns by a physician and surgeon, or, to the extent permitted by applicable law, by other appropriate licensed persons under the supervision of a physician and surgeon, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment, and surgery, if within the scope of that person's license, necessary to relieve or eliminate the emergency medical condition, within the capability of the facility;
(3) family planning counseling, which shall mean comprehensive reproductive health care services, including contraception, pregnancy detection, and options counseling;
(4) family planning lab tests, including genetic testing and coverage for patients to see a licensed genetic counselor;
(5) inpatient hospital care, laboratory, and x-ray services for mothers' prepartum and postpartum care and for newborns; 1[and]1
(6) well-baby medical care1; and
(7) ultrasound testing1.
"Family planning and reproductive health care services" shall not include child birth.
"Medication abortion" means the use, prescription, order, dispensing, administration, or any combination thereof as applicable, of a medication or a combination of medications to induce termination of pregnancy.
2. a. Notwithstanding any State law or regulation to the contrary, the Department of Human Services shall ensure that expenses incurred for family planning and reproductive health care services as set forth in this section shall be provided with no cost sharing to persons served under the State Medicaid and NJ FamilyCare programs, when the services are provided by in-network health care providers.
b. Any copayment, coinsurance, or deductible that may be required pursuant to the contract for services covered pursuant to subsection a. of this section shall not apply.
c. The department may take any administrative action necessary to effectuate the provisions of this section, including modifying or amending any applicable contract or promulgating, amending, or repealing any guidance, guidelines, or rules, which rules or amendments thereto shall be effective immediately upon filing with the Office of Administrative Law for a period not to exceed 12 months, and may, thereafter, be amended, adopted or readopted in accordance with the provisions of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).
d. As used in this section:
"Abortion" means any medical treatment intended to induce the termination of a pregnancy and services rendered to facilitate the termination which may include follow-up care, except for the purpose of producing a live birth. "Abortion" includes, but is not limited to, "aspiration abortion" and "medication abortion," as defined in this subsection.
"Aspiration abortion" means a procedure that terminates a pregnancy utilizing manual or electric suction to empty the uterus.
"Family planning and reproductive health care services" means essential health benefits for maternity and newborn care pursuant to P.L.2019, c.354 (C.17B:27A-7.26 et al.) and shall include the following services:
(1) abortion;
(2) emergency services, which shall mean medical screening, examination, and evaluation for mothers and newborns by a physician and surgeon, or, to the extent permitted by applicable law, by other appropriate licensed persons under the supervision of a physician and surgeon, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment, and surgery, if within the scope of that person's license, necessary to relieve or eliminate the emergency medical condition, within the capability of the facility;
(3) family planning counseling, which shall mean comprehensive reproductive health care services, including contraception, pregnancy detection, and options counseling;
(4) family planning lab tests, including genetic testing and coverage for patients to see a licensed genetic counselor;
(5) inpatient hospital care, laboratory, and x-ray services for mothers' prepartum and postpartum care and for newborns; 1[and]1
(6) well-baby medical care1; and
(7) ultrasound testing1.
"Family planning and reproductive health care services" shall not include child birth.
"Medication abortion" means the use, prescription, order, dispensing, administration, or any combination thereof as applicable, of a medication or a combination of medications to induce termination of pregnancy.
3. a. The State Health Benefits Plan and the School Employees' Health Benefits Plan, on or after the effective date of this act, shall provide coverage for family planning and reproductive health care services as set forth in this section, when the services are provided by in-network health care providers.
b. The benefits required pursuant to this section shall be provided without a deductible, coinsurance, copayment, or any other cost sharing requirement on the coverage required under this section. For a qualifying high-deductible health plan for a health savings account, the plans shall establish the plans' cost sharing for the coverage provided pursuant to this section at the minimum level necessary to preserve a member's ability to claim tax-exempt contributions and withdrawals from the member's health savings account under section 223(c)(2)(A) of the Internal Revenue Code (26 U.S.C. s.223).
c. Notwithstanding the provisions of subsections a. and b. of this section to the contrary, if the State Treasurer concludes that enforcement of this section may adversely affect the allocation of federal funds to this State, the State Treasurer may grant an exemption to the requirements of this section, but only to the minimum extent necessary to ensure the continued receipt of federal funds.
d. As used in this section:
"Abortion" means any medical treatment intended to induce the termination of a pregnancy and services rendered to facilitate the termination which may include follow-up care, except for the purpose of producing a live birth. "Abortion" includes, but is not limited to, "aspiration abortion" and "medication abortion," as defined in this subsection.
"Aspiration abortion" means a procedure that terminates a pregnancy utilizing manual or electric suction to empty the uterus.
"Family planning and reproductive health care services" means essential health benefits for maternity and newborn care pursuant to P.L.2019, c.354 (C.17B:27A-7.26 et al.) and shall include the following services:
(1) abortion;
(2) emergency services, which shall mean medical screening, examination, and evaluation for mothers and newborns by a physician and surgeon, or, to the extent permitted by applicable law, by other appropriate licensed persons under the supervision of a physician and surgeon, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment, and surgery, if within the scope of that person's license, necessary to relieve or eliminate the emergency medical condition, within the capability of the facility;
(3) family planning counseling, which shall mean comprehensive reproductive health care services, including contraception, pregnancy detection, and options counseling;
(4) family planning lab tests, including genetic testing and coverage for patients to see a licensed genetic counselor;
(5) inpatient hospital care, laboratory, and x-ray services for mothers' prepartum and postpartum care and for newborns; 1[and]1
(6) well-baby medical care1; and
(7) ultrasound testing1.
"Family planning and reproductive health care services" shall not include child birth.
"Medication abortion" means the use, prescription, order, dispensing, administration, or any combination thereof as applicable, of a medication or a combination of medications to induce termination of pregnancy.
4. This act shall take effect on the 120th day following enactment, and section 1 shall apply to contracts entered into or renewed after that date.
