Bill Text: NJ A4834 | 2018-2019 | Regular Session | Introduced


Bill Title: Provides guaranteed issue rights to certain applicants for Medicare supplement insurance policies.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2019-01-15 - Introduced, Referred to Assembly Health and Senior Services Committee [A4834 Detail]

Download: New_Jersey-2018-A4834-Introduced.html

ASSEMBLY, No. 4834

STATE OF NEW JERSEY

218th LEGISLATURE

 

INTRODUCED JANUARY 15, 2019

 


 

Sponsored by:

Assemblywoman  YVONNE LOPEZ

District 19 (Middlesex)

 

 

 

 

SYNOPSIS

     Provides guaranteed issue rights to certain applicants for Medicare supplement insurance policies.

 

CURRENT VERSION OF TEXT

     As introduced.

 


An Act concerning Medicare supplement insurance coverage and supplementing P.L.1982, c.94 (C.17B:26A‑1 et seq.).

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    a.   No later than 60 days after the effective date of this act, no carrier issuing or renewing Medicare supplement insurance policies or contracts in this State shall:  (1) deny or condition the effectiveness or issuance, or discriminate in the pricing, of Medicare supplement insurance policies or contracts based on the health status, claims experience, receipt of health care by, or medical condition of an applicant, and (2) exclude benefits based on an applicant's preexisting medical conditions.  The provisions of this act shall only apply when the application for Medicare supplement coverage is submitted on or after the first day of the first month in which the applicant is 65 years of age or older and the applicant is enrolled for benefits under Medicare Part B.

     b.    As used in this act:

     "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.

     "Health benefits plan" means a hospital and medical expense insurance policy; hospital service corporation contract, medical service corporation contract or health service corporation contract delivered or issued for delivery in this State.

 

     2.    The Commissioner of Banking and Insurance shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of this act.

 

     3.    This act shall take effect immediately.

 

 

STATEMENT

 

     This bill prohibits health insurance companies, health service corporations, hospital service corporations, medical service corporations, and health maintenance organizations that issue Medicare supplement insurance policies or contracts in the State:  (1) from denying or conditioning the effectiveness or issuance, or discriminating in the pricing, of Medicare supplement insurance policies or contracts based on the health status, claims experience, receipt of health care by, or medical condition of an applicant; and (2) from excluding benefits based on an applicant's preexisting medical condition.  Under the bill, these provisions only apply when the application for Medicare supplement coverage is submitted on or after the first day of the first month in which the applicant is 65 years of age or older and the applicant is enrolled for benefits under Medicare Part B.

     Medicare supplement insurance, also known as "medigap" insurance, is sold by private insurance companies and can help pay some of the out-of-pocket costs associated with Medicare Part A and Medicare Part B, such as copayments, coinsurance, deductibles and other fees.

     The types of consumer protections provided under this bill are collectively known as guaranteed issue rights and prohibit health insurance carriers from denying an applicant a Medicare supplement insurance policy or contract based on factors such as age, gender, or health status, and from varying premiums based on an applicant's pre-existing medical conditions.

     Currently in New Jersey, applicants are provided guaranteed issued rights to Medicare supplement insurance during a one-time, six-month open enrollment period for beneficiaries ages 65 and older when enrolling in Medicare Part B, and for certain qualifying events which generally include instances when Medicare beneficiaries involuntarily lose supplemental coverage.  Medicare beneficiaries who miss these enrollment opportunities may unknowingly forfeit the chance to purchase Medicare supplement insurance later in life.  This bill addresses this issue by providing continuous guaranteed issue rights to applicants ages 65 and older who are also enrolled for benefits under Medicare Part B.

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