Bill Text: NJ A5090 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires health insurers, SHBP, and SEHBP to provide coverage for medication and treatment for hepatitis C.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-07-13 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A5090 Detail]
Download: New_Jersey-2016-A5090-Introduced.html
Sponsored by:
Assemblyman TIM EUSTACE
District 38 (Bergen and Passaic)
SYNOPSIS
Requires health insurers, SHBP, and SEHBP to provide coverage for medication and treatment for hepatitis C.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health benefits coverage for medication and treatment for hepatitis C 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 hospital service corporation contract that provides hospital and medical expense benefits and 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, on or after the effective date of this act, shall provide coverage for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the contract.
c. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A medical service corporation contract that provides hospital and medical expense benefits and 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, on or after the effective date of this act, shall provide coverage for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the contract.
c. This section shall apply to those hospital service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A health service corporation contract that provides hospital and medical expense benefits and 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, on or after the effective date of this act, shall provide coverage for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the contract.
c. This section shall apply to those hospital service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. a. An individual health insurance policy that provides hospital and medical expense benefits and 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, on or after the effective date of this act, shall provide coverage for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the policy.
c. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. a. A group health insurance policy that provides hospital and medical expense benefits and 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, on or after the effective date of this act, shall provide coverage for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the policy.
c. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. a. An individual health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), 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 for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the plan.
c. This section shall apply to those plans in which the carrier has reserved the right to change the premium.
7. a. A small employer health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), 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 for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the plan.
c. This section shall apply to those plans in which the carrier has reserved the right to change the premium.
8. a. A health maintenance organization contract for health care services 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, on or after the effective date of this act, shall provide coverage for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the enrollee uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the contract.
c. This section shall apply to those contracts for health care services in which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.
9. a. The State Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be
provided to the same extent as for any other condition under the contract.
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed medication and treatment for hepatitis C. Coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
b. The benefits shall be provided to the same extent as for any other condition under the contract.
11. This act shall take effect on the 90th day next following enactment.
STATEMENT
This bill requires hospital, medical, and health service corporations, commercial, individual, and group health insurers, health maintenance organizations, and health benefits plans issued pursuant to the New Jersey Individual Coverage and Small Employer Health Benefits programs, as well as the State Health Benefits Commission and the School Employees' Health Benefits Commission, to provide health benefits coverage for medication and treatment for hepatitis C.
The bill specifically provides that coverage shall not be denied on the basis that:
(1) the covered person uses drugs or alcohol;
(2) the disease has not reached an advanced stage; or
(3) the prescribing health care professional is not a specialist.
