Bill Text: NJ A5525 | 2020-2021 | Regular Session | Introduced
Bill Title: Requires health benefits carriers to allow parents or guardians of dependent child to determine order of benefits under certain circumstances.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2021-03-22 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A5525 Detail]
Download: New_Jersey-2020-A5525-Introduced.html
Sponsored by:
Assemblyman JON M. BRAMNICK
District 21 (Morris, Somerset and Union)
SYNOPSIS
Requires health benefits carriers to allow parents or guardians of dependent child to determine order of benefits under certain circumstances.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health benefits dependent coverage and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Except as provided in subsection b. of this section, a health benefits plan offered by a carrier in this State shall allow the parents or guardians of a child who has coverage as a dependent under two or more health benefits plans of different subscribers to determine the order of benefits for the child among the plans.
b. If a court order provides that one of the parents or guardians is responsible for the dependent child's health care expenses or health care coverage, that plan shall be primary. If the parent or guardian with responsibility has no health care coverage for the dependent child's health care expenses, but the spouse of the parent or guardian has health care coverage, that spouse's plan shall be the primary plan.
c. The Commissioner of Banking and Insurance shall promulgate rules and regulations to effectuate this act, including rules for the provision of notice by a carrier to a covered person describing the person's right to determine order of benefits pursuant to this act. The rules and regulations shall also include rules for the determination of the order of benefits for a dependent child who is covered by a self-funded health benefits plan and a health benefits plan offered by a carrier in this State.
d. 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, and shall include the State Health Benefits Program and the School Employees' Health Benefits Program.
2. This act shall take effect on 30th day next following enactment, and shall apply to all health benefits plans currently in effect in the State, or that are 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.
STATEMENT
This bill requires health benefits carriers to allow the parents or guardians of a dependent child to determine the order of benefits under certain circumstances.
Specifically, the bill provides that a health benefits plan offered by a carrier in this State is required to allow the parents or guardians of a dependent child to determine the order of benefits for the child among the plans, if the child has coverage as a dependent under two or more health benefits plans of different subscribers.
The bill provides that, if a court order provides that one of the parents or guardians is responsible for the dependent child's health care expenses or health care coverage, that plan is primary. If the parent or guardian with responsibility has no health care coverage for the dependent child's health care expenses, but the spouse of the parent or guardian has health care coverage, that spouse's plan is required to be the primary plan.
