Bill Text: NJ S1127 | 2022-2023 | Regular Session | Introduced
Bill Title: Requires health insurance carriers to adhere to certain practices to protect health information related to sensitive services.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2022-01-31 - Introduced in the Senate, Referred to Senate Commerce Committee [S1127 Detail]
Download: New_Jersey-2022-S1127-Introduced.html
Sponsored by:
Senator JOSEPH F. VITALE
District 19 (Middlesex)
SYNOPSIS
Requires health insurance carriers to adhere to certain practices to protect health information related to sensitive services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the protection of health information related to sensitive services and supplementing P.L.1997, c.192 (C.26:2S-1 et al.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. As used in this act:
"Carrier" means a carrier as defined in section 2 of P.L.1997, c.192 (C.26:2S-2), except that carrier shall also include the State Health Benefits Program and the School Employees' Health Benefits Program.
"Sensitive services" means health care services related to sexual assault, pregnancy, family planning, sexually transmitted diseases, domestic violence and substance or alcohol abuse, and any other services that may be determined to be sensitive services by the Commissioner of Banking and Insurance, in consultation with the Commissioner of Health.
2. a. The Commissioner of Banking and Insurance shall prescribe by regulation a standardized explanation of benefits form designed to be clearly understandable to covered persons in a manner consistent with the "Life and Health Insurance Policy Language Simplification Act," P.L.1979, c.167 (C.17B:17-17 et seq.).
b. Except as provided in subsection d. of this section, the standardized explanation of benefits form shall include, but not be limited to, a summary of benefits for current services, including: the cost of the health care service; the amount paid by the carrier; the amount to be paid by the covered person; and an explanation of the reason for benefit denial or limitation, if any.
c. A carrier issuing health benefits plans in this State shall provide a written explanation of benefits which complies with the standardized form prescribed pursuant to subsection a. of this section to each covered person separately, but not to any other covered person, whenever a claim under the health benefits plan is generated by that covered person.
d. An explanation of benefits shall not contain information about sensitive services unless requested by a covered person who is legally authorized to consent to medical care.
3. a. A carrier shall provide an explanation of benefits which relates to sensitive services if requested in writing by a covered person pursuant to subsection d. of section 2 of this act, by using an alternative method of delivery.
b. A carrier shall provide a covered person, who is legally authorized to consent to medical care, with the option to elect not to receive an explanation of benefits for a claim in a situation in which there is no remaining balance related to the claim.
c. An explanation of benefits is related to sensitive services for the purposes of this act if it discloses protected health information, including information regarding treatment or diagnosis, or the name or address of a provider of sensitive services, or if disclosure of all or part of the protected health information could endanger the covered person.
4. Alternative methods for delivery of an explanation of benefits related to sensitive services shall include, but not be limited to, the following:
a. a paper form sent to the address of the covered person who received the sensitive service;
b. a paper form sent to any alternate address designated by the covered person who received the sensitive service; or
c. allowing only the covered person who received the sensitive service to access the communication through electronic means, as available, provided that such access is granted in compliance with any applicable State and federal laws and regulations pertaining to data security.
5. A carrier shall communicate the right to request an alternative method of delivery of an explanation of benefits related to sensitive services, and the process to make a request, in plain language and in a clear and conspicuous manner in coverage documents and member privacy communications. The carrier shall also conspicuously display the covered person's right to request that alternative method of delivery on the carrier's website and online portals for covered persons.
6. a. A carrier shall not require an explanation as to the basis for a covered person's request pursuant to this act, unless otherwise required by law or court order.
b. A carrier shall not condition enrollment or coverage on the waiver of rights provided in this act.
7. This act shall take effect on the 120th day next following enactment.
STATEMENT
This bill supplements the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et al.) by requiring health insurance carriers, and the State Health Benefits and School Employees' Health Benefits programs, to use a standardized explanation of benefits form and to adhere to certain practices to protect the health information of covered persons related to sensitive services. "Sensitive services" are defined as health care services related to sexual assault, pregnancy, family planning, sexually transmitted diseases, domestic violence and substance or alcohol abuse, and any other services that may be determined to be sensitive services by the Commissioner of Banking and Insurance, in consultation with the Commissioner of Health.
The enactment of the federal "Patient Protection and Affordable Care Act," (ACA) expanded the opportunity for many individuals to maintain health insurance as dependents on a policy held in someone else's name. Under the ACA, children of policyholders may remain on the policy as dependents until they reach the age of 26. In certain cases, coverage for dependents may be extended even further by New Jersey law. As coverage for dependents increases, so too do concerns for the privacy of these dependents.
Carriers typically provide policyholders with documentation of the benefits rendered for all persons covered under the policy. As a result, many dependents find themselves having to make a difficult choice between getting the medical treatment they need, and keeping their health information private. This is especially problematic when a dependent has been victimized in some manner by a policyholder, as the dependent may fear for their safety if the policyholder discovers that the dependent sought medical treatment after the fact. This bill protects all covered dependents' confidential health information related to sensitive services from being released to policyholders against the wishes of the dependent.
The bill provides that the Commissioner of Banking and Insurance shall prescribe by regulation a standardized explanation of benefits form designed to be clearly understandable to covered persons in a manner consistent with the "Life and Health Insurance Policy Language Simplification Act," P.L.1979, c.167 (C.17B:17-17 et seq.). Except for certain protections related to sensitive services, the standardized explanation of benefits form shall include, but not be limited to, a summary of benefits for current services, including: the cost of the health care service; the amount paid by the carrier; the amount to be paid by the covered person; and an explanation of the reason for benefit denial, if any.
The bill also requires a carrier issuing health benefits plans in this State to provide a written explanation of benefits which complies with the standardized form to each covered person separately, but not to any other covered person, whenever a claim under the health benefits plan is generated by that covered person.
The bill provides that an explanation of benefits shall not contain information about sensitive services unless requested by a covered person who is legally authorized to consent to medical care.
The bill also provides that a carrier is required, upon written request, to provide an explanation of benefits which relates to sensitive services if requested in writing by a covered person who is legally authorized to consent to medical care by using an alternative method of delivery. The bill provides several alternative methods for a carrier to use for delivery of an explanation of benefits related to sensitive services.
A carrier shall also provide a covered person, who is legally authorized to consent to medical care, with the option to elect not to receive an explanation of benefits for a claim in a situation in which there is no remaining balance related to the claim.
The bill specifies that an explanation of benefits is related to sensitive services for the purposes of the bill if it discloses protected health information, including information regarding treatment or diagnosis, or the name or address of a provider of sensitive services, or if disclosure of all or part of the protected health information could endanger the covered person.
The bill requires a carrier to communicate the rights established by this bill and the procedure to have these rights recognized in plain language and in a clear and conspicuous manner in coverage documents and member privacy communications, and to conspicuously display this information on the carrier's website and online portals for covered persons.
Finally, the bill also protects covered persons by prohibiting a carrier from demanding an explanation for the covered person's request pursuant to this bill, and from conditioning enrollment or coverage on the waiver of rights granted by this bill.
