Bill Text: NJ S1306 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires health insurers to offer benefits for dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants for treatment of sickle cell anemia.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-02-08 - Introduced in the Senate, Referred to Senate Commerce Committee [S1306 Detail]
Download: New_Jersey-2010-S1306-Introduced.html
Sponsored by:
Senator NIA H. GILL
District 34 (Essex and Passaic)
SYNOPSIS
Requires health insurers to offer benefits for dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants for treatment of sickle cell anemia.
CURRENT VERSION OF TEXT
As introduced.
An Act requiring health insurers to offer benefits for certain treatments of sickle cell anemia, amending the title and body of P.L.1995, c.100, and supplementing Title 17B of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. The Title of P.L.1995, c.100 is amended to read as follows:
Title.
An Act concerning health insurance and requiring health insurers to offer benefits for certain treatments of cancer and sickle cell anemia under certain conditions and supplementing P.L.1938, c.366 (C.17:48-1 et seq.); P.L.1940, c.74 (C.17:48A-1 et seq.), P.L.1985, c.236 (C.17:48E-1 et seq.), chapters 26 and 27 of Title 17B of the New Jersey Statutes and P.L.1973, c.337 (C.26:2J-1 et seq.).
(cf: P.L.1995, c.100, Title)
2. Section 1 of P.L.1995, c.100 (C.17:48-6k) is amended to read as follows:
1. [In addition to benefits provided under regulations adopted pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), a] A hospital service corporation shall offer under every group or individual hospital service corporation contract providing hospital or medical expense benefits 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 to provide benefits for the treatment of:
a. cancer by dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants when performed by institutions approved by the National Cancer Institute or pursuant to protocols consistent with the guidelines of the American Society of Clinical Oncologists; and
b. sickle cell anemia by dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants when performed by institutions approved by the National Heart, Lung and Blood Institute or pursuant to protocols consistent with the guidelines of any nationally recognized professional medical specialty academy or organization.
Benefits for such [treatment] treatments shall be provided to the same extent as for any other illness under the contract.
The offer required pursuant to this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium. Nothing in this section shall be construed to limit a hospital service corporation in adjusting premium amounts, or providing for reasonable deductibles or copayments, with respect to benefits provided pursuant to this section.
(cf: P.L.1995, c.100, s.1)
3. Section 2 of P.L.1995, c.100 (C.17:48A-7j) is amended to read as follows:
2. [In addition to benefits provided under regulations adopted pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), a] A medical service corporation shall offer under every group or individual medical service corporation contract providing hospital or medical expense benefits 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 to provide benefits for the treatment of:
a. cancer by dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants when performed by institutions approved by the National Cancer Institute or pursuant to protocols consistent with the guidelines of the American Society of Clinical Oncologists; and
b. sickle cell anemia by dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants when performed by institutions approved by the National Heart, Lung and Blood Institute or pursuant to protocols consistent with the guidelines of any nationally recognized professional medical specialty academy or organization.
Benefits for such [treatment] treatments shall be provided to the same extent as for any other illness under the contract.
The offer required pursuant to this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium. Nothing in this section shall be construed to limit a medical service corporation in adjusting premium amounts, or providing for reasonable deductibles or copayments, with respect to benefits provided pursuant to this section.
(cf: P.L.1995, c.100, s.2)
4. Section 3 of P.L.1995, c.100 (C.17:48E-35.8) is amended to read as follows:
3. [In addition to benefits provided under regulations adopted pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), a] A health service corporation shall offer under every group or individual health service corporation contract providing hospital or medical expense benefits 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 to provide benefits for the treatment of:
a. cancer by dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants when performed by institutions approved by the National Cancer Institute or pursuant to protocols consistent with the guidelines of the American Society of Clinical Oncologists; and
b. sickle cell anemia by dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants when performed by institutions approved by the National Heart, Lung and Blood Institute or pursuant to protocols consistent with the guidelines of any nationally recognized professional medical specialty academy or organization.
Benefits for such [treatment] treatments shall be provided to the same extent as for any other illness under the contract.
The offer required pursuant to this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium. Nothing in this section shall be construed to limit a health service corporation in adjusting premium amounts, or providing for reasonable deductibles or copayments, with respect to benefits provided pursuant to this section.
(cf: P.L.1995, c.100, s.3)
5. Section 4 of P.L.1995, c.100 (C.17B:26-2.1j) is amended to read as follows:
4. [In addition to benefits provided under regulations adopted pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), an] An insurer shall offer under every individual policy providing health insurance coverage 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 to provide benefits for the treatment of:
a. cancer by dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants when performed by institutions approved by the National Cancer Institute or pursuant to protocols consistent with the guidelines of the American Society of Clinical Oncologists; and
b. sickle cell anemia by dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants when performed by institutions approved by the National Heart, Lung and Blood Institute or pursuant to protocols consistent with the guidelines of any nationally recognized professional medical specialty academy or organization.
Benefits for such [treatment] treatments shall be provided to the same extent as for any other illness under the policy.
The offer required pursuant to this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium. Nothing in this section shall be construed to limit an insurer in adjusting premium amounts, or providing for reasonable deductibles or copayments, with respect to benefits provided pursuant to this section.
(cf: P.L.1995, c.100, s.4)
6. Section 5 of P.L.1995, c.100 (C.17B:27-46.1j) is amended to read as follows:
5. [In addition to benefits provided under regulations adopted pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), an] An insurer shall offer under every group policy providing health insurance coverage 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 to provide benefits for the treatment of:
a. cancer by dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants when performed by institutions approved by the National Cancer Institute or pursuant to protocols consistent with the guidelines of the American Society of Clinical Oncologists; and
b. sickle cell anemia by dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants when performed by institutions approved by the National Heart, Lung and Blood Institute or pursuant to protocols consistent with the guidelines of any nationally recognized professional medical specialty academy or organization.
Benefits for such [treatment] treatments shall be provided to the same extent as for any other illness under the policy.
The offer required pursuant to this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium. Nothing in this section shall be construed to limit an insurer in adjusting premium amounts, or providing for reasonable deductibles or copayments, with respect to benefits provided pursuant to this section.
(cf: P.L.1995, c.100, s.5)
7. Section 6 of P.L.1995, c.100 (C.26:2J-4.8) is amended to read as follows:
6. [In addition to benefits provided under regulations adopted pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), no] No certificate of authority to establish and operate a health maintenance organization in this State shall be issued or continued on or after the effective date of this act unless the health maintenance organization offers to provide health care services to any contract holder for the treatment of:
a. cancer by dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants when performed by institutions approved by the National Cancer Institute or pursuant to protocols consistent with the guidelines of the American Society of Clinical Oncologists; and
b. sickle cell anemia by dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants when performed by institutions approved by the National Heart, Lung and Blood Institute or pursuant to protocols consistent with the guidelines of any nationally recognized professional medical specialty academy or organization.
[This treatment] These treatments shall be provided to the same extent as for any other illness.
The offer required pursuant to this section shall apply to all contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved. Nothing in this section shall be construed to limit a health maintenance organization in adjusting the schedule of charges for enrollee coverage, or providing for reasonable deductibles or copayments, with respect to benefits provided pursuant to this section.
(cf: P.L.1995, c.100, s.6)
8. (New section) Notwithstanding any provisions of law to the contrary, on or after the effective date of this act, a carrier shall offer under every individual health benefits plan issued pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) to provide benefits for the treatment of:
a. cancer by dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants when performed by institutions approved by the National Cancer Institute or pursuant to protocols consistent with the guidelines of the American Society of Clinical Oncologists; and
b. sickle cell anemia by dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants when performed by institutions approved by the National Heart, Lung and Blood Institute or pursuant to protocols consistent with the guidelines of any nationally recognized professional medical specialty academy or organization.
Benefits for such treatments shall be provided to the same extent as for any other illness under the health benefits plan.
The offer required pursuant to this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium. Nothing in this section shall be construed to limit a carrier in adjusting premium amounts, or providing for reasonable deductibles or copayments, with respect to benefits provided pursuant to this section.
9. (New section) Notwithstanding any provisions of law to the contrary, on or after the effective date of this act, a carrier shall offer under every small employer health benefits plan issued pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) to provide benefits for the treatment of:
a. cancer by dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants when performed by institutions approved by the National Cancer Institute or pursuant to protocols consistent with the guidelines of the American Society of Clinical Oncologists; and
b. sickle cell anemia by dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants when performed by institutions approved by the National Heart, Lung and Blood Institute or pursuant to protocols consistent with the guidelines of any nationally recognized professional medical specialty academy or organization.
Benefits for such treatments shall be provided to the same extent as for any other illness under the health benefits plan.
The offer required pursuant to this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium. Nothing in this section shall be construed to limit a carrier in adjusting premium amounts, or providing for reasonable deductibles or copayments, with respect to benefits provided pursuant to this section.
10. This act shall take effect on the 90th day after enactment.
STATEMENT
This bill amends P.L.1995, c.100 and supplements the individual and small employer health benefits plan statutes, P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), respectively, to require hospital, medical and health service corporations, individual, small employer and large group insurers, and health maintenance organizations to offer health benefits coverage for dose-intensive chemotherapy/bone marrow transplants and umbilical cord blood transplants for treatment of sickle cell anemia.
P.L.1995, c.100 currently requires health insurers to offer health benefits coverage for dose-intensive chemotherapy/autologous bone marrow transplants and peripheral blood stem cell transplants for the treatment of cancer. This bill corrects a technical defect in the current statute regarding its application to insurers that provide individual and small employer health benefits plans by explicitly requiring that those insurers offer this coverage under those plans, in addition to coverage for the specified sickle cell anemia treatments.
Bone marrow transplants from matched siblings and umbilical cord blood transplants are among the promising new methods of treatment for sickle cell anemia that have emerged from clinical studies in recent years.
