Bill Text: NJ S951 | 2016-2017 | Regular Session | Introduced


Bill Title: Requires immediate resumed qualification as dependent covered person under certain health benefits plans after active military duty under certain circumstances.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2016-02-04 - Introduced in the Senate, Referred to Senate Commerce Committee [S951 Detail]

Download: New_Jersey-2016-S951-Introduced.html

SENATE, No. 951

STATE OF NEW JERSEY

217th LEGISLATURE

 

INTRODUCED FEBRUARY 4, 2016

 


 

Sponsored by:

Senator  JOSEPH PENNACCHIO

District 26 (Essex, Morris and Passaic)

 

 

 

 

SYNOPSIS

     Requires immediate resumed qualification as dependent covered person under certain health benefits plans after active military duty under certain circumstances.

 

CURRENT VERSION OF TEXT

     As introduced.

  


An Act concerning status as a covered person under certain health benefits plans 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.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Covered person" means a person on whose behalf a hospital service corporation is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under a hospital service corporation contract as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the hospital service corporation of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever a hospital service corporation receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the hospital service corporation shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the contract as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under a hospital service corporation contract as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the contract. 

     e.     The provisions of this section shall apply to all hospital service corporation contracts delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 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 section, in which the hospital service corporation has reserved the right to change the premium.

     2.    a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Covered person" means a person on whose behalf a medical service corporation is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under a medical service corporation contract as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the medical service corporation of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever a medical service corporation receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the medical service corporation shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the contract as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under a medical service corporation contract as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the contract. 

     e.     The provisions of this section shall apply to all medical service corporation contracts delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 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 section, in which the medical service corporation has reserved the right to change the premium.

 

     3.    a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Covered person" means a person on whose behalf a health service corporation is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under a health service corporation contract as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the health service corporation of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever a health service corporation receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the health service corporation shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the contract as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under a health service corporation contract as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the contract. 

     e.     The provisions of this section shall apply to all health service corporation contracts delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 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 section, in which the health service corporation has reserved the right to change the premium.

 

     4.    a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Covered person" means a person on whose behalf an individual health insurer is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under an individual health insurance policy as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the individual health insurer of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever an individual health insurer receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the individual health insurer shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the policy as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under an individual health insurance policy as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the policy. 

     e.     The provisions of this section shall apply to all individual health insurance policies delivered, issued, executed or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this section, in which the individual health insurer has reserved the right to change the premium.

 

     5.    a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Covered person" means a person on whose behalf a group health insurer is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under a group health insurance policy as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the group health insurer of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever a group health insurer receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the group health insurer shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the policy as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under a group health insurance policy as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the policy. 

     e.     The provisions of this section shall apply to all group health insurance policies delivered, issued, executed or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this section, in which the group health insurer has reserved the right to change the premium.

 

     6.    a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Covered person" means a person on whose behalf a carrier is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under an individual health benefits plan as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the carrier of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever a carrier receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the carrier shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the plan as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under an individual health benefits plan as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the plan. 

     e.     The provisions of this section shall apply to all individual health benefits plans 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 section, in which the carrier has reserved the right to change the premium.

 

     7.    a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Covered person" means a person on whose behalf a carrier is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under a small employer health benefits plan as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the carrier of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever a carrier receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the carrier shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the plan as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under a small employer health benefits plan as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the plan. 

     e.     The provisions of this section shall apply to all small employer health benefits plans 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 section, in which the carrier has reserved the right to change the premium.

 

     8.    a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Covered person" means a person on whose behalf a health maintenance organization is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under a health maintenance organization contract as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the health maintenance organization of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever a health maintenance organization receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the health maintenance organization shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the contract as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under a health maintenance organization contract as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the contract. 

     e.     The provisions of this section shall apply to all health maintenance organization contracts delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 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 section, in which the health maintenance organization has reserved the right to change the schedule of charges.

 

     9.    a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Commission" means the State Health Benefits Commission created pursuant to section 3 of P.L.1961, c.49 (C.52:14-17.27).

     "Covered person" means a person on whose behalf the commission is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under a contract purchased by the commission as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the commission of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever the commission receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the commission shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the contract as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under a contract as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the contract. 

     e.     The provisions of this section shall apply to every contract purchased or renewed by the State Health Benefits Commission on or after the effective date of this section.

 

     10.  a.  As used in this section:

     "Active duty" means partial or full mobilization for State or federal active duty as a member of the National Guard or a Reserve component of the Armed Forces of the United States.

     "Commission" means the School Employees' Health Benefits Commission created pursuant to section 33 of P.L.2007, c.103 (C.52:14-17.46.3).

     "Covered person" means a person on whose behalf the commission is obligated to pay benefits or provide services.

     b.    In the case of a covered person 18 years of age or older, who is covered under a contract purchased by the commission as a dependent child as the result of his or her status as a student enrolled full time in an educational institution, and whose coverage is terminated when he or she no longer qualifies as a full time student because that covered person is deployed to active duty, upon that covered person's return from active duty, that person may immediately apply for, and shall immediately qualify for, coverage as a dependent enrolled as a full time student, notwithstanding that the person cannot immediately matriculate as a full time student due to the academic calendar, so long as that person provides satisfactory proof to the commission of his or her resumed status as a full time student within six months of return from active duty.

     c.     Whenever the commission receives notice that a covered person is no longer eligible for coverage due to loss of full time student status under the circumstances described in subsection b. of this section, the commission shall notify the covered person that, upon return from active duty, he or she may apply for, and shall immediately qualify for, coverage under the terms of the contract as provided in subsection b. of this section.

     d.    Nothing in this section shall operate to extend coverage under a contract as a dependent covered person beyond the maximum age or other terms of eligibility as defined by the contract. 

     e.     The provisions of this section shall apply to every contract purchased or renewed by the School Employees' Health Benefits Commission on or after the effective date of this section

 

     11.  This act shall take effect on the first day of the fourth month next following enactment, but: the Commissioner of Banking and Insurance; the New Jersey Individual Health Coverage Program Board; the New Jersey Small Employer Health Benefits Program Board; the State Health Benefits Commission; and the School Employees' Health Benefits Commission may take any anticipatory administrative action in advance thereof as necessary for the implementation of this act.

 

 

STATEMENT

 

     This bill requires health insurance carriers (hospital, medical and health service corporations, individual, small employer and larger group commercial insurers, and health maintenance organizations), the State Health Benefits Program (SHBP), and the School Employees' Health Benefits Program (SEHBP), if they provide coverage to dependent children of insureds beyond the age of 18 if they are enrolled as full time students, to reinstitute that coverage after a break in that coverage due to service in the military under certain circumstances. 

     Under the bill, if the dependent child/full time student has left school, and therefore lost his or her eligibility under the health benefits plan, to serve on active duty in the military, and thereafter returns from active military duty, he or she may immediately apply for, and shall immediately qualify for, that coverage as a dependent enrolled as a full time student, under that plan, notwithstanding that the individual cannot immediately matriculate as a full time student due to the academic calendar, so long as that individual provides proof of his or her resumed status as a full student within six months of return from active duty.

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