ASSEMBLY, No. 135

 

STATE OF NEW JERSEY

 

Introduced Pending Technical Review by Legislative Counsel

 

PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION

 

 

By Assemblyman JONES

 

 

An Act requiring health insurance benefits for testing for prostate cancer and supplementing Title 17 of the Revised Statutes and Title 17B of the New Jersey Statutes.

 

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

    1. No health service corporation contract providing hospital or medical expense benefits for groups with greater than 49 persons shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting a prostate-specific antigen, or PSA, blood test. The benefits shall be provided to the same extent as for any other medical condition under the contract.

    This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.

 

    2. No hospital service corporation contract providing hospital or medical expense benefits for groups with greater than 49 persons shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting a prostate-specific antigen, or PSA, blood test. The benefits shall be provided to the same extent as for any other medical condition under the contract.

    This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

 

    3. No medical service corporation contract providing hospital or medical expense benefits for groups with greater than 49 persons shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting a prostate-specific antigen, or PSA, blood test. The benefits shall be provided to the same extent as for any other medical condition under the contract.

    This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

 

    4. No group health insurance policy providing hospital or medical expense benefits for groups with greater than 49 persons shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting a prostate-specific antigen, or PSA, blood test. The benefits shall be provided to the same extent as for any other medical condition under the policy.

    This section shall apply to all group health insurance policies in which the health insurer has reserved the right to change the premium.

 

    5. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Health on or after the effective date of this act unless the health maintenance organization offers health care services to any enrollee which include a prostate-specific antigen, or PSA, blood test. The health care services shall be provided to the same extent as for any other medical condition under the contract.

    The provisions of 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.

 

    6. This act shall take effect on the 30th day after enactment.

 

 

STATEMENT

 

    This bill requires all health insurers which cover groups with 50 or more persons and health maintenance organizations to provide benefits for prostate-specific antigen, or PSA, blood tests. The PSA blood test was recently approved by the federal Food and Drug Administration to help detect prostate cancer in men 50 years of age and older when used in conjuction with a digital rectal examination.

    Prostate cancer is the second leading cause of cancer death in men, with an estimated 38,000 deaths in 1994 in the United States. An estimated 200,000 new cases in the United States will be detected in 1994. Between 1980 and 1990, prostate cancer incidence rates increased 50%, largely due to improved detection. It is expected that there will be further increases in the incidence of this disease with widespread use of PSA blood tests.

 

 

 

Requires insurers to provide coverage for prostate-specific antigen blood test for prostate cancer.