ASSEMBLY, No. 263
STATE OF NEW JERSEY
Introduced Pending Technical Review by Legislative Counsel
PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION
By Assemblyman BATEMAN
An Act requiring health insurance benefits for aesthetic rehabilitation services.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. No hospital service corporation contract providing hospital or medical expense benefits to groups with more 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 person covered thereunder for expenses incurred in providing aesthetic rehabilitation services. These benefits shall be provided to the same extent as for any other medical condition for which reconstructive surgery is covered under the contract and for which a referral has been given by a physician or psychologist.
This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. No medical service corporation contract providing hospital or medical expense benefits to groups with more 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 person covered thereunder for expenses incurred in providing aesthetic rehabilitation services. These benefits shall be provided to the same extent as for any other medical condition for which reconstructive surgery is covered under the contract and for which a referral has been given by a physician or psychologist.
This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. No health service corporation contract providing hospital or medical expense benefits to groups with more 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 person covered thereunder for expenses incurred in providing aesthetic rehabilitation services. These benefits shall be provided to the same extent as for any other medical condition for which reconstructive surgery is covered under the contract and for which a referral has been given by a physician or psychologist.
This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. No individual health insurance policy or contract providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the board on or after the effective date of this act, unless the policy or contract provides benefits to any person covered thereunder for expenses incurred in providing aesthetic rehabilitation services. These benefits shall be provided to the same extent as for any other medical condition for which reconstructive surgery is covered under the policy or contract and for which a referral has been given by a physician or psychologist.
This section shall apply to all individual health insurance policies or contracts in which the insurer has reserved the right to change the premium.
5. No small employer health insurance policy or contract providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the board on or after the effective date of this act, unless the policy or contract provides benefits to any person covered thereunder for expenses incurred in providing aesthetic rehabilitation services. These benefits shall be provided to the same extent as for any other medical condition for which reconstructive surgery is covered under the policy or contract and for which a referral has been given by a physician or psychologist.
This section shall apply to all small employer health insurance policies or contracts in which the insurer has reserved the right to change the premium.
6. No group health insurance policy providing hospital or medical expense benefits to groups with more 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 person covered thereunder for expenses incurred in providing aesthetic rehabilitation services. These benefits shall be provided to the same extent as for any other medical condition for which reconstructive surgery is covered under the policy and for which a referral has been given by a physician or psychologist.
This section shall apply to all group health insurance policies in which the insurer has reserved the right to change the premium.
7. Notwithstanding any provision of law to the contrary, 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 provides health care services to any enrollee in a group with more than 49 persons for aesthetic rehabilitation services. These health care services shall be provided by a health maintenance organization to the same extent as for any other medical condition for which reconstructive surgery is covered and for which a referral has been given by a physician or psychologist.
This section shall apply to all health maintenance organizations in which the right to change the enrollee charge has been reserved.
8. This act shall take effect on the 90th day after enactment.
STATEMENT
This bill requires hospital service corporations, medical service corporations, health service corporations (Blue Cross/Blue Shield of New Jersey, Inc.), commercial individual, small employer and larger group insurers and health maintenance organizations to provide benefits for aesthetic rehabilitation services. These benefits would be provided to the same extent as for any other medical condition for which reconstructive surgery is covered under the contract or policy and for which a referral has been given by a physician or psychologist.
Aesthetic rehabilitation is a growing field of extended care for trauma patients, accident victims, persons with hair loss resulting from medical disorders such as alopecia areata and persons with pigmentation deformities and congenital markings such as vitiligo and port wine stains, to normalize deformities either in place of, or until, surgical intervention. Aesthetic rehabilitation addresses both the physical appearance of the deformity and the psychological needs of the patient to enable patients to resume a normal lifestyle.
Requires health insurers and HMOs to pay for aesthetic rehabilitation services.