ASSEMBLY, No. 397
STATE OF NEW JERSEY
Introduced Pending Technical Review by Legislative Counsel
PRE-FILED FOR INTRODUCTION IN THE 1996 SESSION
By Assemblywoman HECK
An Act requiring health insurers to provide coverage for individuals with Down syndrome 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.), chapter 26 of Title 17B of the New Jersey Statutes, chapter 27 of Title 17B of the New Jersey Statutes, and P.L.1973, c.337 (C.26:2J-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. No group or individual hospital service corporation 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 Commissioner of Insurance on or after the effective date of this act, unless it provides coverage to a person with Down syndrome. Benefits shall be provided to individuals with Down syndrome to the same extent as they are provided to other individuals 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.
2. No group or individual medical service corporation 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 Commissioner of Insurance on or after the effective date of this act, unless it provides coverage to a person with Down syndrome. Benefits shall be provided to individuals with Down syndrome to the same extent as they are provided to other individuals 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.
3. No group or individual health service corporation 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 Commissioner of Insurance on or after the effective date of this act, unless it provides coverage to a person with Down syndrome. Benefits shall be provided to individuals with Down syndrome to the same extent as they are provided to other individuals 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.
4. No individual health insurance policy 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 Commissioner of Insurance on or after the effective date of this act, unless it provides coverage to a person with Down syndrome. Benefits shall be provided to individuals with Down syndrome to the same extent as they are provided to other individuals under the policy.
This section shall apply to all individual health insurance policies in which the insurer has reserved the right to change the premium.
5. No group health insurance policy 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 Commissioner of Insurance on or after the effective date of this act, unless it provides coverage to a person with Down syndrome. Benefits shall be provided to individuals with Down syndrome to the same extent as they are provided to other individuals under the policy. This section shall apply to all group health insurance policies in which the insurer has reserved the right to change the premium.
6. 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 if the health maintenance organization unless it provides health care services to a person with Down syndrome. Health care services shall be provided by a health maintenance organization to a person with Down syndrome to the same extent as any other person covered under the plan.
This section shall apply to all health maintenance organizations in which the right to change the enrollee charge has been reserved.
7. This act shall take effect on the 90th day after enactment.
STATEMENT
This bill requires hospital service corporations (Blue Cross), medical service corporations (Blue Shield), health service corporations (Blue Cross and Blue Shield of New Jersey), commercial insurers and health maintenance organizations to provide coverage to individuals with Down syndrome.
Currently, private insurers and health maintenance organizations are not required to provide coverage on an individual basis to persons with Down syndrome and generally do not do so. While Blue Cross and Blue Cross of New Jersey, as an insurer of last resort, is required to provide such coverage, the coverage provided is limited in nature, and the cost is relatively high.
Requires health insurers to provide coverage to individuals with Down syndrome.