[First Reprint]

ASSEMBLY, No. 1473

STATE OF NEW JERSEY

INTRODUCED FEBRUARY 5, 1996

By Assemblymen FELICE, KAVANAUGH, Assemblywomen Vandervalk and Murphy

An Act requiring health insurers ¹and certain subsidiaries of insurers¹ to use standard enrollment and claim forms and supplementing various parts of the statutory law.

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

    1. Within 12 months of the ¹[effective date of] promulgation of regulations by the Commissioner of Banking and Insurance pursuant to¹ this act, a hospital service corporation ¹or a subsidiary that processes health care benefits claims as a third party administrator¹ shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all ¹[its]¹ group and individual contracts issued, delivered, executed or renewed in this State.

    2. Within 12 months of the ¹[effective date of] promulgation of regulations by the Commissioner of Banking and Insurance pursuant to¹ this act, a medical service corporation ¹or a subsidiary that processes health care benefits claims as a third party administrator¹ shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all ¹[its]¹ group and individual contracts issued, delivered, executed or renewed in this State.

    3. Within 12 months of the ¹[effective date of] promulgation of regulations by the Commissioner of Banking and Insurance pursuant to¹ this act, a health service corporation ¹or a subsidiary that processes health care benefits claims as a third party administrator¹ shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all ¹[its]¹ group and individual contracts issued, delivered, executed or renewed in this State.

    4. Within 12 months of the ¹[effective date of] promulgation of regulations by the Commissioner of Banking and Insurance pursuant to¹ this act, a health insurer ¹or a subsidiary that processes health care benefits claims as a third party administrator¹ shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all ¹[its]¹ individual policies issued, delivered, executed or renewed in this State.

    5. Within 12 months of the ¹[effective date of] promulgation of regulations by the Commissioner of Banking and Insurance pursuant to¹ this act, a health insurer ¹or a subsidiary that processes health care benefits claims as a third party administrator¹ shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all ¹[its]¹ group policies issued, delivered, executed or renewed in this State.

    6. Within 12 months of the ¹[effective date of] promulgation of regulations by the Commissioner of Banking and Insurance pursuant to¹ this act, a health maintenance organization ¹or a subsidiary that processes health care benefits claims as a third party administrator¹ shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all ¹[its]¹ contracts for health care services issued, delivered, executed or renewed in this State.

    7. a. The Commissioner of ¹Banking and¹ Insurance shall ¹[approve and]¹ promulgate ¹regulations to establish¹one set of standard health care enrollment and claim forms ¹in paper or electronic format¹ to be used by all hospital service, medical service and health service corporations, all health insurers ¹[and],¹ all health maintenance organizations ¹, all dental service corporations, all dental plan organizations, or subsidiaries that process health care benefits claims as third party administrators, and all insurers writing automobile insurance and workers' compensation coverage, or a subsidiary of an insurer writing worker's compensation coverage that processes health care benefits claims as a third party administrator,¹ authorized to do business in this State.

    b. In developing and promulgating the forms, the commissioner shall:

    (1) Consult with the Healthcare Information Electronic Data

Interchange Policy ¹Advisory¹ Council established pursuant to P.L. ,c. (C. )(now pending before the Legislature as Assembly, No. 1476 and Senate, No. 50 of 1996);

    (2) Consult with the boards of the New Jersey Individual Health Coverage Program and the New Jersey Small Employer Health Benefits Program and with respect to claim forms, take into consideration the claim forms adopted by those programs pursuant to section 11 of P.L.1993, c.164 (C.17B:27A-16.4) and section 29 of P.L.1992, c.162 (C.17B:27A-45), respectively; and

    (3) ¹[To the greatest extent possible, use] Use¹ national standards for electronic data interchange (EDI) as recommended by the ¹[policy] advisory¹ council and the boards of the two programs.

    ¹8. Within 12 months of the promulgation of regulations by the Commissioner of Banking and Insurance pursuant to this act, a dental plan organization or a subsidiary that processes health care benefits claims as a third party administrator shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all contracts for health care services issued, delivered, executed or renewed in this State.¹

    ¹9. Within 12 months of the promulgation of regulations by the Commissioner of Banking and Insurance pursuant to this act, a dental service corporation or a subsidiary that processes health care benefits claims as a third party administrator shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all contracts for dental services issued, delivered, executed or renewed in this State.¹

    ¹10. Within 12 months of the promulgation of regulations by the Commissioner of Banking and Insurance pursuant to this act, an insurer authorized to write automobile insurance pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.) shall use the standard health care claim forms promulgated pursuant to section 7 of this act in connection with all its claims for health care services in this State.¹

    ¹11. Within 12 months of the promulgation of regulations by the Commissioner of Banking and Insurance pursuant to this act, an insurer authorized to transact the business of workers' compensation insurance pursuant to Chapter 15 of Title 34 of the Revised Statutes, or a subsidiary that processes health care benefits claims as a third party administrator shall use the standard claim forms promulgated pursuant to section 7 of this act in connection with all claims for health care services in this State.¹

    ¹[8.] 12.¹ The commissioner shall promulgate regulations to effectuate the purposes of this act pursuant to the "Administrative Procedure Act," P.L.1968, c. 410 (C.52:14B-1 et seq.).

    ¹[9.] 13.¹ This act shall take effect immediately.

Requires health insurers to use standardized enrollment and claim forms.