ASSEMBLY, No. 1954

 

STATE OF NEW JERSEY

 

INTRODUCED MAY 6, 1996

 

 

By Assemblywoman ALLEN, Assemblymen GARRETT, Geist, LeFevre, Assemblywomen Heck, Bark, Assemblyman Bodine, Assemblywomen Weinberg, Gill, Cruz-Perez, Assemblymen T. Smith, Arnone, DeSopo, Corodemus, Augustine, Assemblywoman Myers, Assemblymen Malone, Blee, Gibson, Assemblywomen Farragher, J. Smith, Buono, Assemblyman Steele, Assemblywoman Quigley, Assemblymen R. Smith, Bagger, Wolfe, Lance, Assemblywoman Crecco, Assemblymen Felice, Roma, Stuhltrager, Rocco, Cottrell, O'Toole, Assemblywomen Murphy, Vandervalk, Assemblyman Jones, Assemblywomen Turner, Friscia and Assemblyman DiGaetano

 

 

An Act concerning the provision of health benefits to victims of domestic violence 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.), chapters 26 and 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. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), no group or individual hospital service corporation contract providing hospital or medical expense benefits shall contain any provision which denies benefits for expenses incurred in the treatment of an injury or injuries sustained as the result of domestic violence as defined in section 3 of P.L.1991, c.261 (C.2C:25-19), to a subscriber or other person covered thereunder. Benefits shall be provided to the same extent as for any other treatment under the contract. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.

 

    2. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), no group or individual medical service corporation contract providing hospital or medical expense benefits shall contain any provision which denies benefits for expenses incurred in the treatment of an injury or injuries sustained as the result of domestic violence as defined in section 3 of P.L.1991, c.261 (C.2C:25-19), to a subscriber or other person covered thereunder. Benefits shall be provided to the same extent as for any other treatment under the contract. The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.

 

    3. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), no group or individual health service corporation contract providing hospital or medical expense benefits shall contain any provision which denies benefits for expenses incurred in the treatment of an injury or injuries sustained as the result of domestic violence as defined in section 3 of P.L.1991, c.261 (C.2C:25-19), to a subscriber or other person covered thereunder. Benefits shall be provided to the same extent as for any other treatment under the contract. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.

 

    4. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.), no individual health insurance policy providing hospital or medical expense benefits shall contain any provision which denies benefits for expenses incurred in the treatment of an injury or injuries sustained as the result of domestic violence as defined in section 3 of P.L.1991, c.261 (C.2C:25-19), to a named insured or other person covered thereunder. Benefits shall be provided to the same extent as for any other treatment under the policy. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

 

    5. Except as otherwise provided in P.L.1992, c.162 (C.17B:27A-17 et seq.), no group health insurance policy providing hospital or medical expense benefits shall contain any provision which denies benefits for expenses incurred in the treatment of an injury or injuries sustained as the result of domestic violence as defined in section 3 of P.L.1991, c.261 (C.2C:25-19), to a named insured or other person covered thereunder. Benefits shall be provided to the same extent as for any other treatment under the policy. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

 

    6. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), no health maintenance organization shall deny health care services for the treatment of an injury or injuries sustained as the result of domestic violence as defined in section 3 of P.L.1991, c.261 (C.2C:25-19), to its enrollees. Services shall be provided to the same extent as for any other treatment. The provisions of this section shall apply to all certificates of authority in which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.

 

    7. This act shall take effect on the 90th day after enactment.

 

 

STATEMENT

 

    This bill would prohibit commercial individual and group health insurers, hospital service corporations, medical service corporations, health service corporations and health maintenance organizations (HMOs) from denying benefits, otherwise available under the terms of a person's health insurance coverage, to a covered person for expenses incurred in the treatment of an injury or injuries sustained as the result of domestic violence.

    It is the sponsor's sense that, just as the health care community, and the community at large, is beginning to recognize and understand domestic violence, health insurers may be denying coverage for treatment of the injuries that result. More women are seeking help and health care professionals are doing more to identify and help victims.

    Doctors are being trained to document incidents of abuse in medical records so women have evidence to take to court; but in some instances, this information may be used by a health insurer to deny coverage, treating the situation as a "pre-existing condition" or specifically excluding domestic violence injuries from coverage. It is the sponsor's intent to prevent an inequity such as this, whereby the victim is in essence penalized under her own health insurance coverage for coming forward about the nature of her injuries.

 

 

 

Prohibits insurers from denying health benefits to victims of domestic violence.