ASSEMBLY, No. 2437

STATE OF NEW JERSEY

INTRODUCED OCTOBER 21, 1996

By Assemblywoman TURNER

An Act concerning certain maternity health insurance benefits and supplementing Titles 34 and 45 of the Revised Statutes.

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

    1. An employer in this State who provides coverage for maternity benefits to his employees or their dependents shall annually and upon request of an employee at other times during the year, notify his employees whether the employees' coverage for maternity benefits is subject to the requirements of P.L.1995, c.138 concerning the minimum time a woman shall be permitted to remain at a health care facility following childbirth.

    2. The attending physician or nurse midwife of a pregnant woman who has health care insurance coverage which includes maternity benefits, shall, prior to the woman's delivery date, determine if the coverage is subject to the requirements of P.L.1995, c.138 concerning the minimum time a woman shall be permitted to remain at a health care facility following childbirth. If the physician or nurse midwife determines that the woman's coverage is not subject to the requirements of P.L.1995, c.138, that health care provider shall promptly notify the woman of that fact and, if known, the duration of inpatient care to which the woman is entitled under her insurance coverage.

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

STATEMENT

    This bill requires an employer in this State who provides coverage for maternity benefits to his employees or their dependents to annually, and upon request of an employee at other times during the year, notify each employee whether that employee's coverage for maternity benefits is subject to the requirements of P.L.1995, c.138 concerning the minimum time a woman shall be permitted to remain at a health care facility following childbirth (i.e., 48 hours for a vaginal delivery and 96 hours for a cesarean section).

    The bill also requires the attending physician and nurse midwife of a pregnant woman who has health insurance coverage which includes maternity benefits, to determine if the coverage is subject to the requirements of P.L.1995, c.138 concerning the minimum time a woman shall be permitted to remain at the facility following childbirth. If the health care provider determines that the woman's coverage is not subject to the requirements of that law, the provider shall promptly notify the woman of that fact and, if known, the duration of the inpatient care to which the woman is entitled under her insurance coverage.

    The requirements of P.L.1995, c.138 affect health, hospital and medical service corporation contracts, individual, small employer and group health insurance policies and health maintenance organization coverage issued in this State. The requirements do not extend to coverage issued by an out-of-State carrier or to self-insured health benefits plans that are not subject to State regulation. This gap in coverage, which can only be corrected by federal legislation, has resulted in women who believed that they would be covered under the 1995 law being denied 48 hours or 96 hours of inpatient care, as appropriate, after childbirth by their insurance carrier. This bill will ensure that the woman is promptly notified about any such limitations in her health insurance coverage.

Requires employers and certain health care providers to notify insured pregnant women if their health insurance coverage is not subject to 48-hour maternity law.