[First Reprint]

ASSEMBLY, No. 2593

STATE OF NEW JERSEY

INTRODUCED DECEMBER 16, 1996

By Assemblyman KRAMER and Assemblywoman WRIGHT

An Act concerning maternity benefits in the State Health Benefits Program and supplementing P.L.1961, c.49 (C.52:14-17.25 et seq.).

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

    1. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides obstetrical benefits shall provide coverage for a minimum of 48 hours of inpatient care following a vaginal delivery and a minimum of 96 hours of inpatient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). The contract shall also provide that upon receipt of notification that the woman will be or has been admitted to an inpatient facility, the carrier shall preauthorize inpatient care for the woman and her newly born child for the 48-hour or 96-hour period, as applicable. The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.

    b. Notwithstanding the provisions of subsection a. of this section, a contract that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of inpatient care unless such inpatient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize inpatient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. The commission shall provide notice to employees regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health and Senior Services pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the ¹[earliest] earlier¹ of ¹[:]¹ (1) the next mailing to the employee ¹[;] or¹ (2) the ¹next¹ yearly ¹distribution of an¹ informational packet ¹[sent]¹ to the employee ¹[; or (3) January 1, 1997]¹. The commission shall also ensure that the carrier under contract with the commission, upon receipt of information that a covered person is pregnant, shall promptly notify that person of the coverage required by this section.

    2. This act shall take effect immediately.

Requires State Health Benefits Program to provide certain maternity benefits.