SENATE, No. 49

 

STATE OF NEW JERSEY

 

INTRODUCED JANUARY 18, 1996

 

 

By Senators LaROSSA and LITTELL

 

 

An Act requiring health insurers 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 effective date of this act, a hospital service corporation shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all its group and individual contracts issued, delivered, executed or renewed in this State.

 

    2. Within 12 months of the effective date of this act, a medical service corporation shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all its group and individual contracts issued, delivered, executed or renewed in this State.

 

    3. Within 12 months of the effective date of this act, a health service corporation shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all its group and individual contracts issued, delivered, executed or renewed in this State.

 

    4. Within 12 months of the effective date of this act, a health insurer shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all its individual policies issued, delivered, executed or renewed in this State.

 

    5. Within 12 months of the effective date of this act, a health insurer shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all its group policies issued, delivered, executed or renewed in this State.

 

    6. Within 12 months of the effective date of this act, a health maintenance organization shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all its contracts for health care services issued, delivered, executed or renewed in this State.

 

    7. a. The Commissioner of Insurance shall approve and promulgate one set of standard health care enrollment and claim forms to be used by all hospital service, medical service and health service corporations, all health insurers and all health maintenance organizations 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 Council established pursuant to P.L. , c. (C. )(now pending before the Legislature as 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) To the greatest extent possible, use national standards for electronic data interchange (EDI) as recommended by the policy council and the boards of the two programs.

 

    8. 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.).

 

    9. This act shall take effect immediately.

 

 

STATEMENT

 

    This bill requires hospital service, medical service and health service corporations, commercial health insurers and health maintenance organizations (HMO's) to use standard enrollment and claim forms promulgated by the Commissioner of Insurance in connection with all policies and contracts for health care benefits within 12 months of the effective date of this bill. In promulgating the forms, the commissioner is required to consult with the Healthcare Information Electronic Data Interchange Policy Council established pursuant to Senate, No.50 of 1996, which includes representatives from among the various types of health care benefit providers who would be required to use the forms. The commissioner is also required to consult with the boards of the New Jersey Individual Health Coverage Program and the New Jersey Small Employer Health Benefits Program and take into consideration the claim forms adopted by those programs. To the greatest extent possible the commissioner shall use national standards for electronic data interchange (EDI) as recommended by the policy council and the program boards.

    This bill is part of a legislative package designed to effectuate the recommendations of the Healthcare Information Networks and Technologies (HINT) report to the Legislature under the joint auspices of Thomas Edison State College and the New Jersey Institute of Technology.

 

 

                             

 

Requires health insurers to use standardized enrollment and claim forms.