[First Reprint]

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 ¹[and],¹ all health maintenance organizations ¹, all dental service corporations, all dental plan organizations and all insurers writing automobile insurance and workers' compensation coverage¹ 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.

    ¹8. Within 12 months of the effective date of this act, a dental plan 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.¹

    ¹9. Within 12 months of the effective date of this act, a dental 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 contracts for dental services issued, delivered, executed or renewed in this State.¹

     ¹10. Within 12 months of the effective date of 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 effective date of this act, an insurer authorized to transact the business of workers' compensation insurance pursuant to Chapter 15 of Title 34 of the Revised Statutes, shall use the standard claim forms promulgated pursuant to section 7 of this act in connection with all its 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.