[Third Reprint]

SENATE, No. 49

 

STATE OF NEW JERSEY

 

INTRODUCED JANUARY 18, 1996

 

 

By Senators LaROSSA and LITTELL

 

 

An Act requiring health insurers 2and certain subsidiaries of insurers2 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 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, a hospital service corporation 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all 2[its]2 group and individual contracts issued, delivered, executed or renewed in this State.

 

    2. Within 12 months of the 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, a medical service corporation 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all 2[its]2 group and individual contracts issued, delivered, executed or renewed in this State.

 

    3. Within 12 months of the 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, a health service corporation 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all 2[its]2 group and individual contracts issued, delivered, executed or renewed in this State.

 

    4. Within 12 months of the 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, a health insurer 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all 2[its]2 individual policies issued, delivered, executed or renewed in this State.

 

    5. Within 12 months of the 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, a health insurer 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all 2[its]2 group policies issued, delivered, executed or renewed in this State.

 

    6. Within 12 months of the 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, a health maintenance organization 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all 2[its]2 contracts for health care services issued, delivered, executed or renewed in this State.

 

    7. a. The Commissioner of 3Banking and3 Insurance shall 2[approve and]2 promulgate 2regulations to establish2 one set of standard health care enrollment and claim forms 2in paper or electronic format2 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 2, or subsidiaries that process health care benefits claims as third party administrators,2 and all insurers writing automobile insurance and workers' compensation coverage1 2, or a subsidiary of an insurer writing worker's compensation coverage that processes health care benefits claims as a third party administrator,2 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 3Advisory3 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) 2[To the greatest extent possible, use] Use2national standards for electronic data interchange (EDI) as recommended by the 3[policy] advisory3 council and the boards of the two programs.

 

    18. Within 12 months of the 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, a dental plan organization 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all 2[its]2 contracts for health care services issued, delivered, executed or renewed in this State.1

 

    19. Within 12 months of the 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, a dental service corporation 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard health care enrollment and claim forms promulgated pursuant to section 7 of this act in connection with all 2[its]2 contracts for dental services issued, delivered, executed or renewed in this State.1

 

    110. Within 12 months of the2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 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 2[effective date of] promulgation of regulations by the Commissioner of 3Banking and3 Insurance pursuant to2 this act, an insurer authorized to transact the business of workers' compensation insurance pursuant to Chapter 15 of Title 34 of the Revised Statutes, 2or a subsidiary that processes health care benefits claims as a third party administrator2 shall use the standard claim forms promulgated pursuant to section 7 of this act in connection 3with3 all 2[its]2 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.