S576

SENATE, No. 576

STATE OF NEW JERSEY

INTRODUCED JANUARY 29, 1996

By Senator SINAGRA

An Act concerning health insurance coverage for temporomandibular joint disorders and craniomandibular disorders and supplementing P.L.1938, c.366 (C.17:48-1 et seq.), P.L.1940, c.74 (C.17:48A-1 et seq.), P.L.1985, c.236 (C.17:48E-1 et seq.), Title 17B of the New Jersey Statutes, and P.L.1973, c.337 (C.26:2J-1 et seq.).

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

1. a. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.), no group or individual hospital service corporation contract providing hospital or medical expense benefits for the treatment of any joint of the body shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract includes benefits for the treatment of temporomandibular joint disorders and craniomandibular disorders if this treatment is prescribed or administered by a physician or dentist.

For the purposes of this act, temporomandibular joint disorders and craniomandibular disorders include intra-capsular and extra-capsular injuries, pathologies or diseases affecting the osseous, cartilaginous or other structures of the temporomandibular joints. Covered treatment shall include the surgical and nonsurgical management of disorders affecting the biomechanics of the temporomandibular joints, articular surfaces, supporting structures and associated musculature.

b. These benefits shall be provided to the same extent as benefits for the treatment of other joints of the body covered under the contract.

c. This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

2. a. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.), no group or individual medical service corporation contract providing hospital or medical expense benefits for the treatment of any joint of the body shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract includes benefits for the treatment of temporomandibular joint disorders and craniomandibular disorders if this treatment is prescribed or administered by a physician or dentist.

b. These benefits shall be provided to the same extent as benefits for the treatment of other joints of the body covered under the contract.

c. This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

3. a. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.), no group or individual health service corporation contract providing hospital or medical expense benefits for the treatment of any joint of the body shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the contract includes benefits for the treatment of temporomandibular joint disorders and craniomandibular disorders if this treatment is prescribed or administered by a physician or dentist.

b. These benefits shall be provided to the same extent as benefits for the treatment of other joints of the body covered under the contract.

c. This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.

4. a. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.), no individual health insurance policy providing hospital or medical expense benefits for the treatment of any joint of the body shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the policy includes benefits for the treatment of temporomandibular joint disorders and craniomandibular disorders if this treatment is prescribed or administered by a physician or dentist.

b. These benefits shall be provided to the same extent as benefits for the treatment of other joints of the body covered under the policy.

c. This section shall apply to all individual health insurance policies in which the health insurer has reserved the right to change the premium.

5. a. Except as otherwise provided in P.L.1992, c.162 (C.17B:27A-17 et seq.), no group health insurance policy providing hospital or medical expense benefits for the treatment of any joint of the body shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act, unless the policy includes benefits for the treatment of temporomandibular joint disorders and craniomandibular disorders if this treatment is prescribed or administered by a physician or dentist.

b. These benefits shall be provided to the same extent as benefits for the treatment of other joints of the body covered under the policy.

c. This section shall apply to all group health insurance policies in which the health insurer has reserved the right to change the premium.

6. a. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.), and notwithstanding any other provision of the law to the contrary, a certificate of authority to operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Health on or after the effective date of this act unless the health maintenance organization provides health care services for the treatment of temporomandibular joint disorders and craniomandibular disorders if this treatment is prescribed or administered by a participating physician or dentist and coverage is provided under the contract for health care services for the treatment of any joint of the body.

b. These services shall be provided by the health maintenance organization to the same extent as services provided for the treatment of other joints of the body covered under the contract.

c. This section shall apply to all contracts for health care services by health maintenance organizations in which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.

7. This act shall take effect on the 180th day after enactment.

STATEMENT

This bill requires hospital, medical and health service corporations, commercial insurers and health maintenance organizations that provide coverage for the treatment of any joint of the body to provide treatment for temporomandibular joint disorders ("TMJ") and craniomandibular disorders, if this treatment is prescribed or administered by a physician or dentist.

Temporomandibular joint disorders and craniomandibular disorders include intra-capsular and extra-capsular injuries, pathologies or diseases affecting the osseous, cartilaginous or other structures of the temporomandibular joints, and covered treatment shall include the surgical and nonsurgical management of disorders affecting the biomechanics of the temporomandibular joints, articular surfaces, supporting structures and associated musculature.

Requires health insurers to provide coverage for temporomandibular joint disorders and craniomandibular disorders under certain circumstances.