SENATE, No. 858
STATE OF NEW JERSEY
INTRODUCED FEBRUARY 26, 1996
By Senator BUBBA
An Act concerning reimbursement of certain duplicate insurance payments to health care providers.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A health care provider shall reimburse a person covered under an individual or group contract providing benefits for health care services for payment from that person when the health care provider also receives payment for the same health care services to the covered person from the hospital service corporation, within 10 days of the latter payment.
Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.
b. An overdue reimbursement shall bear simple interest at the rate of 10% per year.
c. For purposes of this section "health care provider" means a provider of health care services; and "health care services" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products.
d. The provisions of this section shall apply to every group or individual hospital service corporation contract delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act and to all contracts in which the hospital service corporation has reserved the right to change the premium.
e. A health care provider shall be subject to a fine of not more than $100 for the first violation of the provisions of this section, and not more than $500 for each subsequent violation.
f. The State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to carry out the provisions of this section.
2. a. A health care provider shall reimburse a person covered under an individual or group contract providing benefits for health care services for payment received from that person when the health care provider also receives payment for the same health care services to the covered person from the medical service corporation, within 10 days of the latter payment.
Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.
b. An overdue reimbursement shall bear simple interest at the rate of 10% per year.
c. For purposes of this section "health care provider" means a provider of health care services; and "health care services" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products.
d. The provisions of this section shall apply to every group or individual medical service corporation contract delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act and to all contracts in which the medical service corporation has reserved the right to change the premium.
e. A health care provider shall be subject to a fine of not more than $100 for the first violation of the provisions of this section, and not more than $500 for each subsequent violation.
f. The State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to carry out the provisions of this section.
3. a. A provider of health care services shall reimburse a person covered under an individual or group contract providing benefits for health care services for payment received from that person when the provider also receives payment for the same health care services to the covered person from the health service corporation, within 10 days of the latter payment.
Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.
b. An overdue reimbursement shall bear simple interest at the rate of 10% per year.
c. The provisions of this section shall apply to every group or individual health service corporation contract delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act and to all contracts in which the health service corporation has reserved the right to change the premium.
d. A provider of health care services shall be subject to a fine of not more than $100 for the first violation of the provisions of this section, and not more than $500 for each subsequent violation.
e. The State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to carry out the provisions of this section.
4. a. A health care provider shall reimburse a person covered under an individual health insurance policy providing benefits for health care services for payment received from that person when the health care provider also receives payment for the same health care services to the covered person from the insurer, within 10 days of the latter payment.
Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.
b. An overdue reimbursement shall bear simple interest at the rate of 10% per year.
c. For purposes of this section "health care provider" means a provider of health care services; and "health care services" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products.
d. The provisions of this section shall apply to every policy delivered, issued, executed or renewed in this State pursuant to Chapter 26 of Title 17B of the New Jersey Statutes or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act and to all policies in which the insurer has reserved the right to change the premium.
e. A health care provider shall be subject to a fine of not more than $100 for the first violation of the provisions of this section, and not more than $500 for each subsequent violation.
f. The State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to carry out the provisions of this section.
5. a. A health care provider shall reimburse a person covered under a group health insurance policy providing benefits for health care services for payment received from that person when the health care provider also receives payment for the same health care services to the covered person from the insurer, within 10 days of the latter payment.
Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.
b. An overdue reimbursement shall bear simple interest at the rate of 10% per year.
c. For purposes of this section "health care provider" means a provider of health care services; and "health care services" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products.
d. The provisions of this section shall apply to every policy delivered, issued, executed or renewed in this State pursuant to Chapter 27 of Title 17B of the New Jersey Statutes or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act and to all policies in which the insurer has reserved the right to change the premium.
e. A health care provider shall be subject to a fine of not more than $100 for the first violation of the provisions of this section, and not more than $500 for each subsequent violation.
f. The State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to carry out the provisions of this section.
6. a. A provider shall reimburse a person covered under an enrollee agreement providing benefits for health care services for payment received from that person when the provider also receives payment for the same health care services to the covered person from the health maintenance organization, within 10 days of the latter payment.
Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.
b. An overdue reimbursement shall bear simple interest at the rate of 10% per year.
c. The provisions of this section shall apply to every enrollee agreement delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Health on or after the effective date of this act and to all agreements in which the health maintenance organization has reserved the right to change the premium.
d. A health care provider shall be subject to a fine of not more than $100 for the first violation of the provisions of this section, and not more than $500 for each subsequent violation.
e. The State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to carry out the provisions of this section.
7. a. A health care provider shall reimburse a person covered under an individual or group contract providing dental expense benefits for payment receives from that person when the health care provider also received payment for the same health care services to the covered person from the dental service corporation, within 10 days of the latter payment.
Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.
b. An overdue reimbursement shall bear simple interest at the rate of 10% per year.
c. For purposes of this section "health care provider" means a provider of health care services; and "health care services" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products.
d. The provisions of this section shall apply to every group or individual dental service corporation contract delivered, issued, executed or renewed in this State pursuant to P.L.1968, c.305 (C.17:48C-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act and to all contracts in which the dental service corporation has reserved the right to change the premium.
e. A health care provider shall be subject to a fine of not more than $100 for the first violation of the provisions of this section, and not more than $500 for each subsequent violation.
f. The State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to carry out the provisions of this section.
8. a. A health care provider shall reimburse a person covered under an individual or group contract providing dental expense benefits for payment received from that person when the health care provider also receives payment for the same health care services to the covered person from the dental plan organization, within 10 days of the latter payment.
Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.
b. An overdue reimbursement shall bear simple interest at the rate of 10% per year.
c. For purposes of this section "health care provider" means a provider of health care services; and "health care services" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products.
d. The provisions of this section shall apply to every group or individual dental plan organization contract delivered, issued, executed or renewed in this State pursuant to P.L.1979, c.478 (C.17:48D-1 et seq.) or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of this act and to all contracts in which the dental plan organization has reserved the right to change the premium.
e. A health care provider shall be subject to a fine of not more than $100 for the first violation of the provisions of this section, and not more than $500 for each subsequent violation.
f. The State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) to carry out the provisions of this section.
9. This act shall take effect immediately.
STATEMENT
This bill requires a health care provider to reimburse an individual who has paid for health care services within 10 days if the health care provider has also received payment for his services under the individual's health insurance. Reimbursement shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery. The bill also provides that an overdue reimbursement shall bear simple interest at the rate of 10% per year.
Under the bill a health care provider is subject to a fine of not more than $100 for a first violation and a fine not more than $500 for each subsequent violation.
The bill directs the State Board of Medical Examiners, the New Jersey State Board of Dentistry, the New Jersey State Board of Optometrists, the Board of Pharmacy of the State of New Jersey and the Department of Health, in consultation with the Department of Insurance, to adopt rules and regulations to effectuate the provisions of the bill.
The provisions of the bill apply to reimbursement received under contracts or policies of hospital service,medical service and health service corporation contracts, individual and group commercial health insurance policies, dental service corporation and dental plan organization contracts, and health maintenance organization enrollee agreements providing hospital or medical expense benefits.
Requires reimbursement of certain duplicate insurance payments to health care providers within 10 days; provides penalties for noncompliance.