SENATE, No. 1196

STATE OF NEW JERSEY

INTRODUCED MAY 30, 1996

By Senator MARTIN

An Act requiring health insurers to provide coverage for medically necessary expenses incurred in the diagnosis and treatment of infertility and supplementing Title 17 of the Revised Statutes, 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. No hospital service corporation contract providing hospital or medical expense benefits for groups with more than 49 persons, which includes pregnancy-related benefits, 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 provides coverage to any named subscriber or other person covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility. For purposes of this section, "infertility" means the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract.

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

    2. No medical service corporation contract providing hospital or medical expense benefits for groups with more than 49 persons, which includes pregnancy-related benefits, 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 provides coverage to any named subscriber or other person covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility. For purposes of this section, "infertility" means the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract.

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

    3. No health service corporation contract providing hospital or medical expense benefits for groups with more than 49 persons, which includes pregnancy-related benefits, 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 provides coverage to any named subscriber or other person covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility. For purposes of this section, "infertility" means the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the contract.

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

    4. No group health insurance policy providing hospital or medical expense benefits for groups with more than 49 persons, which includes pregnancy-related benefits, 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 provides coverage to any named insured or other person covered under the contract for medically necessary expenses incurred in the diagnosis and treatment of infertility. For purposes of this section, "infertility" means the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year. The benefits shall be provided to the same extent as for other pregnancy-related procedures under the policy.

    This section shall apply to those insurance policies in which the insurer has reserved the right to change the premium.

    5. A certificate of authority to establish and 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 offers health care services, for groups of more than 49 enrollees, for medically necessary expenses incurred in the diagnosis and treatment of infertility. For the purposes of this section, "infertility" means the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year. The health care services shall be provided to the same extent as for any other pregnancy-related procedures under the contract.

    The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.

    6. This act shall take effect on the 30th day after enactment.

STATEMENT

    This bill requires health insurers, including hospital service corporations, medical service corporations, health service corporations, commercial insurers and health maintenance organizations that cover groups with 50 or more persons, to provide coverage for medically necessary expenses incurred in the diagnosis or treatment of infertility if the contract or policy includes pregnancy-related benefits. The bill defines "infertility" as the condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year.

Requires health insurers to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility.