[First Reprint]

SENATE, No. 1360

STATE OF NEW JERSEY

INTRODUCED JUNE 20, 1996

By Senators INVERSO and MATHEUSSEN

An Act concerning preauthorization for and notification to covered persons of certain maternity benefits and amending P.L.1995, c.138.

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

    1. Section 1 of P.L.1995, c.138 (C.17:48-6l) is amended to read as follows:

    1. a. Every individual or group contract that provides maternity benefits and is 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 ¹Banking and¹ Insurance on or after the effective date of this act shall provide coverage for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). Upon receipt of notification that the woman will be or has been admitted to an in-patient facility, the hospital service corporation shall preauthorize in-patient care for the woman and her newly born child for the 48-hour or 96-hour period, as applicable. ¹The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.¹

    The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.

    b. Notwithstanding the provisions of subsection a. of this section, a hospital service corporation contract that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize in-patient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. Every hospital service corporation shall provide notice to policyholders regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health ¹and Senior Services¹ pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) January 1, 1996. A hospital service corporation also shall, upon receipt of information that a covered person is pregnant, promptly notify that person of the coverage required by this section.

(cf: P.L.1995, c.138, s.1)

    2. Section 2 of P.L.1995, c.138 (C.17:48A-7k) is amended to read as follows:

    2. a. Every individual or group contract that provides maternity benefits and is 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 ¹Banking and¹ Insurance on or after the effective date of this act shall provide coverage for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). Upon receipt of notification that the woman will be or has been admitted to an in-patient facility, the medical service corporation shall preauthorize in-patient care for the woman and her newly born child for the full 48-hour or 96-hour period, as applicable. ¹The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.¹

    The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.

    b. Notwithstanding the provisions of subsection a. of this section, a medical service corporation contract that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize in-patient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. Every medical service corporation shall provide notice to policyholders regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health ¹and Senior Services¹ pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) January 1, 1996. A medical service corporation also shall, upon receipt of information that a covered person is pregnant, promptly notify that person of the coverage required by this section.

(cf: P.L.1995, c.138, s.2)

    3. Section 3 of P.L.1995, c.138 (C.17:48E-35.9) is amended to read as follows:

    3. a. Every individual or group contract that provides maternity benefits and is 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 ¹Banking and¹ Insurance on or after the effective date of this act shall provide coverage for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). Upon receipt of notification that the woman will be or has been admitted to an in-patient facility, the health service corporation shall preauthorize in-patient care for the woman and her newly born child for the full 48-hour or 96-hour period, as applicable. ¹The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.¹

    The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.

    b. Notwithstanding the provisions of subsection a. of this section, a health service corporation contract that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize in-patient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. Every health service corporation shall provide notice to policyholders regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health ¹and Senior Services¹ pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) January 1, 1996. A health service corporation also shall, upon receipt of information that a covered person is pregnant, promptly notify that person of the coverage required by this section.

(cf: P.L.1995, c.138, s.3)

    4. Section 4 of P.L.1995, c.138 (C.17B:26-2.1k) is amended to read as follows:

    4. a. Every policy that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of ¹Banking and¹ Insurance on or after the effective date of this act shall provide coverage for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). Upon receipt of notification that the woman will be or has been admitted to an in-patient facility, the insurer shall preauthorize in-patient care for the woman and her newly born child for the full 48-hour or 96-hour period, as applicable. ¹The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.¹

    The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

    b. Notwithstanding the provisions of subsection a. of this section, a policy that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize in-patient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. Every insurer shall provide notice to policyholders regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health ¹and Senior Services¹ pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) January 1, 1996. An insurer also shall, upon receipt of information that a covered person is pregnant, promptly notify that person of the coverage required by this section.

(cf: P.L.1995, c.138, s.4)

    5. Section 5 of P.L.1995, c.138 (C.17B:27A-7.1) is amended to read as follows:

    5. a. Every policy that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in this State ¹[by the Commissioner of Insurance]¹ on or after the effective date of this act shall provide benefits for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). Upon receipt of notification that the woman will be or has been admitted to an in-patient facility, the insurer shall preauthorize in-patient care for the woman and her newly born child for the full 48-hour or 96-hour period, as applicable. ¹The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.¹

    The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

    b. Notwithstanding the provisions of subsection a. of this section, a policy that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize in-patient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. Every insurer shall provide notice to policyholders regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health ¹and Senior Services¹ pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) January 1, 1996. An insurer also shall, upon receipt of information that a covered person is pregnant, promptly notify that person of the coverage required by this section.

(cf: P.L.1995, c.138, s.5)

    6. Section 6 of P.L.1995, c.138 (C.17B:27A-19.2) is amended to read as follows:

    6. a. Every policy that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal in this State ¹[by the Commissioner of Insurance]¹ on or after the effective date of this act shall provide benefits for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). Upon receipt of notification that the woman will be or has been admitted to an in-patient facility, the insurer shall preauthorize in-patient care for the woman and her newly born child for the full 48-hour or 96-hour period, as applicable. ¹The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.¹

    The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

    b. Notwithstanding the provisions of subsection a. of this section, a policy that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize in-patient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. Every insurer shall provide notice to policyholders regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health ¹and Senior Services¹ pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) January 1, 1996. An insurer also shall, upon receipt of information that a covered person is pregnant, promptly notify that person of the coverage required by this section.

(cf: P.L.1995, c.138, s.6)

    7. Section 7 of P.L.1995, c.138 (C.17B:27-46.1k) is amended to read as follows:

    7. a. Every policy that provides maternity benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of ¹Banking and¹ Insurance on or after the effective date of this act shall provide benefits for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). Upon receipt of notification that the woman will be or has been admitted to an in-patient facility, the insurer shall preauthorize in-patient care for the woman and her newly born child for the full 48-hour or 96-hour period, as applicable. ¹The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.¹

    The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

    b. Notwithstanding the provisions of subsection a. of this section, a policy that provides coverage for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize in-patient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. Every insurer shall provide notice to policyholders regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health ¹and Senior Services¹ pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the policyholder; (2) the yearly informational packet sent to the policyholder; or (3) January 1, 1996. An insurer also shall, upon receipt of information that a covered person is pregnant, promptly notify that person of the coverage required by this section.

(cf: P.L.1995, c.138, s.7)

    8. Section 8 of P.L.1995, c.138 (C.26:2J-4.9) is amended to read as follows:

    8. a. Every enrollee agreement that provides maternity benefits and is 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 ¹[Insurance] Health and Senior Services¹ on or after the effective date of this act shall provide health care services for a minimum of 48 hours of in-patient care following a vaginal delivery and a minimum of 96 hours of in-patient care following a cesarean section for a mother and her newly born child in a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.). Upon receipt of notification that the woman will be or has been admitted to an in-patient facility, the health maintenance organization shall preauthorize in-patient care for the woman and her newly born child for the full 48-hour or 96-hour period, as applicable. ¹The preauthorization requirement shall remain in effect until the provisions of Pub.L.104-204, the "Newborns' and Mothers' Health Protection Act of 1996," become operative.¹

    The provisions of this section shall apply to enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.

    b. Notwithstanding the provisions of subsection a. of this section, an enrollee agreement that provides health care services for post-delivery care to a mother and her newly born child in the home shall not be required to provide for a minimum of 48 hours and 96 hours, respectively, of in-patient care unless such in-patient care is determined to be medically necessary by the attending physician or is requested by the mother; except that, the requirement in subsection a. of this section to preauthorize in-patient care for the full 48-hour or 96-hour period, as applicable, also shall apply to this subsection. For the purposes of this section, attending physician shall include the attending obstetrician, pediatrician or other physician attending the mother or newly born child.

    c. Every health maintenance organization shall provide notice to enrollees regarding the coverage required by this section in accordance with this subsection and regulations promulgated by the Commissioner of Health ¹and Senior Services¹ pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). The notice shall be in writing and prominently positioned in any literature or correspondence and shall be transmitted at the earliest of: (1) the next mailing to the enrollee; (2) the yearly informational packet sent to the enrollee; or (3) January 1, 1996. A health maintenance organization also shall, upon receipt of information that an enrollee is pregnant, promptly notify that enrollee of the coverage required by this section.

(cf: P.L.1995, c.138, s.8)

    9. This act shall take effect immediately.

Requires insurers to preauthorize and notify pregnant woman of certain inpatient maternity benefits.