[First Reprint]
SENATE, No. 1561
STATE OF NEW JERSEY
INTRODUCED OCTOBER 3, 1996
By Senator SINGER
An Act requiring health insurance benefits for expenses incurred for 1certain1 bone density tests 1[in connection with the diagnosis or treatment of osteoporosis]1 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.), chapters 26 and 27 of 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. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), 1[every] no1 group or individual hospital service corporation contract providing hospital or medical expense benefits 1shall be1delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act1[, shall provide benefits for bone density tests which are performed in connection with the diagnosis or treatment of osteoporosis] unless the hospital service corporation develops guidelines which establish the hospital service corporation's policy for determining when bone density tests are medically indicated, and provides benefits for bone density tests performed in accordance with the guidelines. At a minimum, the guidelines shall take into account co-existing medical conditions, family history and lifestyle practices and medications that place a patient at risk for osteoporosis. The hospital service corporation shall make the guidelines available to a health care provider upon request1. Benefits for such tests shall be provided to the same extent as for any other illness under the contract. 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. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), 1[every] no1 group or individual medical service corporation contract providing hospital or medical expense benefits 1shall be1delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act1[, shall provide benefits for bone density tests which are performed in connection with the diagnosis or treatment of osteoporosis] unless the medical service corporation develops guidelines which establish the medical service corporation's policy for determining when bone density tests are medically indicated, and provides benefits for bone density tests performed in accordance with the guidelines. At a minimum, the guidelines shall take into account co-existing medical conditions, family history and lifestyle practices and medications that place a patient at risk for osteoporosis. The medical service corporation shall make the guidelines available to a health care provider upon request1. Benefits for such tests shall be provided to the same extent as for any other illness under the contract. 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. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), 1[every] no1 group or individual health service corporation contract providing hospital or medical expense benefits 1shall be1 delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act1[, shall provide benefits for bone density tests which are performed in connection with the diagnosis or treatment of osteoporosis] unless the health service corporation develops guidelines which establish the health service corporation's policy for determining when bone density tests are medically indicated, and provides benefits for bone density tests performed in accordance with the guidelines. At a minimum, the guidelines shall take into account co-existing medical conditions, family history and lifestyle practices and medications that place a patient at risk for osteoporosis. The health service corporation shall make the guidelines available to a health care provider upon request1. Benefits for such tests shall be provided to the same extent as for any other illness under the contract. 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. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) 1[every] no1 individual policy providing health insurance coverage 1shall be1delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of 1Banking and1 Insurance on or after the effective date of this act1[, shall provide benefits for bone density tests which are performed in connection with the diagnosis or treatment of osteoporosis] unless the insurer develops guidelines which establish the insurer's policy for determining when bone density tests are medically indicated, and provides benefits for bone density tests performed in accordance with the guidelines. At a minimum, the guidelines shall take into account co-existing medical conditions, family history and lifestyle practices and medications that place a patient at risk for osteoporosis. The insurer shall make the guidelines available to a health care provider upon request1. Benefits for such tests shall be provided to the same extent as for any other illness under the policy.
This section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
5. Except as otherwise provided in P.L.1992, c.162 (C.17B:27A-17 et seq.), 1[every] no1 group policy providing health insurance coverage 1shall be1 delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act1[, shall provide benefits for bone density tests which are performed in connection with the diagnosis or treatment of osteoporosis] unless the insurer develops guidelines which establish the insurer's policy for determining when bone density tests are medically indicated, and provides benefits for bone density tests performed in accordance with the guidelines. At a minimum, the guidelines shall take into account co-existing medical conditions, family history and lifestyle practices and medications that place a patient at risk for osteoporosis. The insurer shall make the guidelines available to a health care provider upon request1. Benefits for such tests shall be provided to the same extent as for any other illness under the policy.
This section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
6. Except as otherwise provided in P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.), no certificate of authority to establish and operate a health maintenance organization in this State shall be issued or continued on or after the effective date of this act unless the health maintenance organization 1[provides health care services for any enrollee for bone density tests which are performed in connection with the diagnosis or treatment of osteoporosis] develops guidelines which establish the health maintenance organization's policy for determining when bone density tests are medically indicated, and provides health care services for any enrollee for bone density tests performed in accordance with the guidelines. At a minimum, the guidelines shall take into account co-existing medical conditions, family history and lifestyle practices and medications that place a patient at risk for osteoporosis. The health maintenance organization shall make the guidelines available to a participating health care provider upon request1. These health care services shall be provided to the same extent as for any other sickness.
The provisions of this section shall apply to all contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.
7. This act shall take effect on the 90th day after enactment.
Requires health insurers to establish guidelines for bone density tests and provide coverage in accordance with the guidelines.