SENATE, No. 2050

 

STATE OF NEW JERSEY

 

INTRODUCED MAY 8, 1997

 

 

By Senators BASSANO, CODEY, Connors, Matheussen, Rice and Singer

 

 

An Act concerning health benefits coverage for serious mental illness and supplementing various parts of the statutory law.

 

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

 

    1. a. Every individual or group hospital service corporation contract providing hospital or medical expense benefits that 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 Banking and Insurance, on or after the effective date of this act shall provide benefits to any subscriber or other person covered thereunder for the treatment of serious mental illness when that treatment is recommended or prescribed by a licensed physician. When a diagnosis of serious mental illness is accompanied by substance abuse, the individual or group hospital service corporation contract shall also provide benefits for the treatment of substance abuse.

    b. For purposes of this section, "serious mental illness" means any mental illness that is recognized in the latest edition of relevant manuals of the American Psychiatric Association or by the International Classification of Diseases, and affirmed by medical science as caused by biological disorder of the brain, and that substantially limits the life activities of the covered person. The term includes, but is not limited to, schizophrenia, schizoaffective disorders, anxiety and panic disorders, bipolar affective disorders, major depression and obsessive-compulsive disorder.

    c. The benefits required by this section shall be provided to the same extent as for any other sickness under the contract.

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

    e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).


    2. a. Every individual or group medical service corporation contract providing hospital or medical expense benefits that 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 Banking and Insurance, on or after the effective date of this act shall provide benefits to any subscriber or other person covered thereunder for the treatment of serious mental illness when that treatment is recommended or prescribed by a licensed physician. When a diagnosis of serious mental illness is accompanied by substance abuse, the individual or group medical service corporation contract shall also provide benefits for the treatment of substance abuse.

    b. For purposes of this section, "serious mental illness" means any mental illness that is recognized in the latest edition of relevant manuals of the American Psychiatric Association or by the International Classification of Diseases, and affirmed by medical science as caused by biological disorder of the brain, and that substantially limits the life activities of the covered person. The term includes, but is not limited to, schizophrenia, schizoaffective disorders, anxiety and panic disorders, bipolar affective disorders, major depression and obsessive-compulsive disorder.

    c. The benefits required by this section shall be provided to the same extent as for any other sickness under the contract.

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

    e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).

 

    3. a. Every individual or group health service corporation contract providing hospital or medical expense benefits that 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 Banking and Insurance, on or after the effective date of this act shall provide benefits to any subscriber or other person covered thereunder for the treatment of serious mental illness when that treatment is recommended or prescribed by a licensed physician. When a diagnosis of serious mental illness is accompanied by substance abuse, the individual or group health service corporation contract shall also provide benefits for the treatment of substance abuse.

    b. For purposes of this section, "serious mental illness" means any mental illness that is recognized in the latest edition of relevant manuals of the American Psychiatric Association or by the International Classification of Diseases, and affirmed by medical science as caused by biological disorder of the brain, and that substantially limits the life activities of the covered person. The term includes, but is not limited to, schizophrenia, schizoaffective disorders, anxiety and panic disorders, bipolar affective disorders, major depression and obsessive-compulsive disorder.

    c. The benefits required by this section shall be provided to the same extent as for any other sickness under the contract.

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

    e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).

 

    4. a. Every individual health insurance policy providing hospital or medical expense benefits that is 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 Banking and Insurance, on or after the effective date of this act shall provide benefits to any person covered thereunder for the treatment of serious mental illness when that treatment is recommended or prescribed by a licensed physician. When a diagnosis of serious mental illness is accompanied by substance abuse, the individual or group health service corporation contract shall also provide benefits for the treatment of substance abuse.

    b. For purposes of this section, "serious mental illness" means any mental illness that is recognized in the latest edition of relevant manuals of the American Psychiatric Association or by the International Classification of Diseases, and affirmed by medical science as caused by biological disorder of the brain, and that substantially limits the life activities of the covered person. The term includes, but is not limited to, schizophrenia, schizoaffective disorders, anxiety and panic disorders, bipolar affective disorders, major depression and obsessive-compulsive disorder.

    c. The benefits required by this section shall be provided to the same extent as for any other sickness under the policy.

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

    e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).

 

    5. a. Every group health insurance policy providing hospital or medical expense benefits that is 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 Banking and Insurance, on or after the effective date of this act shall provide benefits to any person covered thereunder for the treatment of serious mental illness when that treatment is recommended or prescribed by a licensed physician. When a diagnosis of serious mental illness is accompanied by substance abuse, the individual or group health service corporation contract shall also provide benefits for the treatment of substance abuse.

    b. For purposes of this section, "serious mental illness" means any mental illness that is recognized in the latest edition of relevant manuals of the American Psychiatric Association or the International Classification of Diseases, and affirmed by medical science as caused by biological disorder of the brain, and that substantially limits the life activities of the covered person. The term includes, but is not limited to, schizophrenia, schizoaffective disorders, anxiety and panic disorders, bipolar affective disorders, major depression and obsessive- compulsive disorder.

    c. The benefits required by this section shall be provided to the same extent as for any other sickness under the policy.

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

    e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).

 

    6. a. 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 and Senior Services on or after the effective date of this act unless the health maintenance organization provides health care services to any enrollee or other person covered thereunder for the treatment of serious mental illness when that treatment is recommended or prescribed by a licensed physician. When a diagnosis of serious mental illness is accompanied by substance abuse, the contract shall also provide benefits for the treatment of substance abuse.

    b. For purposes of this section, "serious mental illness" means any mental illness that is recognized in the latest edition of relevant manuals of the American Psychiatric Association or by the International Classification of Diseases, and affirmed by medical science as caused by biological disorder of the brain, and that substantially limits the life activities of the covered person. The term includes, but is not limited to, schizophrenia, schizoaffective disorders, anxiety and panic disorders, bipolar affective disorders, major depression and obsessive-compulsive disorder.

    c. The health care services required by this section shall be provided to the same extent as for any other sickness under the enrollee agreement.

    d. This section shall apply to all enrollee agreements for health care services in which the health maintenance organization has reserved the right to change the schedule of charges.

    e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).

 

    7. This act shall take effect immediately.

 

 

STATEMENT

 

    This bill requires hospital service corporations, medical service corporations, health service corporations, commercial individual and group health insurers and health maintenance organizations to provide health benefits coverage for the treatment of serious mental illness when such treatment is recommended or prescribed by a licensed physician. The bill also requires that benefits be provided for the treatment of substance abuse if the diagnosis of serious mental illness is accompanied by such abuse.

    The bill defines "serious mental illness" as any mental illness that is recognized in the latest edition of relevant manuals of the American Psychiatric Association or by the International Classification of Diseases, and affirmed by medical science as caused by biological disorder of the brain, and that substantially limits the life activities of the covered person. The term includes, but is not limited to, schizophrenia, schizoaffective disorders, anxiety and panic disorders, bipolar affective disorders, major depression and obsessive-compulsive disorder.

    By requiring health benefits coverage for the treatment of serious mental illness, the bill promotes the relief and alleviation of health and medical problems which affect a significant portion of the population.

 

 

                             

 

Requires health benefits coverage for serious mental illness.