Sponsored by:
Senator LORETTA WEINBERG
District 37 (Bergen)
SYNOPSIS
Requires health insurers and SHBP and SEHBP to provide coverage for screening for cervical cancer, including testing for HPV.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning insurance coverage for testing for cervical cancer and revising parts of statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1995, c.415 (C.17:48E-35.12) is amended to read as follows:
1. No health service corporation contract providing hospital or medical expense benefits for groups with greater than 50 persons shall be 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 act, unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting [a Pap smear. The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, and notwithstanding the provisions of this section to the contrary, "Pap smear" means an initial Pap smear and any confirmatory test when medically necessary and as ordered by the covered person's physician and includes all laboratory costs associated with the initial Pap smear and any such confirmatory test.] cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening" includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The benefits shall be provided to the same extent as for any other medical condition 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.
(cf: P.L.2001, c.227, s.1)
2. Section 2 of P.L.1995, c.415 (C.17:48-6o) is amended to read as follows:
2. No hospital service corporation contract providing hospital or medical expense benefits for groups with greater than 50 persons shall be 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 act, unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting [a Pap smear. The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, and notwithstanding the provisions of this section to the contrary, "Pap smear" means an initial Pap smear and any confirmatory test when medically necessary and as ordered by the covered person's physician and includes all laboratory costs associated with the initial Pap smear and any such confirmatory test.] cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening" includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The benefits shall be provided to the same extent as for any other medical condition 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.
(cf: P.L.2001, c.227, s.2)
3. Section 3 of P.L.1995, c.415 (C.17:48A-7m) is amended to read as follows:
3. No medical service corporation contract providing hospital or medical expense benefits for groups with greater than 50 persons shall be 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 act, unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting [a Pap smear. The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, and notwithstanding the provisions of this section to the contrary, "Pap smear" means an initial Pap smear and any confirmatory test when medically necessary and as ordered by the covered person's physician and includes all laboratory costs associated with the initial Pap smear and any such confirmatory test.] cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening" includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The benefits shall be provided to the same extent as for any other medical condition 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.
(cf: P.L.2001, c.227, s.3)
4. Section 4 of P.L.1995, c.415 (C.17B:27-46.1n) is amended to read as follows:
4. No group health insurance policy providing hospital or medical expense benefits for groups with greater than 50 persons shall be 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 act, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting [a Pap smear. The benefits shall be provided to the same extent as for any other medical condition under the policy.
As used in this section, and notwithstanding the provisions of this section to the contrary, "Pap smear" means an initial Pap smear and any confirmatory test when medically necessary and as ordered by the covered person's physician and includes all laboratory costs associated with the initial Pap smear and any such confirmatory test.] cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening"includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The benefits shall be provided to the same extent as for any other medical condition under the policy.
This section shall apply to all group health insurance policies in which the health insurer has reserved the right to change the premium.
(cf: P.L.2001, c.227, s.4)
5. Section 5 of P.L.1995, c.415 (C.26:2J-4.12) is amended to read as follows:
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 and Senior Services] on or after the effective date of this act unless the health maintenance organization offers health care services to any enrollee or other person covered thereunder which include [a Pap smear. The health care services shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, and notwithstanding the provisions of this section to the contrary, "Pap smear" means an initial Pap smear and any confirmatory test when medically necessary and as ordered by the covered person's physician and includes all laboratory costs associated with the initial Pap smear and any such confirmatory test.] cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening" includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The health care services shall be provided to the same extent as for any other medical condition under the contract.
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.
(cf: P.L.2001, c.227, s.5)
6. Section 6 of P.L.2001, c.227 (C.52:14-17.29f) is amended to read as follows:
6. The State Health Benefits Commission shall provide benefits to each person covered under the State Health Benefits Program for expenses incurred in conducting [a Pap smear. The benefits shall be provided to the same extent as for any other medical condition under the contract.
As used in this section, and notwithstanding the provisions of this section to the contrary, "Pap smear" means an initial Pap smear and any confirmatory test when medically necessary and as ordered by the covered person's physician and includes all laboratory costs associated with the initial Pap smear and any such confirmatory test.] cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening" includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The benefits shall be provided to the same extent as for any other medical condition under the program.
(cf: P.L.2001, c.227, s.6)
7. (New section) Every individual health benefits plan that 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, on or after the effective date of this act, shall provide benefits to a covered person for expenses incurred in conducting cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening" includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
8. (New section) Every small employer health benefits plan that 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, on or after the effective date of this act, shall provide benefits to a covered person for expenses incurred in conducting cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening" includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
The provisions of this section shall apply to all health benefit plans in which the carrier has reserved the right to change the premium.
9. (New section) The School Employees Health Benefits Commission shall provide benefits to each person covered under the School Employees Health Benefits Program for expenses incurred in conducting cervical cytology screening for the early detection of cervical cancer.
As used in this section, "cervical cytology screening" includes, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The benefits shall be provided to the same extent as for any other medical condition under the program.
10. This act shall take effect on the 60th day following enactment and shall apply to all contracts and policies delivered, issued or renewed on or after that date.
STATEMENT
This bill requires health, hospital, and medical service corporations, individual, small employer, and larger group health insurers, health maintenance organizations, and the State Health Benefits Program (SHBP) and School Employees Health Benefits Program (SEHBP) to provide coverage for cervical cytology screening for the early detection of cervical cancer. The bill defines “cervical cytology screening” to include, as determined medically necessary by the covered person's licensed health care provider: a Pap test, including liquid-based cytology, HPV test, and any confirmatory test; and all laboratory costs associated with the tests.
The State currently requires larger group health insurers (groups greater than 50 persons), health maintenance organizations and SHBP to provide coverage for expenses incurred in conducting a Pap test, and any confirmatory test, which coverage includes all laboratory costs associated with the Pap test and any confirmatory test.
This bill broadens the requirement to include individual and small employer health benefits plans and to specify that the coverage is for cervical cytology screening for the early detection of cervical cancer, which would include testing for HPV, as well as a Pap test.
HPV (human papilloma virus) infections are now recognized as the major cause of cervical cancer. HPVs are a group of more than 100 viruses, some of which are sexually transmitted. HPVs classified as "low risk" seldom are associated with cervical cancer; however, HPVs classified as "high risk" have been linked with genital or anal cancers in both men and women. Most HPV infections do not last very long because the body is able to fight the infection, and most people with HPV do not know they have the virus because they may not have any symptoms. If the HPV does not go away, however, the virus may cause cells in the cervix to change and become precancer cells, which changes can be detected by the Pap test. Further HPV testing can determine the exact type of HPV causing the infection and whether additional testing or treatment is required to prevent the development of cervical cancer.