S1290

An Act concerning health benefits coverage for certain organ transplants 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. Notwithstanding any other provision of law to the contrary, every hospital service corporation contract that provides hospital and medical expense 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 Banking and Insurance, on or after the effective date of this act, shall comply with the provisions of this section.

b. The hospital service corporation shall develop informational materials in conjunction with the federally designated organ procurement organization for the State to inform its subscribers at each contract renewal about how to register for organ donor designation with the New Jersey Motor Vehicle Commission.

c. The hospital service corporation may require that its subscribers provide documentation of registration as organ donors, and may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is at least 18 years of age or is an emancipated minor and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit a hospital service corporation from providing a premium discount for a subscriber who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L.2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

d. 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. a. Notwithstanding any other provision of law to the contrary, every medical service corporation contract that provides hospital and medical expense 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 Banking and Insurance, on or after the effective date of this act, shall comply with the provisions of this section.

b. The medical service corporation shall develop informational materials in conjunction with the federally designated organ procurement organization for the State to inform its subscribers at each contract renewal about how to register for organ donor designation with the New Jersey Motor Vehicle Commission.

c. The medical service corporation may require that its subscribers provide documentation of registration as organ donors, and may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is at least 18 years of age or is an emancipated minor and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit a medical service corporation from providing a premium discount for a subscriber who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L.2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

d. 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. a. Notwithstanding any other provision of law to the contrary, every health service corporation contract that provides hospital and medical expense 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 Banking and Insurance, on or after the effective date of this act, shall comply with the provisions of this section.

b. The health service corporation shall develop informational materials in conjunction with the federally designated organ procurement organization for the State to inform its subscribers at each contract renewal about how to register for organ donor designation with the New Jersey Motor Vehicle Commission.

c. The health service corporation may require that its subscribers provide documentation of registration as organ donors, and may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is at least 18 years of age or is an emancipated minor and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit a health service corporation from providing a premium discount for a subscriber who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L.2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

d. 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. a. An individual health policy that provides hospital and medical expense 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 Banking and Insurance, on or after the effective date of this act, shall comply with the provisions of this section.

b. The insurer shall develop informational materials in conjunction with the federally designated organ procurement organization for the State to inform its insureds at each policy renewal about how to register for organ donor designation with the New Jersey Motor Vehicle Commission.

c. The insurer may require that its insureds provide documentation of registration as organ donors, and may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is at least 18 years of age or is an emancipated minor and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit an insurer from providing a premium discount for an insured who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

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

5. a. A group health policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to N.J.S.17B:27-26 et seq., on or after the effective date of this act, shall comply with the provisions of this section.

c. The policy may require that insureds provide documentation of registration as organ donors, and the insurer may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is at least 18 years of age or is an emancipated minor and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit the insurer from providing a premium discount for an insured who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

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

6. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed on or after the effective date of this act in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), shall comply with the provisions of this section.

b. The health maintenance organization shall develop informational materials in conjunction with the federally designated organ procurement organization for the State to inform its enrollees at each policy renewal about how to register for organ donor designation with the New Jersey Motor Vehicle Commission.

c. The health maintenance organization may require that enrollees provide documentation of registration as organ donors, and may limit health care services for a solid organ transplant if the transplant recipient is at least 18 years of age or is an emancipated minor and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit the health maintenance organization from providing a premium discount for an enrollee who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L.2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

d. This section shall apply to those contracts for health care services under which the right to change the schedule of charges for enrollee coverage is reserved.

7. a. An 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.), on or after the effective date of this act, shall comply with the provisions of this section.

b. The carrier shall develop informational materials in conjunction with the federally designated organ procurement organization for the State to inform its covered persons at each plan renewal about how to register for organ donor designation with the New Jersey Motor Vehicle Commission.

c. The carrier may require that its covered persons provide documentation of registration as organ donors, and may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is at least 18 years of age or is an emancipated minor and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit the carrier from providing a premium discount for a covered person who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L.2008, c.50. For purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

d. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.

8. a. A 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.), on or after the effective date of this act, shall comply with the provisions of this section.

c. The insurer may require that its covered persons provide documentation of registration as organ donors, and may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is at least 18 years of age or is an emancipated minor and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit the carrier from providing a premium discount for a covered person who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

d. This section shall apply to those health benefit plans in which the carrier has reserved the right to change the premium.

9. a. The State Health Benefits Commission shall develop informational materials in conjunction with the federally designated organ procurement organization for the State to inform persons covered under every contract purchased by the commission, on or after the effective date of this act, at each contract renewal about how to register for organ donor designation with the New Jersey Motor Vehicle Commission.

b. The commission may require that covered persons age 18 and older provide documentation of registration as organ donors, and may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is age 18 or older and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit the State Health Benefits Program from providing a discount for the cost of coverage for a covered person who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L.2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

10. a. The School Employees’ Health Benefits Commission shall develop informational materials in conjunction with the federally designated organ procurement organization for the State to inform persons covered under every contract purchased by the commission, on or after the effective date of this act, at each renewal about how to register for organ donor designation with the New Jersey Motor Vehicle Commission.

b. The commission may require that covered persons age 18 and older provide documentation of registration as organ donors, and may limit reimbursement for otherwise medically necessary expenses incurred for a solid organ transplant if the transplant recipient is age 18 or older and has not provided documentation of registration as an organ donor, or made an anatomical gift pursuant to P.L.2008, c.50 (C.26:6-77 et seq.). Nothing in this subsection shall be construed to limit the School Employees’ Health Benefits Program from providing a discount for the cost of coverage for a covered person who provides documentation of registration as an organ donor or of a document of gift in accordance with the provisions of P.L.2008, c.50. For the purposes of this subsection, “solid organ” means a kidney, liver, heart, or lung.

11. This act shall take effect on the first day of the fourth month next following the date of enactment and shall apply to all contracts and policies issued on or after the effective date.

STATEMENT

This bill requires certain health insurers to develop informational materials in conjunction with the federally designated organ procurement organization for the State that informs their policy holders at each renewal period about how to register as an organ donor with the New Jersey Motor Vehicle Commission.

In addition, the bill allows these insurers to limit reimbursement for the costs associated with solid organ (kidney, liver, heart, or lung) transplants for adult transplant recipients and emancipated minors who have not made an anatomical gift pursuant to the Revised Uniform Anatomical Gift Act. That law provides numerous ways for prospective organ donors to designate themselves as such, including through wills and when renewing drivers licenses. A prospective organ transplant recipient can be a designated organ donor.

The provisions of the bill apply to hospital, medical, and health service corporations, commercial insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage Program and Small Employer Health Benefits Program, and the State Health Benefits Program and School Employees’ Health Benefits Program.

The public policy of New Jersey has been to encourage organ donation because of the ongoing shortage of life-saving organs. While the availability of an organ for transplant should not be based upon the generosity of the recipient, public policy supports the imposition of increased expenses on those insured individuals who would take advantage of the precious resource of organs to save their own lives, but would not similarly commit to giving. Thus, this bill supports the ethic of reciprocity, or “Golden Rule”; individuals who willingly accept organs from others should be willing to similarly designate themselves as organ donors.