[First Reprint]

ASSEMBLY, No. 4455

STATE OF NEW JERSEY

218th LEGISLATURE

INTRODUCED SEPTEMBER 17, 2018

Sponsored by:

Assemblyman  LOUIS D. GREENWALD

District 6 (Burlington and Camden)

Assemblywoman  CAROL A. MURPHY

District 7 (Burlington)

Assemblywoman  VALERIE VAINIERI HUTTLE

District 37 (Bergen)

Co-Sponsored by:

Assemblywomen McKnight and Timberlake

SYNOPSIS

     Requires health insurance carriers to adhere to certain practices to protect health information related to sensitive services.

CURRENT VERSION OF TEXT

     As reported by the Assembly Financial Institutions and Insurance Committee on May 13, 2019, with amendments.

An Act concerning the protection of health information related to sensitive services and supplementing P.L.1997, c.192 (C.26:2S-1 et al.).

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

     1.    As used in this act:

     “Carrier” means a carrier as defined in section 2 of P.L.1997, c.192 (C.26:2S-2), except that carrier shall also include the State Health Benefits Program and the School Employees’ Health Benefits Program.

     “Sensitive services” means health care services related to sexual assault, pregnancy, family planning, sexually transmitted diseases, domestic violence and substance or alcohol abuse, and any other services that may be determined to be sensitive services by the Commissioner of Banking and Insurance, in consultation with the Commissioner of Health.

     2.    a. The Commissioner of Banking and Insurance shall prescribe by regulation a standardized explanation of benefits form designed to be clearly understandable to covered persons in a manner consistent with the "Life and Health Insurance Policy Language Simplification Act," P.L.1979, c.167 (C.17B:17-17 et seq.).

     b.    Except as provided in subsection d. of this section, the standardized explanation of benefits form shall include, but not be limited to, a summary of benefits for current services, including: the cost of the health care service; the amount paid by the carrier; the amount to be paid by the covered person; and an explanation of the reason for benefit denial or limitation, if any.

     c.     A carrier issuing health benefits plans in this State shall provide a written explanation of benefits which complies with the standardized form prescribed pursuant to subsection a. of this section to each covered person separately, but not to any other covered person, whenever a claim under the health benefits plan is generated by that covered person.

     d.    An explanation of benefits shall not contain information about sensitive services unless¹[: 

     (1)   the parent or guardian of a minor under the age of 18 makes a written request to the carrier that the explanation of benefits for that dependent contain information about sensitive services  that were provided to that dependent; or

     (2)   a covered person who is 18 years of age or older makes a written request to the carrier to have the explanation of benefits for that covered person contain information about sensitive services that were provided to that covered person] requested by a covered person who is legally authorized to consent to medical care¹.

     3.    a.  A carrier shall provide an explanation of benefits which relates to sensitive services¹[, pursuant to the circumstances set forth in] if requested in writing by a covered person pursuant to¹ subsection d. of section 2 of this act, by using an alternative method of delivery ¹[, as designated by the parent or guardian of the minor, or by the covered person, upon written request]¹.

     b.    A carrier shall provide a covered person, who is ¹[18 years of age or older] legally authorized to consent to medical care¹, with the option to elect not to receive an explanation of benefits for a claim in a situation in which there is no remaining balance related to the claim.

     c.     An explanation of benefits is related to sensitive services for the purposes of this act if it discloses protected health information, including information regarding treatment or diagnosis, or the name or address of a provider of sensitive services, or if disclosure of all or part of the protected health information could endanger the covered person.

     4.    Alternative methods for delivery of an explanation of benefits related to sensitive services shall include, but not be limited to, the following:

     a.     a paper form sent to the address of the covered person who received the sensitive service;

     b.    a paper form sent to any alternate address designated by the covered person who received the sensitive service; or

     c.     allowing only the covered person who received the sensitive service to access the communication through electronic means, as available, provided that such access is granted in compliance with any applicable State and federal laws and regulations pertaining to data security.

     5.    A carrier shall communicate the right to request an alternative method of delivery of an explanation of benefits related to sensitive services, and the process to make a request, in plain language and in a clear and conspicuous manner in coverage documents and member privacy communications. The carrier shall also conspicuously display the covered person’s right to request that alternative method of delivery on the carrier’s website and online portals for covered persons.

     6.    a.  A carrier shall not require an explanation as to the basis for a covered person’s request pursuant to this act, unless otherwise required by law or court order.

     b.    A carrier shall not condition enrollment or coverage on the waiver of rights provided in this act.

     7.    This act shall take effect on the 120th day next following enactment.