Sponsored by:
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
Assemblyman RALPH R. CAPUTO
District 28 (Essex)
SYNOPSIS
Requires SHBP and SEHBP to provide coverage for health care benefits provided by physicians who terminate contract with federal Medicare program.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health care benefits coverage under the State Health Benefits Program and the School Employees’ Health Benefits Program and supplementing P.L.1961, c.79 (C.52:14-17.25 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any other provision of law to the contrary, the State Health Benefits Commission and the School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission provides that if a physician providing services for a retired program enrollee terminates participation as a physician in the federal Medicare program, the State Health Benefits Program or the School Employees’ Health Benefits Program, as appropriate, shall provide coverage for health care benefits to each such retiree whose physician terminated participation in the federal Medicare program for expenses incurred in continuing treatment and care of that enrollee by that physician. The continuing treatment by a particular physician as provided for in this section shall be at the option of the covered person.
The State Health Benefits Program or the School Employees’ Health Benefits Program shall require that health care benefits or services, as appropriate, shall be provided for the medically necessary treatment of conditions to the same extent as such benefits or services were provided while the physician was participating in the federal Medicare program. Reimbursement for the health care services shall be pursuant to the same fee schedule used to reimburse for the services when the physician was participating in the federal Medicare program.
2. This act shall take effect immediately.
STATEMENT
This bill requires the State Health Benefits Program and the School Employees’ Health Benefits Program to pay for medically necessary health care benefits coverage for a retired public employee when the retiree’s physician no longer participates in the federal Medicare program. Coverage will be provided to the same extent as such benefits or services were provided while the physician was participating in the federal Medicare program. The bill requires that reimbursement for the health care services will be pursuant to the same fee schedule used to reimburse for the services when the physician was participating in the federal Medicare program. The continuing treatment by a particular physician as provided for in this section shall be at the option of the covered person.