Sponsored by:
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
Assemblywoman ANGELA V. MCKNIGHT
District 31 (Hudson)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Assemblywoman LINDA S. CARTER
District 22 (Middlesex, Somerset and Union)
Co-Sponsored by:
Assemblyman Caputo, Assemblywomen Chaparro and Murphy
SYNOPSIS
Requires health benefits coverage of hearing aids and cochlear implants for insureds aged 21 or younger.
CURRENT VERSION OF TEXT
As introduced.
An Act requiring health benefits coverage for hearing aids and cochlear implants, amending P.L.2008, c.126 and supplementing P.L.2007, c.103 (C 52:14-17.46).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.2008, c.126 (C.17:48-6gg) is amended to read as follows:
2. a. A 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 provide coverage for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A hospital service corporation contract shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A hospital service corporation may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A hospital service corporation contract shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the contract.
e. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.2)
2. Section 3 of P.L.2008, c.126 (C.17:48A-7dd) is amended to read as follows:
3. a. A 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 provide coverage for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A medical service corporation contract shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A medical service corporation may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A medical service corporation contract shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the contract.
e. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.3)
3. Section 4 of P.L.2008, c.126 (C.17:48E-35.31) is amended to read as follows:
4. a. A 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 al.), 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 coverage for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A health service corporation contract shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A health service corporation may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A health service corporation contract shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the contract.
e. This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.4)
4. Section 5 of P.L.2008, c.126 (C.17B:26-2.1aa) is amended to read as follows:
5. a. An individual health insurance policy that provides hospital and medical expense benefits and 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 coverage for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A policy shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [An insurer may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) An individual health insurance policy shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a policy does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the policy shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the policy.
e. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.5)
5. Section 6 of P.L.2008, c.126 (C.17B:27-46.1gg) is amended to read as follows:
6. a. A group health insurance policy that provides hospital and medical expense benefits and 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 coverage for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A policy shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [An insurer may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A group health insurance policy shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a policy does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the policy shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the policy.
e. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.6)
6. Section 7 of P.L.2008, c.126 (C.17B:27A-7.14) is amended to read as follows:
7. a. An individual health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et al.), on or after the effective date of this act, shall provide coverage for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A health benefits plan shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A carrier may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) An individual health benefits plan shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a plan does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the plan shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the health benefits plan.
e. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.7)
7. Section 8 of P.L.2008, c.126 (C.17B:27A-19.18) is amended to read as follows:
8. a. A small employer health benefits plan that provides hospital and medical expense benefits and 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 provide coverage for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A health benefits plan shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A carrier may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A small employer health benefits plan shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a plan does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the plan shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the health benefits plan.
e. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.8)
8. Section 9 of P.L.2008, c.126 (C.26:2J-4.32) is amended to read as follows:
9. a. A health maintenance organization contract for health care services that is delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-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 health care services for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for an enrollee [15] 21 years of age or younger, as provided in this section.
b. The health care services shall include the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A health maintenance organization may limit the health care services provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. An enrollee may choose a hearing aid that is priced higher than the health care services payable under this section and may pay the difference between the price of the hearing aid and the health care services payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A health maintenance organization contract shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The health care services shall be provided to the same extent as for any other condition under the contract.
e. 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.
(cf: P.L.2008, c.126, s.9)
9. Section 10 of P.L.2008, c.126 (C.52:14-17.29n) is amended to read as follows:
10. a. The State Health Benefits Commission shall, on or after the effective date of this act, provide benefits for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. The benefits shall include the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [The commission may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) The benefits shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
(cf: P.L.2008, c.126, s.10)
10. Section 11 of P.L.2008, c.126 (C.30:4J-12.2) is amended to read as follows:
11. a. The Commissioner of Human Services shall ensure that every contract for health care services under the NJ FamilyCare Program established pursuant to sections 3 through 5 of P.L.2005, c.156 (C.30:4J-10 through C.30:4J-12), entered into on or after the effective date of this act, provides benefits for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. The benefits shall include the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [The commissioner may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months in any of the NJ FamilyCare Program plans, and may provide, when applicable, that a covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) The benefits shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
(cf: P.L.2008, c.126, s.11)
11. (New section) a. The School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act provides benefits for medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person as provided in this section.
b. The benefits shall include the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist.
c. (1) The benefits shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
12. This act shall take effect on the 90th day next after the date of enactment.
STATEMENT
This bill amends P.L.2008, c.126, “Grace’s Law,” by removing the specification that health insurers (health, hospital, and medical service corporations, commercial individual and group health insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the NJ FamilyCare Program) provide coverage for expenses incurred in the purchase of a hearing aid only for covered persons who are 15 years old or younger, and providing instead that they provide coverage for those expenses for covered persons who are 21 year old or younger.
The bill also requires that benefits provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
The bill provides that if a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract must cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
In addition, the bill supplements P.L.2007, c.103 (C.52:14-17.46.1 et seq.) to require the School Employees’ Health Benefits Commission to ensure that every contract purchased by the commission meets the same requirements for hearing aid and cochlear implant coverage as “Grace’s Law.”