Bill Text: NJ A1109 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires health insurance carriers to use standard explanation of benefits form.
Spectrum: Partisan Bill (Democrat 6-0)
Status: (Introduced - Dead) 2010-01-12 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A1109 Detail]
Download: New_Jersey-2010-A1109-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Assemblyman PATRICK J. DIEGNAN, JR.
District 18 (Middlesex)
Assemblyman JOSEPH V. EGAN
District 17 (Middlesex and Somerset)
Co-Sponsored by:
Assemblymen P. Barnes, III, Wisniewski, Chivukula and Scalera
SYNOPSIS
Requires health insurance carriers to use standard explanation of benefits form.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning certain health benefits forms and supplementing P.L.1999, c.155 (C.17B:30-26 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Every carrier issuing health benefits plans in this State shall provide a written explanation of benefits form which complies with the standardized form prescribed pursuant to subsection b. of this section to a covered person whenever a claim is generated under the covered person's health benefits plan.
b. 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.). The uniform explanation of benefits form shall be used by every carrier as required by subsection a. of this section. The uniform explanation of benefits form shall include, but not be limited to, a summary of benefits for current services, including the cost of service, the amount paid by the carrier and the amount to be paid by the covered person; an explanation of the reason for benefit denial, if any; and a summary of the covered person's policy.
2. This act shall take effect immediately.
STATEMENT
This bill requires health insurance carriers issuing health benefits plans in this State to provide a standardized written explanation of benefits form (commonly referred to as an "EOB") to a covered person whenever a claim is generated under the covered person's health benefits plan.
The bill provides that 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.) to be used by carriers in complying with the bill's requirements. The uniform explanation of benefits form shall include, but not be limited to, a summary of current services, including the cost of service, the amount paid by the carrier and the amount to be paid by the covered person; an explanation of the reason for benefit denial, if any; and a summary of the covered person's policy.
