Bill Text: NJ A2012 | 2010-2011 | Regular Session | Introduced
Bill Title: Revises health wellness insurance benefits.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2010-02-08 - Introduced, Referred to Assembly Health and Senior Services Committee [A2012 Detail]
Download: New_Jersey-2010-A2012-Introduced.html
Sponsored by:
Assemblywoman CHARLOTTE VANDERVALK
District 39 (Bergen)
SYNOPSIS
Revises health wellness insurance benefits.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health wellness insurance benefits and amending P.L.1993, c.327.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 3 of P.L.1993, c.327 (C.17:48-6i) is amended to read as follows:
3. a. 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 P.L.1999, c.339, shall provide benefits, as set forth in this section, to any subscriber or other person covered thereunder for expenses incurred in a health promotion program through health wellness examinations and counselling, [which] and shall annually notify each subscriber in writing of the availability of these benefits. The health promotion program shall include, but not be limited to, the following tests and services:
(1) For all persons 20 years of age and older, [annual] biennial tests to determine [blood hemoglobin;] blood pressure; blood glucose level; and blood cholesterol level or, alternatively, low-density lipoprotein (LDL) level and blood high-density lipoprotein (HDL) level;
(2) For all persons [35] 40 years of age or older, a glaucoma eye test every five years;
(3) For all persons [40] 45 years of age or older, an annual stool examination for presence of blood;
(4) For all persons 45 years of age or older, a left-sided colon examination of 35 to 60 centimeters every five years or a full colonoscopy every 10 years;
(5) For all women 20 years of age or older, a pap smear pursuant to the provisions of section 2 of P.L.1995, c.415 (C.17:48-6o);
(6) For all women 40 years of age or older, a mammogram examination pursuant to the provisions of section 1 of P.L.1991, c.279 (C.17:48-6g);
(7) For all adults, recommended immunizations; [and]
(8) For all persons 20 years of age or older[, an annual]: a biennial comprehensive prevention examination, which shall include consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being including, but not limited to, smoking control, nutrition and diet recommendations, exercise plans, lower back protection, weight control, immunization practices, breast self-examination, testicular self-examination and seat belt usage in motor vehicles; and, in alternate years, a biennial counseling and risk-factor intervention session that also includes the measurement of blood pressure and the calculation of body mass index;
(9) For post-menopausal women, screening of the hip and spine for osteopenia or osteoporosis every 10 years if the initial test is normal and more often as medically appropriate if the woman is found to be osteopenic or osteoporatic; and
(10) For all persons 20 years of age or older annual screening for depression using a standard depression scale.
Notwithstanding the provisions of this subsection to the contrary, if a physician or other health care provider recommends that it would be medically appropriate for a covered person to receive a different schedule of tests and services than that provided for under this subsection, the hospital service corporation shall provide payment for the tests or services actually provided, within the limits of the amounts listed in subsection b. of this section.
b. Every individual or group health care contract offered for sale in this State by a hospital service corporation pursuant to subsection a. of this section shall provide payment for the benefits set forth in subsection a. of this section in an amount which shall not exceed: $125 a year for each person between the ages of 20 to 39, inclusive; $145 a year for each man age 40 and over; and $235 a year for each woman age 40 and over; except that:
(1) for persons 45 years of age or older, the cost of a left-sided colon examination or a full colonoscopy shall not be included in the above amount; [however, no hospital service corporation shall be required to provide payment for benefits for a left-sided colon examination in excess of $150] and
(2) for post-menopausal women, the cost of a screening of the hip and spine for osteopenia or osteoporosis with dual-energy absorptiometry shall not be included in the above amount.
c. The Commissioner of Banking and Insurance, in consultation with the Department of the Treasury, shall annually adjust the threshold amounts provided by subsection b. of this section in direct proportion to the increase or decrease in the consumer price index for all urban consumers in the New York City and Philadelphia areas as reported by the United States Department of Labor. The adjustment shall become effective on July 1 of the year in which the adjustment is made.
d. This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).
(cf: P.L.1999, c.339, s.1)
2. Section 4 of P.L.1993, c.327 (C.17:48A-7h) is amended to read as follows:
4. a. 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 P.L.1999, c.339, shall provide benefits, as set forth in this section, to any subscriber or other person covered thereunder for expenses incurred in a health promotion program through health wellness examinations and counselling, [which] and shall annually notify each subscriber in writing of the availability of these benefits. The health promotion program shall include, but not be limited to, the following tests and services:
(1) For all persons 20 years of age and older, [annual] biennial tests to determine [blood hemoglobin,] blood pressure, blood glucose level, and blood cholesterol level or, alternatively, low-density lipoprotein (LDL) level and blood high-density lipoprotein (HDL) level;
(2) For all persons [35] 40 years of age or older, a glaucoma eye test every five years;
(3) For all persons [40] 45 years of age or older, an annual stool examination for presence of blood;
(4) For all persons 45 years of age or older, a left-sided colon examination of 35 to 60 centimeters every five years or a full colonoscopy every 10 years;
(5) For all women 20 years of age or older, a pap smear pursuant to the provisions of section 3 of P.L.1995, c.415 (C.17:48A-7m);
(6) For all women 40 years of age or older, a mammogram examination pursuant to the provisions of section 2 of P.L.1991, c.279 (C.17:48A-7f);
(7) For all adults, recommended immunizations; [and]
(8) For all persons 20 years of age or older[, an annual]: a biennial comprehensive prevention examination, which shall include consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being including, but not limited to, smoking control, nutrition and diet recommendations, exercise plans, lower back protection, weight control, immunization practices, breast self-examination, testicular self-examination and seat belt usage in motor vehicles; and, in alternate years, a biennial counseling and risk-factor intervention session that also includes the measurement of blood pressure and the calculation of body mass index;
(9) For post-menopausal women, screening of the hip and spine for osteopenia or osteoporosis every 10 years if the initial test is normal and more often as medically appropriate if the woman is found to be osteopenic or osteoporatic; and
(10) For all persons 20 years of age or older annual screening for depression using a standard depression scale.
Notwithstanding the provisions of this subsection to the contrary, if a physician or other health care provider recommends that it would be medically appropriate for a covered person to receive a different schedule of tests and services than that provided for under this subsection, the medical service corporation shall provide payment for the tests or services actually provided, within the limits of the amounts listed in subsection b. of this section.
b. Every individual or group basic health care contract offered for sale in this State by a medical service corporation pursuant to subsection a. of this section shall provide payment for the benefits set forth in subsection a. of this section in an amount which shall not exceed: $125 a year for each person between the ages of 20 to 39, inclusive; $145 a year for each man age 40 and over; and $235 a year for each woman age 40 and over; except that:
(1) for persons 45 years of age or older, the cost of a left-sided colon examination or a full colonoscopy shall not be included in the above amount; [however, no medical service corporation shall be required to provide payment for benefits for a left-sided colon examination in excess of $150] and
(2) for post-menopausal women, the cost of a screening of the hip and spine for osteopenia or osteoporosis with dual-energy absorptiometry shall not be included in the above amount.
c. The Commissioner of Banking and Insurance, in consultation with the Department of the Treasury, shall annually adjust the threshold amounts provided by subsection b. of this section in direct proportion to the increase or decrease in the consumer price index for all urban consumers in the New York City and Philadelphia areas as reported by the United States Department of Labor. The adjustment shall become effective on July 1 of the year in which the adjustment is made.
d. This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).
(cf: P.L.1999, c.339, s.2)
3. Section 5 of P.L.1993, c.327 (C.17:48E-35.6) is amended to read as follows:
5. a. 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 P.L.1999, c.339, shall provide benefits, as set forth in this section, to any subscriber or other person covered thereunder for expenses incurred in a health promotion program through health wellness examinations and counselling, [which] and shall annually notify each subscriber in writing of the availability of these benefits. The health promotion program shall include, but not be limited to, the following tests and services:
(1) For all persons 20 years of age and older, [annual] biennial tests to determine [blood hemoglobin,] blood pressure, blood glucose level, and blood cholesterol level or, alternatively, low-density lipoprotein (LDL) level and blood high-density lipoprotein (HDL) level;
(2) For all persons [35] 40 years of age or older, a glaucoma eye test every five years;
(3) For all persons [40] 45 years of age or older, an annual stool examination for presence of blood;
(4) For all persons 45 years of age or older, a left-sided colon examination of 35 to 60 centimeters every five years or a full colonoscopy every 10 years;
(5) For all women 20 years of age or older, a pap smear pursuant to the provisions of section 1 of P.L.1995, c.415 (C.17:48E-35.12);
(6) For all women 40 years of age or older, a mammogram examination pursuant to the provisions of section 3 of P.L.1991, c.279 (C.17:48E-35.4);
(7) For all adults, recommended immunizations; [and]
(8) For all persons 20 years of age or older[, an annual]: a biennial comprehensive prevention examination, which shall include consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being including, but not limited to, smoking control, nutrition and diet recommendations, exercise plans, lower back protection, weight control, immunization practices, breast self-examination, testicular self-examination and seat belt usage in motor vehicles; and, in alternate years, a biennial counseling and risk-factor intervention session that also includes the measurement of blood pressure and the calculation of body mass index;
(9) For post-menopausal women, screening of the hip and spine for osteopenia or osteoporosis every 10 years if the initial test is normal and more often as medically appropriate if the woman is found to be osteopenic or osteoporatic; and
(10) For all persons 20 years of age or older annual screening for depression using a standard depression scale.
Notwithstanding the provisions of this subsection to the contrary, if a physician or other health care provider recommends that it would be medically appropriate for a covered person to receive a different schedule of tests and services than that provided for under this subsection, the health service corporation shall provide payment for the tests or services actually provided, within the limits of the amounts listed in subsection b. of this section.
b. Every individual or group health care contract offered for sale in this State by a health service corporation pursuant to subsection a. of this section shall provide payment for the benefits set forth in subsection a. of this section in an amount which shall not exceed: $125 a year for each person between the ages of 20 to 39, inclusive; $145 a year for each man age 40 and over; and $235 a year for each woman age 40 and over; except that:
(1) for persons 45 years of age or older, the cost of a left-sided colon examination or a full colonoscopy shall not be included in the above amount; [however, no health service corporation shall be required to provide payment for benefits for a left-sided colon examination in excess of $150] and
(2) for post-menopausal women, the cost of a screening of the hip and spine for osteopenia or osteoporosis with dual-energy absorptiometry shall not be included in the above amount.
c. The Commissioner of Banking and Insurance, in consultation with the Department of the Treasury, shall annually adjust the threshold amounts provided by subsection b. of this section in direct proportion to the increase or decrease in the consumer price index for all urban consumers in the New York City and Philadelphia areas as reported by the United States Department of Labor. The adjustment shall become effective on July 1 of the year in which the adjustment is made.
d. This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
e. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).
(cf: P.L.1999, c.339, s.3)
4. Section 6 of P.L.1993, c.327 (C.17B:26-2.1h) is amended to read as follows:
6. a. Every individual 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 P.L.1999, c.339, shall provide benefits, as set forth in this section, to each person covered thereunder for expenses incurred in a health promotion program through health wellness examinations and counselling, [which] and shall annually notify each covered person in writing of the availability of these benefits. The health promotion program shall include, but not be limited to, the following tests and services:
(1) For all persons 20 years of age and older, [annual] biennial tests to determine [blood hemoglobin,] blood pressure, blood glucose level, and blood cholesterol level or, alternatively, low-density lipoprotein (LDL) level and blood high-density lipoprotein (HDL) level;
(2) For all persons [35] 40 years of age or older, a glaucoma eye test every five years;
(3) For all persons [40] 45 years of age or older, an annual stool examination for presence of blood;
(4) For all persons 45 years of age or older, a left-sided colon examination of 35 to 60 centimeters every five years or a full colonoscopy every 10 years;
(5) For all women 20 years of age or older, a pap smear every two years;
(6) For all women 40 years of age or older, a mammogram examination pursuant to the provisions of section 4 of P.L.1991, c.279 (C.17B:26-2.1e);
(7) For all adults, recommended immunizations; [and]
(8) For all persons 20 years of age or older[, an annual]: a biennial comprehensive prevention examination, which shall include consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being including, but not limited to, smoking control, nutrition and diet recommendations, exercise plans, lower back protection, weight control, immunization practices, breast self-examination, testicular self-examination and seat belt usage in motor vehicles; and, in alternate years, a biennial counseling and risk-factor intervention session that also includes the measurement of blood pressure and the calculation of body mass index ;
(9) For post-menopausal women, screening of the hip and spine for osteopenia or osteoporosis every 10 years if the initial test is normal and more often as medically appropriate if the woman is found to be osteopenic or osteoporatic; and
(10) For all persons 20 years of age or older annual screening for depression using a standard depression scale.
Notwithstanding the provisions of this subsection to the contrary, if a physician or other health care provider recommends that it would be medically appropriate for a covered person to receive a different schedule of tests and services than that provided for under this subsection, the insurer shall provide payment for the tests or services actually provided, within the limits of the amounts listed in subsection b. of this section.
b. Every individual health care policy offered for sale in this State by an insurer pursuant to subsection a. of this section shall provide payment for the benefits set forth in subsection a. of this section in an amount which shall not exceed: $125 a year for each person between the ages of 20 to 39, inclusive; $145 a year for each man age 40 and over; and $235 a year for each woman age 40 and over; except that:
(1) for persons 45 years of age or older, the cost of a left-sided colon examination or a full colonoscopy shall not be included in the above amount; [however, no insurer shall be required to provide payment for benefits for a left-sided colon examination in excess of $150] and
(2) for post-menopausal women, the cost of a screening of the hip and spine for osteopenia or osteoporosis with dual-energy absorptiometry shall not be included in the above amount.
c. The Commissioner of Banking and Insurance, in consultation with the Department of the Treasury, shall annually adjust the threshold amounts provided by subsection b. of this section in direct proportion to the increase or decrease in the consumer price index for all urban consumers in the New York City and Philadelphia areas as reported by the United States Department of Labor. The adjustment shall become effective on July 1 of the year in which the adjustment is made.
d. The requirements of this section shall apply only to health insurers which issue or deliver primary health insurance coverage in this State providing hospital or medical expense benefits. Primary health insurance coverage shall not include the following plans, policies, or contracts: accident only, credit, disability, long-term care, Medicare supplement coverage, CHAMPUS supplement coverage, coverage for Medicare services pursuant to a contract with the United States government, coverage for Medicaid services pursuant to a contract with the State, coverage arising out of a workers' compensation or similar law, automobile medical payment insurance, personal injury protection insurance issued pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), or hospital confinement indemnity coverage.
e. This section shall apply to all individual health insurance policies in which the carrier has reserved the right to change the premium.
f. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).
(cf: P.L.1999, c.339, s.4)
5. Section 7 of P.L.1993, c.327 (C.17B:27-46.1h) is amended to read as follows:
7. a. Every group 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., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of P.L.1999, c.339, shall provide benefits, as set forth in this section, to each person covered thereunder for expenses incurred in a health promotion program through health wellness examinations and counselling, [which] and shall annually notify each covered person in writing of the availability of these benefits. The health promotion program shall include, but not be limited to, the following tests and services:
(1) For all persons 20 years of age and older, [annual] biennial tests to determine [blood hemoglobin,] blood pressure, blood glucose level, and blood cholesterol level or, alternatively, low-density lipoprotein (LDL) level and blood high-density lipoprotein (HDL) level;
(2) For all persons [35] 40 years of age or older, a glaucoma eye test every five years;
(3) For all persons [40] 45 years of age or older, an annual stool examination for presence of blood;
(4) For all persons 45 years of age or older, a left-sided colon examination of 35 to 60 centimeters every five years or a full colonoscopy every 10 years;
(5) For all women 20 years of age or older, a pap smear pursuant to the provisions of section 4 of P.L.1995, c.415 (C.17B:27-46.1n);
(6) For all women 40 years of age or older, a mammogram examination pursuant to the provisions of section 5 of P.L.1991, c.279 (C.17B:27-46.1f);
(7) For all adults, recommended immunizations; [and]
(8) For all persons 20 years of age or older[, an annual]: a biennial comprehensive prevention examination, which shall include consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being including, but not limited to, smoking control, nutrition and diet recommendations, exercise plans, lower back protection, weight control, immunization practices, breast self-examination, testicular self-examination and seat belt usage in motor vehicles; and, in alternate years, a biennial counseling and risk-factor intervention session that also includes the measurement of blood pressure and the calculation of body mass index;
(9) For post-menopausal women, screening of the hip and spine for osteopenia or osteoporosis every 10 years if the initial test is normal and more often as medically appropriate if the woman is found to be osteopenic or osteoporatic; and
(10) For all persons 20 years of age or older annual screening for depression using a standard depression scale.
Notwithstanding the provisions of this subsection to the contrary, if a physician or other health care provider recommends that it would be medically appropriate for a covered person to receive a different schedule of tests and services than that provided for under this subsection, the insurer shall provide payment for the tests or services actually provided, within the limits of the amounts listed in subsection b. of this section.
b. Every group health care policy offered for sale in this State by an insurer pursuant to subsection a. of this section shall provide payment for the benefits set forth in subsection a. in an amount which shall not exceed: $125 a year for each person between the ages of 20 to 39, inclusive; $145 a year for each man age 40 and over; and $235 a year for each woman age 40 and over; except that:
(1) for persons 45 years of age or older, the cost of a left-sided colon examination or a full colonoscopy shall not be included in the above amount; [however, no insurer shall be required to provide payment for benefits for a left-sided colon examination in excess of $150] and
(2) for post-menopausal women, the cost of a screening of the hip and spine for osteopenia or osteoporosis with dual-energy absorptiometry shall not be included in the above amount.
c. The Commissioner of Banking and Insurance, in consultation with the Department of the Treasury, shall annually adjust the threshold amounts provided by subsection b. of this section in direct proportion to the increase or decrease in the consumer price index for all urban consumers in the New York City and Philadelphia areas as reported by the United States Department of Labor. The adjustment shall become effective on July 1 of the year in which the adjustment is made.
d. The requirements of this section shall apply only to health insurers which issue or deliver primary health insurance coverage in this State providing hospital or medical expense benefits. Primary health insurance coverage shall not include the following plans, policies, or contracts: accident only, credit, disability, long-term care, Medicare supplement coverage, CHAMPUS supplement coverage, coverage for Medicare services pursuant to a contract with the United States government, coverage for Medicaid services pursuant to a contract with the State, coverage arising out of a workers' compensation or similar law, automobile medical payment insurance, personal injury protection insurance issued pursuant to P.L.1972, c.70 (C.39:6A-1 et seq.), or hospital confinement indemnity coverage.
e. This section shall apply to all group health insurance policies in which the carrier has reserved the right to change the premium.
f. The provisions of this section shall not apply to a health benefits plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).
(cf: P.L.1999, c.339, s.5)
6. Section 8 of P.L.1993, c.327 (C.26:2J-4.6) is amended to read as follows:
8. a. Notwithstanding any provision of this act or any other law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Health and Senior Services on or after the effective date of this act unless the health maintenance organization provides health care services, as set forth in this section, to any enrollee which include a health promotion program providing health wellness examinations and counselling, [which] and shall annually notify each enrollee in writing of the availability of these health care services. The health promotion program shall include, but not be limited to, the following tests and services:
(1) For all persons 20 years of age and older, [annual] biennial tests to determine [blood hemoglobin,] blood pressure, blood glucose level, and blood cholesterol level or, alternatively, low-density lipoprotein (LDL) level and blood high-density lipoprotein (HDL) level;
(2) For all persons [35] 40 years of age or older, a glaucoma eye test every five years;
(3) For all persons [40] 45 years of age or older, an annual stool examination for presence of blood;
(4) For all persons 45 years of age or older, a left-sided colon examination of 35 to 60 centimeters every five years or a full colonoscopy every 10 years;
(5) For all women 20 years of age or older, a pap smear pursuant to the provisions of section 5 of P.L.1995, c.415 (C.26:2j-4.12);
(6) For all women 40 years of age or older, a mammogram examination pursuant to the provisions of section 6 of P.L.1991, c.279 (C.26:2j-4.4);
(7) For all adults, recommended immunizations; [and]
(8) For all persons 20 years of age or older[, an annual]: a biennial comprehensive prevention examination, which shall include consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being including, but not limited to, smoking control, nutrition and diet recommendations, exercise plans, lower back protection, weight control, immunization practices, breast self-examination, testicular self-examination and seat belt usage in motor vehicles; and, in alternate years, a biennial counseling and risk-factor intervention session that also includes the measurement of blood pressure and the calculation of body mass index;
(9) For post-menopausal women, screening of the hip and spine for osteopenia or osteoporosis every 10 years if the initial test is normal and more often as medically appropriate if the woman is found to be osteopenic or osteoporatic; and
(10) For all persons 20 years of age or older annual screening for depression using a standard depression scale.
Notwithstanding the provisions of this subsection to the contrary, if a physician or other health care provider recommends that it would be medically appropriate for an enrollee to receive a different schedule of tests and services than that provided for under this subsection, the health maintenance organization shall provide coverage for the tests or services actually provided, within the limits of the amounts listed in subsection b. of this section.
b. A health maintenance organization shall not be required to offer services to enrollees set forth in subsection a. of this section for which the value exceeds: $125 a year for each person between the ages of 20 to 39, inclusive; $145 a year for each man age 40 and over; and $235 a year for each woman age 40 and over; except that:
(1) for persons 45 years of age or older, the value of a left-sided colon examination or a full colonoscopy shall not be included in the above amount; [however, no health maintenance organization shall be required to provide services to enrollees for a left-sided colon examination with a value in excess of $150] and
(2) for post-menopausal women, the value of a screening of the hip and spine for osteopenia or osteoporosis with dual-energy absorptiometry shall not be included in the above amount.
c. The Commissioner of Health and Senior Services, in consultation with the Department of the Treasury, shall annually adjust the threshold amounts provided by subsection b. of this section in direct proportion to the increase or decrease in the consumer price index for all urban consumers in the New York City and Philadelphia areas as reported by the United States Department of Labor. The adjustment shall become effective on July 1 of the year in which it is reported.
d. Nothing in this act shall be construed to require that a health maintenance organization take any actions which conflict with the health benefits, underwriting and rating standards established by the federal government pursuant to subchapter XI of Pub.L.93-222 (42 U.S.C. s.300e et seq.).
e. This section shall apply to all health maintenance organization contracts in which the right to change the enrollee charge has been reserved.
f. The provisions of this section shall not apply to a health benefits
plan subject to the provisions of P.L.1992, c.161 (C.17B:27A-2 et seq.) or P.L.1992, c.162 (C.17B:27A-17 et seq.).
(cf: P.L.1999, c.339, s.6)
7. This act shall take effect on the 90th day after enactment and shall apply to policies or contracts issued or renewed on or after the effective date.
STATEMENT
This bill makes several revisions in the benefits for health wellness examinations and counseling that health insurers are required to provide under the "Health Wellness Promotion Act," P.L.1993, c.327 (as amended by P.L.1999, c.339).
These revisions are based on recommendations included in the report to the Governor and the Legislature of the Health Wellness Promotion Advisory Board established pursuant to the "Health Wellness Promotion Act," and are derived from new scientific data and experiences related to implementation of this statute.
The bill makes the following specific revisions in the required health wellness benefits:
· a new requirement that insurers annually notify covered persons in writing of the availability of the covered health wellness benefits;
· for all covered persons 20 years of age and older, a change from annual to biennial tests to determine blood pressure; blood glucose level; and blood cholesterol level or, alternatively, low-density lipoprotein (LDL) level and blood high-density lipoprotein (HDL) level; and deletion of the requirement for blood hemoglobin tests;
· an increase from 35 to 40 years in the age at which covered persons would be covered for a glaucoma eye test every five years;
· an increase from 40 to 45 years in the age at which covered persons would be covered for an annual stool examination for presence of blood;
· a new requirement that insurers cover a full colonoscopy every 10 years for covered persons 45 years of age or older as an alternative to a left-sided colon examination of 35 to 60 centimeters every five years and deletion of the cap on the cost of the procedure for which insurers would be responsible;
· a new requirement that insurers cover a biennial comprehensive prevention examination for covered persons 20 years of age or older, including consultation with a health care provider to discuss lifestyle behaviors that promote health and well-being (a consultation that insurers must now cover on an annual basis), and, in alternate years, a biennial counseling and risk-factor intervention session that also includes the measurement of blood pressure and the calculation of body mass index;
· a new requirement that insurers cover, for post-menopausal women, screening of the hip and spine for osteopenia or osteoporosis every 10 years if the initial test is normal and more often as medically appropriate if the woman is found to be osteopenic or osteoporatic and a new provision that the cost of this screening shall not be included in the annual amount allowed for the health wellness benefits; and
· a new requirement that insurers cover for all persons 20 years of age or older annual screening for depression using a standard depression scale; and
· deletion of the specific dollar cap on an insurer's payment for a left-sided colon examination.
· The bill takes effect on the 90th day after enactment and applies to policies or contracts issued or renewed on or after the effective date.
