Bill Text: NJ A3534 | 2020-2021 | Regular Session | Introduced
Bill Title: Requires insurance coverage of epinephrine for persons aged 18 or younger when medically necessary.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-02-25 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A3534 Detail]
Download: New_Jersey-2020-A3534-Introduced.html
Sponsored by:
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
SYNOPSIS
Requires insurance coverage of epinephrine for persons aged 18 or younger when medically necessary.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance coverage of epinephrine and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A hospital service corporation contract that provides hospital or 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 benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
b. The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A medical service corporation contract that provides hospital or 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 benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
b. The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A health service corporation contract that provides hospital or 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 benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
b. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. 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 benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
b. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. 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 benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
b. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. 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 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 benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
b. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. 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.), 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 benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
b. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. 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 benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
b. This section shall apply to those contracts for health care services under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.
9. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
10. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide benefits to any covered person 18 years of age or younger for expenses incurred in the purchase of epinephrine auto-injector devices when medically necessary and as prescribed by the treating health care provider. The benefits shall be provided without the imposition of any prior authorization or other utilization management requirements.
As used in this section, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
11. This act shall take effect on the 90th day next following the date of enactment.
STATEMENT
This bill requires 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 School Employees' Health Benefits Program) to provide coverage to any covered person 18 years of age or younger, for expenses incurred in the purchase of epinephrine auto-injector devices, when medically necessary and as prescribed by the treating health care provider. Under the bill, "epinephrine auto-injector device" means a single-use device used for the automatic injection of a pre-measured dose of epinephrine into the human body.
