Bill Text: NJ A3674 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires health insurers, SHBP and SEHBP to provide coverage for vision rehabilitation services to covered person experiencing sudden onset of blindness.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-01-06 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A3674 Detail]
Download: New_Jersey-2010-A3674-Introduced.html
Sponsored by:
Assemblyman GORDON M. JOHNSON
District 37 (Bergen)
SYNOPSIS
Requires health insurers, SHBP and SEHBP to provide coverage for vision rehabilitation services to covered person experiencing sudden onset of blindness.
CURRENT VERSION OF TEXT
As introduced.
An Act requiring health insurance coverage for vision rehabilitation services under certain circumstances 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 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 vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The benefits provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
The benefits provided by this section shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those 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 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 vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The benefits provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
The benefits provided by this section shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those 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 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 this act, shall provide coverage for vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The benefits provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
The benefits provided by this section shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. 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 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 this act, shall provide coverage for vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The benefits provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
The benefits provided by this section shall be provided to the same extent as for any other condition under the policy.
This section shall apply to those group health insurance policies in which the insurer has reserved the right to change the premium.
5. 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 coverage for vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The benefits provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
The benefits provided by this section shall be provided to the same extent as for any other condition under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
6. 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 coverage for vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The benefits provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
The benefits provided by this section shall be provided to the same extent as for any other condition under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. a. A certificate of authority to establish and operate a health maintenance organization in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this act, unless the health maintenance organization provides health care services for vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. These health care services shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The health care services provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The health care services shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
The health care services provided by this section shall be provided to the same extent as for any other condition under the contract for services.
This section shall apply to all contracts for health care services in which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.
8. a. 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 coverage for vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The benefits provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
9. 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 that provides hospital and medical expense benefits, shall provide coverage for vision rehabilitation services to a covered person who experiences the sudden onset of blindness occurring as a result of an accident or injury as diagnosed by a covered person's ophthalmologist or optometrist. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes. As used in this section, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
b. The benefits provided by this section shall only be covered if determined to be medically necessary by the ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
10. This act shall take effect on the first day of the seventh month next following enactment.
STATEMENT
This bill requires health insurers and health maintenance organizations, as well as health benefits plans or contracts which are issued or purchased pursuant to the New Jersey Individual Health Coverage Program, New Jersey Small Employer Program, State Health Benefits Program, and School Employees' Health Benefits Program, to provide coverage for vision rehabilitation services to any covered person experiencing a sudden onset of blindness as the result of an accident or injury. This coverage shall not apply to any onset of blindness that is subject to coverage under the workers' compensation law, chapter 15 of Title 34 of the Revised Statutes.
Under the bill, "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; and an eye which is accompanied by a limitation in the fields of vision so that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
The benefits provided by the bill shall only be covered if determined to be medically necessary by an ophthalmologist or optometrist due to the covered person's blindness. The benefits shall be provided through a vision rehabilitation program approved by the State Board of Medical Examiners in consultation with the State's Commission for the Blind and Visually Impaired, and shall be administered by a vision rehabilitation therapist who is certified by a nationally recognized certifying organization or otherwise by an appropriately qualified and trained licensed health care provider, as determined by the board.
