Bill Text: NJ S1511 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires health insurance carriers offering tiered network health benefits plans to protect covered persons from excess cost sharing in certain circumstances.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2016-02-16 - Introduced in the Senate, Referred to Senate Commerce Committee [S1511 Detail]
Download: New_Jersey-2016-S1511-Introduced.html
Sponsored by:
Senator SHIRLEY K. TURNER
District 15 (Hunterdon and Mercer)
SYNOPSIS
Requires health insurance carriers offering tiered network health benefits plans to protect covered persons from excess cost sharing in certain circumstances.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning certain health insurance networks and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. In the case of a health benefits plan with a tiered network, a carrier shall ensure that if a covered person receives medically necessary services on an emergency or urgent basis, the health care facility and health care professional shall not bill the covered person in excess of the lowest cost sharing amount applicable to the highest or preferred tier pursuant to the covered person's health benefits plan.
b. As used in this section:
"Emergency or urgent basis" means all emergency and urgent care services including, but not limited to, those services defined pursuant to N.J.A.C.11:24-5.3.
"Tiered network" means a managed care plan provider network with more than one level or tier of in-network benefits, based on different levels of reimbursement and cost sharing accepted by the health care providers in that network.
2. This act shall take effect immediately.
STATEMENT
This bill requires health insurance carriers that offer a tiered health benefits plan to ensure that covered persons who receive medically necessary services on an emergency or urgent basis are not billed in excess of the lowest cost sharing amount applicable to the highest or preferred tier pursuant to the covered person's health benefits plan. A tiered network is a managed care plan provider network with more than one level or tier of in-network benefits, based on different levels of reimbursement and cost sharing accepted by the health care providers in that network.
Under the bill, if a covered person in a tiered network plan receives medically necessary services on an emergency or urgent basis, the carrier must ensure that the health care facility and health care professional do not bill the covered person in excess of the lowest cost sharing amount applicable to the highest or preferred tier pursuant to the covered person's health benefits plan.
