Bill Text: NJ S926 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires health insurers to cover Lyme disease.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced) 2024-01-09 - Introduced in the Senate, Referred to Senate Commerce Committee [S926 Detail]
Download: New_Jersey-2024-S926-Introduced.html
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Senator KRISTIN M. CORRADO
District 40 (Bergen, Essex and Passaic)
SYNOPSIS
Requires health insurers to cover Lyme disease.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning health insurance benefits for the treatment of Lyme disease 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, 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 expenses incurred in the treatment of Lyme disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as experimental or investigational in nature.
c. This section shall apply to all 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, 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 expenses incurred in the treatment of Lyme disease as determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as experimental or investigational in nature.
c. This section shall apply to all 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, 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 expenses incurred in the treatment of Lyme disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as experimental or investigational in nature.
c. This section shall apply to all 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 or medical expense benefits and is delivered, issued, executed or renewed in this State, 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 expenses incurred in the treatment of Lyme disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as experimental or investigational in nature.
c. This section shall apply to all policies in which the insurer has reserved the right to change the premium.
5. a. A group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, 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 expenses incurred in the treatment of Lyme disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such treatment may be characterized as experimental or investigational in nature.
c. This section shall apply to all policies in which the insurer has reserved the right to change the premium.
6. a. A individual health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State, 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 for expenses incurred in the treatment of Lyme Disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Health care services otherwise eligible for coverage pursuant to this section shall not be denied solely because such services may be characterized as experimental or investigational in nature.
c. This section shall apply to those individual 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, 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 for expenses incurred in the treatment of Lyme Disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because such services may be characterized as experimental or investigational in nature.
c. This section shall apply to those small employer 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, 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 expenses incurred in the treatment of Lyme Disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section shall not be denied solely because the treatment may be characterized as experimental or investigational in nature.
c. 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. 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 or medical expense shall provide coverage for expenses incurred in the treatment of Lyme Disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section may not be denied solely because the treatment may be characterized as experimental or investigational in nature.
10. 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 expenses incurred in the treatment of Lyme Disease determined to be medically necessary by the covered person's physician after making a written evaluation of that person's symptoms, condition and response to treatment.
b. Treatment otherwise eligible for benefits pursuant to this section may not be denied solely because the treatment may be characterized as experimental or investigational in nature.
11. This act shall take effect on the 90th day after 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 for expenses incurred in the treatment of Lyme Disease. Treatment otherwise eligible for benefits pursuant to this bill may not be denied solely because such treatment may be characterized as experimental or investigational in nature.
