Bill > S939

Introduced Session

This bill requires health insurance carriers, including insurance companies, health service corporations, hospital service corporations, medical service corporations, or health maintenance organizations authorized to issue health benefits plans in New Jersey or any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees' Health Benefits Program to provide coverage for persons 18 years of age or younger with diagnosed complex medical needs. The bill requires that the benefits be provided for expenses incurred in conducting medical services, procedures, or testing, nursing care, and the purchase of medical equipment or prescription drugs to persons 18 years of age or younger with diagnosed complex medical needs, provided the attending licensed health care provider determines it medically necessary. In addition, the bill requires that health insurance carriers and contracts for health benefits or prescription drug benefits purchased by the State Health Benefits Program and the School Employees' Health Benefits Program approve any benefit for a person 18 years of age or younger with diagnosed complex medical needs within three days of receipt of a letter from the attending licensed health care provider and shall not condition the payment of any benefit for a medical service, procedure, test, nursing care, or purchase of medical equipment or prescription drug upon any pre-approval or precertification of any kind if that medical service, procedure, test, nursing care, or purchase of medical equipment or prescription drug is otherwise covered under the health benefits plan and it has been prescribed by a licensed health care provider.

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Vin Gopal (D)*,  Shirley Turner (D)*,  Edward Durr (R), 

Introduced in the Senate, Referred to Senate Commerce Committee (on 01/31/2022)

Official Document