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Bill > S534


NJ S534

"Health Insurance Claim Plain Language and Simplification Act."


summary

Introduced
01/09/2024
In Committee
01/09/2024
Crossed Over
Passed
Dead

Introduced Session

2024-2025 Regular Session

Bill Summary

This bill, entitled the "Health Insurance Claim Plain Language and Simplification Act," requires health insurance carriers to provide explanation of benefits forms to covered persons which include certain information on the form in a certain format, and to use simple, plain language that is clearly understandable. The bill requires every carrier issuing health benefits plans in this State to provide a written explanation of benefits form to a covered person whenever a claim is generated under the covered person's health benefits plan. The explanation of benefits form shall contain all of the following information on the first page of the form: (1) the name of the insured, the name of the health care provider, the date of service, the amount of the claim, the amount paid by the carrier, and the amount to be paid by the covered person; (2) if a claim is paid in whole or in part, an explanation of the reasons that the claim was paid in whole or in part; (3) if a claim is denied, an explanation of the reasons that the claim is denied; and (4) instructions as to any action that the covered person is required to take with respect to the claim or any option which may be available to the covered person with respect to the determination of benefits for that claim. The bill requires this information to be the only information provided on the first page of the explanation of benefits form and requires the information to be in 12-point font. The bill also requires the information to be in simple, plain language that is clearly understandable to covered persons, in a manner consistent with the "Life and Health Insurance Policy Language Simplification Act," P.L.1979, c.167 (C.17B:17-17 et seq.).

AI Summary

This bill, entitled the "Health Insurance Claim Plain Language and Simplification Act," requires health insurance carriers to provide explanation of benefits (EOB) forms to covered persons that include certain key information on the first page in a clear and understandable format. The bill mandates that the EOB form must include the name of the insured, the healthcare provider, the date of service, the claim amount, the amount paid by the carrier, and the amount owed by the covered person. If the claim is paid in full or in part, the EOB must explain the reasons; if the claim is denied, the EOB must explain the reasons. The bill also requires the information to be provided in 12-point font and in simple, plain language that is easily understandable to the covered person, consistent with the "Life and Health Insurance Policy Language Simplification Act."

Committee Categories

Business and Industry

Sponsors (2)

Last Action

Introduced in the Senate, Referred to Senate Commerce Committee (on 01/09/2024)

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