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Bill > A3795


NJ A3795

NJ A3795
Permits payment of only one co-payment or deductible for follow-up care or treatment after surgery or illness under certain health benefits plans.


summary

Introduced
02/22/2024
In Committee
02/22/2024
Crossed Over
Passed
Dead

Introduced Session

2024-2025 Regular Session

Bill Summary

This bill supplements the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et seq.) to provide that, when a covered person is receiving post-operative follow-up care, follow-up care for the treatment of a diagnosed illness or condition, or other follow-up care for any other covered service, which follow-up care is provided by a participating provider, the covered person shall be responsible for the payment of only one co-payment or deductible to the participating provider under the plan during any period of 180 days following the payment of that co-payment or deductible. The bill further prohibits the participating provider from collecting more than one such co-payment or deductible, during any period of 180 days following the payment of that co-payment or deductible, regardless of the number of follow-up care visits during that period. The provisions of the bill would only apply if the covered person complies with the preauthorization or review requirements of the health benefits plan regarding the determination of medical necessity to access in-network inpatient benefits.

AI Summary

This bill supplements the "Health Care Quality Act" to provide that when a covered person is receiving post-operative, illness treatment, or other follow-up care from a participating provider, the covered person shall only be responsible for one co-payment or deductible during any 180-day period, and the provider cannot collect more than that single co-payment or deductible during that time, regardless of the number of follow-up visits. The provisions only apply if the covered person complies with the preauthorization or review requirements for accessing in-network inpatient benefits under the health plan.

Committee Categories

Business and Industry

Sponsors (1)

Last Action

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 02/22/2024)

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