Bill
Bill > S4187
NJ S4187
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
03/03/2025
03/03/2025
In Committee
03/03/2025
03/03/2025
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 modifies health insurance regulations to limit patient out-of-pocket expenses for follow-up medical care. Specifically, the bill requires managed care plans to restrict patients to paying only one co-payment or deductible for a series of follow-up care visits within a 180-day period, whether those visits are for post-operative care, treatment of a diagnosed condition, or other covered medical services. The participating healthcare provider is also prohibited from collecting more than one co-payment or deductible during this 180-day window, regardless of the number of follow-up visits. To qualify for this protection, patients must first comply with the health plan's preauthorization and medical necessity review requirements for accessing in-network inpatient benefits. The bill will take effect on the first day of the fourth month after its enactment and will apply to all health insurance contracts and policies issued or renewed on or after that date, providing financial relief for patients undergoing ongoing medical treatment.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced in the Senate, Referred to Senate Commerce Committee (on 03/03/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2024/S4187 |
| BillText | https://pub.njleg.gov/Bills/2024/S4500/4187_I1.HTM |
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