Bill Text: NJ A3699 | 2012-2013 | Regular Session | Introduced
Bill Title: Requires managed care plans to disclose allowed amounts for out-of-network health care services under certain circumstances.
Spectrum: Partisan Bill (Republican 3-0)
Status: (Introduced - Dead) 2013-01-17 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A3699 Detail]
Download: New_Jersey-2012-A3699-Introduced.html
Sponsored by:
Assemblywoman AMY H. HANDLIN
District 13 (Monmouth)
Assemblyman JON M. BRAMNICK
District 21 (Morris, Somerset and Union)
SYNOPSIS
Requires managed care plans to disclose allowed amounts for out-of-network health care services under certain circumstances.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning out-of-network health care benefits and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier which offers a managed care plan that provides for both in-network and out-of-network benefits shall disclose, upon the request of a covered person or the covered person's health care provider, the allowed amount of payment by the carrier for any out-of-network health care service covered under the covered person's health benefits plan.
b. The carrier shall disclose the allowed amount to the covered person or the covered person's health care provider within a reasonable period of time after the request, by telephone, through an Internet website that provides access to allowed amounts, or in writing if the covered person or the covered person's health care provider requests a written disclosure.
c. For the purposes of this section, "allowed amount" means the amount of the out-of-network payment allowed under the plan's reimbursement methodology for a specific health care service, without taking into account any adjustments that could apply to that amount due to the plan's provisions for limitations on visits or any of the covered person's cost-sharing amounts, such as deductibles, copayments, or coinsurance.
2. The Commissioner of Banking and Insurance shall adopt regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out the purposes of this act.
3. This act shall take effect on the 90th day following enactment.
STATEMENT
This bill, which supplements the "Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et seq.), requires health insurance carriers to make certain disclosures regarding amounts of out-of-network payments under managed care plans.
The bill requires a carrier which offers a managed care plan that provides for both in-network and out-of-network benefits to disclose, upon the request of a covered person or the covered person's health care provider, the allowed amount of payment by the carrier for any out-of-network health care service covered under the covered person's health benefits plan. The carrier shall disclose the allowed amount within a reasonable period of time after the request, by telephone, through an Internet website that permits access to allowed amounts, or in writing if the covered person or the covered person's health care provider requests a written disclosure.
The bill defines "allowed amount" to mean the amount of the out-of-network payment allowed under the plan's reimbursement methodology for a specific health care service, without taking into account any adjustments that could apply to that amount due to the plan's provisions for limitations on visits or any of the covered person's cost-sharing amounts such as deductibles, copayments or coinsurance.
The bill provides that the Commissioner of Banking and Insurance shall adopt regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out its purposes.
