Bill Text: NJ A388 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires insurance coverage for magnetic resonance imaging for women at high risk for breast cancer.
Spectrum: Partisan Bill (Democrat 7-0)
Status: (Introduced - Dead) 2010-01-12 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A388 Detail]
Download: New_Jersey-2010-A388-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Assemblyman PATRICK J. DIEGNAN, JR.
District 18 (Middlesex)
Assemblywoman ELEASE EVANS
District 35 (Bergen and Passaic)
Co-Sponsored by:
Assemblyman McKeon, Assemblywoman Vainieri Huttle, Assemblymen Prieto and Coutinho
SYNOPSIS
Requires insurance coverage for magnetic resonance imaging for women at high risk for breast cancer.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning health benefits coverage for magnetic resonance imaging for certain women, amending P.L.1991, c.279 and supplementing P.L.1992, c.161 (C.17B:27A-2 et seq.) and P.L.1992, c.162 (C.17B:27A-17 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1991, c.279 (C.17:48-6g) is amended to read as follows:
1. a. No [group or individual] hospital service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting: one baseline mammogram examination for women who are at least 35 but less than 40 years of age; [and] one mammogram examination every year for women age 40 and over; and, in addition to a mammogram examination, a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, according to the same schedule as for a mammogram examination, if the magnetic resonance imaging is recommended by the woman's physician.
b. As used in subsection a. of this section, "high risk for breast cancer" means the woman:
(1) has a family history of breast cancer; or
(2) has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
c. These benefits shall be provided to the same extent as for any other [sickness] medical condition under the contract.
d. The provisions of this section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
(cf: P.L.1999, c.341, s.1)
2. Section 2 of P.L.1991, c.279 (C.17:48A-7f) is amended to read as follows:
2. a. No [group or individual] medical service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting: one baseline mammogram examination for women who are at least 35 but less than 40 years of age; [and] one mammogram examination every year for women age 40 and over; and, in addition to a mammogram examination, a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, according to the same schedule as for a mammogram examination, if the magnetic resonance imaging is recommended by the woman's physician.
b. As used in subsection a. of this section, "high risk for breast cancer" means the woman:
(1) has a family history of breast cancer; or
(2) has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
c. These benefits shall be provided to the same extent as for any other [sickness] medical condition under the contract.
d. The provisions of this section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
(cf: P.L.1999, c.341, s.2)
3. Section 3 of P.L.1991, c.279 (C.17:48E-35.4) is amended to read as follows:
3. a. No [group or individual] health service corporation contract providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the contract provides benefits to any subscriber or other person covered thereunder for expenses incurred in conducting: one baseline mammogram examination for women who are at least 35 but less than 40 years of age; [and] one mammogram examination every year for women age 40 and over; and, in addition to a mammogram examination, a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, according to the same schedule as for a mammogram examination, if the magnetic resonance imaging is recommended by the woman's physician.
b. As used in subsection a. of this section, "high risk for breast cancer" means the woman:
(1) has a family history of breast cancer; or
(2) has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
c. These benefits shall be provided to the same extent as for any other [sickness] medical condition under the contract.
d. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
(cf: P.L.1999, c.341, s.3)
4. Section 4 of P.L.1991, c.279 (C.17B:26-2.1e) is amended to read as follows:
4. a. No individual health insurance policy providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting: one baseline mammogram examination for women who are at least 35 but less than 40 years of age; [and] one mammogram examination every year for women age 40 and over; and, in addition to a mammogram examination, a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, according to the same schedule as for a mammogram examination, if the magnetic resonance imaging is recommended by the woman's physician.
b. As used in subsection a. of this section, "high risk for breast cancer" means the woman:
(1) has a family history of breast cancer; or
(2) has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
c. These benefits shall be provided to the same extent as for any other [sickness] medical condition under the policy.
d. The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
(cf: P.L.1999, c.341, s.4)
5. Section 5 of P.L.1991, c.279 (C.17B:27-46.1f) is amended to read as follows:
5. a. No group health insurance policy providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting: one baseline mammogram examination for women who are at least 35 but less than 40 years of age; [and] one mammogram examination every year for women age 40 and over; and, in addition to a mammogram examination, a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, according to the same schedule as for a mammogram examination, if the magnetic resonance imaging is recommended by the woman's physician.
b. As used in subsection a. of this section, "high risk for breast cancer" means the woman:
(1) has a family history of breast cancer; or
(2) has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
c. These benefits shall be provided to the same extent as for any other [sickness] medical condition under the policy.
d. The provisions of this section shall apply to all health insurance policies in which the insurer has reserved the right to change the premium.
(cf: P.L.1999, c.341, s.5)
6. Section 6 of P.L.1991, c.279 (C.26:2J-4.4) is amended to read as follows:
6. a. Notwithstanding any provision of law to the contrary, a certificate of authority to establish and operate a health maintenance organization in this State shall not be delivered, issued, executed or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or [continued] approved for issuance or renewal in this State by the Commissioner of [Health and Senior Services] Banking and Insurance, on or after the effective date of this act, unless the health maintenance organization provides health care services to any enrollee for the conduct of: one baseline mammogram examination for women who are at least 35 but less than 40 years of age; [and] one mammogram examination every year for women age 40 and over; and, in addition to a mammogram examination, a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, according to the same schedule as for a mammogram examination, if the magnetic resonance imaging is recommended by the woman's physician.
b. As used in subsection a. of this section, "high risk for breast cancer" means the woman:
(1) has a family history of breast cancer; or
(2) has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
c. These health care services shall be provided to the same extent as for any other [sickness] medical condition under the enrollee agreement.
d. The provisions of this section shall apply to all enrollee agreements in which the health maintenance organization has reserved the right to change the schedule of charges.
(cf: P.L.1999, c.341, s.6)
7. (New section) a. No individual health benefits plan providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State, on or after the effective date of this act, unless the health benefits plan provides benefits to any person covered thereunder for expenses incurred in conducting: one baseline mammogram examination for women who are at least 35 but less than 40 years of age; one mammogram examination every year for women age 40 and over; and, in addition to a mammogram examination, a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, according to the same schedule as for a mammogram examination, if the magnetic resonance imaging is recommended by the woman's physician.
b. As used in subsection a. of this section, "high risk for breast cancer" means the woman:
(1) has a family history of breast cancer; or
(2) has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
c. These benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
d. The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.
8. (New section) a. No small employer health benefits plan providing hospital or medical expense benefits shall be delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State, on or after the effective date of this act, unless the health benefits plan provides benefits to any person covered thereunder for expenses incurred in conducting: one baseline mammogram examination for women who are at least 35 but less than 40 years of age; one mammogram examination every year for women age 40 and over; and, in addition to a mammogram examination, a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, according to the same schedule as for a mammogram examination, if the magnetic resonance imaging is recommended by the woman's physician.
b. As used in subsection a. of this section, "high risk for breast cancer" means the woman:
(1) has a family history of breast cancer; or
(2) has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
c. These benefits shall be provided to the same extent as for any other medical condition under the health benefits plan.
d. The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.
9. This act shall take effect on the 180th day after enactment and shall apply to policies or contracts issued or renewed on or after the effective date.
STATEMENT
This bill amends P.L.1991, c.279 to require that health insurers cover a breast examination by magnetic resonance imaging for women who are considered to be at high risk for breast cancer, if the magnetic resonance imaging is recommended by the woman's physician. This coverage would be in addition to that required for a mammogram examination, and according to the same schedule as for a mammogram examination, pursuant to P.L.1991, c.279.
The bill defines "high risk for breast cancer" to mean that the woman:
--has a family history of breast cancer; or
--has a background, ethnicity or coexisting medical condition, or uses a medication, that the physician believes puts the woman at elevated risk for breast cancer.
The provisions of this bill that amend P.L.1991, c.279 would apply to hospital, medical and health service corporations, commercial individual and group health insurers, and health maintenance organizations. In addition, the bill expands the scope of required coverage for breast cancer examinations by applying this requirement, for both mammograms and magnetic resonance imaging, to individual health benefits plans and small employer health benefits plans, which are not currently subject to the provisions of P.L.1991, c.279.
The bill takes effect on the 180th day after enactment and applies to policies or contracts issued or renewed on or after its effective date.
