Bill Text: NJ A4062 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires oral agreements concerning health insurance be delivered in writing within 30 days of contract formation.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-03-14 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A4062 Detail]
Download: New_Jersey-2024-A4062-Introduced.html
Sponsored by:
Assemblywoman ELLEN J. PARK
District 37 (Bergen)
SYNOPSIS
Requires oral agreements concerning health insurance be delivered in writing within 30 days of contract formation.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance policies and supplementing P.L.1975, c.101 (C.17B:30-13.1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. Following an oral agreement to provide coverage pursuant to a health benefits plan, a carrier shall:
(1) include language in the health benefits plan contract that gives the covered person the right to, upon request, receive any recording of the oral agreement made by the carrier, as well as a written transcript of the oral agreement; and
(2) send a written copy of the agreement to the covered person no later than 30 days after the oral agreement's formation. The written copy shall comply with the "Life and Health Insurance Policy Simplification Act," P.L.1979, c.167 (C.17B:17-17 et seq.).
b. Failure to comply with this act shall be a practice prohibited by N.J.S.17B:30-2.
c. Upon receipt of a written copy of an oral agreement pursuant to subsection a. of this section, a covered person shall have 30 days to notify the insurer of any difference between the written contract and the oral agreement.
d. As used in this section:
"Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation or health maintenance organization authorized to issue health benefits plans in this State and a dental service corporation or dental plan organization authorized to issue dental plans in this State.
"Health benefits plan" means a benefits plan which pays or provides hospital and medical expense benefits for covered services, and is delivered or issued for delivery in this State by or through a carrier. Health benefits plan includes, but is not limited to, Medicare supplement coverage and risk contracts to the extent not otherwise prohibited by federal law.
"Oral agreement" means an agreement between a carrier and a covered person that was entered verbally for purposes including, but not limited to, providing coverage pursuant to a health benefits plan, expanding, decreasing, or revising coverage, and reimbursement of claims.
2. This act shall take
effect on the 90th day next following enactment.
STATEMENT
This bill requires health insurance carriers to provide a covered person with a written copy of any oral agreement entered with the covered person no less than 30 days after entering an oral agreement with the person. Such oral agreements include, but are not limited to, initial agreements to provide coverage, any agreement to expand, decrease, or revise coverage, and reimbursement of claims. Currently, there is no requirement that oral agreements concerning health insurance be put into writing. The bill also requires carriers include language in health benefits plan contracts that gives covered individuals the right to, upon request, receive any recording of the oral agreement that the carrier may have made, along with a written transcript of the oral agreement.
The bill applies to health insurance carriers, including health, hospital and medical service corporations, commercial individual and group health insurers, health maintenance organizations, and health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs.
