Bill Text: NJ A561 | 2012-2013 | Regular Session | Introduced
Bill Title: Prohibits health insurance policy exclusion of coverage for loss sustained while intoxicated or under the influence of narcotics; repeals statute permitting such exclusion.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced - Dead) 2012-01-10 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A561 Detail]
Download: New_Jersey-2012-A561-Introduced.html
STATE OF NEW JERSEY
215th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2012 SESSION
Sponsored by:
Assemblywoman CONNIE WAGNER
District 38 (Bergen and Passaic)
Assemblyman CHARLES MAINOR
District 31 (Hudson)
Assemblywoman MARY PAT ANGELINI
District 11 (Monmouth)
SYNOPSIS
Prohibits health insurance policy exclusion of coverage for loss sustained while intoxicated or under influence of narcotics; repeals statute permitting such exclusion.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning certain health insurance policy exclusions, supplementing various parts of the statutory law and repealing N.J.S.17B:26-27.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A hospital service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State 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, shall not exclude coverage for expenses incurred in the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
b. This section shall not preclude a hospital service corporation contract from excluding coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
c. This section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
2. a. A medical service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State 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, shall not exclude coverage for expenses incurred in the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
b. This section shall not preclude a medical service corporation contract from excluding coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
c. This section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
3. a. A health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State 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, shall not exclude coverage for expenses incurred in the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
b. This section shall not preclude a health service corporation contract from excluding coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
c. This section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
4. a. An individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State 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, shall not exclude coverage for expenses incurred in the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
b. This section shall not preclude an individual health insurance policy from excluding coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
c. This section shall apply to all individual health insurance policies in which the insurer has reserved the right to change the premium.
5. a. A group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State 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, shall not exclude coverage for expenses incurred in the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
b. This section shall not preclude a group health insurance policy from excluding coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
c. This section shall apply to all group health insurance policies in which the insurer has reserved the right to change the premium.
6. a. An individual health benefits plan, that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State 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, shall not exclude coverage for expenses incurred in the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
b. This section shall not preclude an individual health benefits plan from excluding coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
c. This section shall apply to all health benefits plan in which the carrier has reserved the right to change the premium.
7. a. A small employer health benefits plan that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State 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, shall not exclude coverage for expenses incurred in the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
b. This section shall not preclude a small group health benefits plan from excluding coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
c. This section shall apply to all small employer health benefits plans in which the carrier has reserved the right to change the premium.
8. a. A health maintenance organization contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State 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, shall not exclude coverage for expenses incurred in the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
b. This section shall not preclude a health maintenance organization contract from excluding coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
c. This section shall apply to all contracts in which the health maintenance organization has reserved the right to change the premium.
9. N.J.S.17B:26-27 is repealed.
10. This act shall take effect immediately.
STATEMENT
This bill prohibits health insurance policies, health benefits plans and health maintenance organizations from excluding coverage for the treatment of illnesses, injuries, or conditions sustained by a covered person because that person was intoxicated or under the influence of any narcotic.
This bill will allow New Jersey hospital emergency departments to practice a nationally recognized technique called "Screening and Brief Intervention" (SBI), in which healthcare providers screen injured patients for alcohol and drug use and offer counseling services, when applicable. This technique has been proven effective, but can not be implemented in states with "alcohol exclusion laws" - those laws allowing health insurers to exclude, through provisions in the policy or contract, coverage for such illness, injury or condition.
The bill allows the exclusion of coverage for the treatment of any illness, injury, or condition that is the direct result of the commission of a crime by the covered person.
The bill also repeals a section of law currently allowing the exclusion of such coverage.
