Bill Text: NJ A790 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires health insurance coverage for anesthesiology services in connection with outpatient diagnostic screenings, including colonoscopies.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2010-01-12 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A790 Detail]
Download: New_Jersey-2010-A790-Introduced.html
STATE OF NEW JERSEY
214th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2010 SESSION
Sponsored by:
Assemblyman JON M. BRAMNICK
District 21 (Essex, Morris, Somerset and Union)
SYNOPSIS
Requires health insurance coverage for anesthesiology services in connection with outpatient diagnostic screenings, including colonoscopies.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel
An Act concerning health benefits coverage for outpatient diagnostic screenings, and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. A hospital service corporation contract that provides hospital and medical expense benefits and is 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, shall provide coverage for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
These benefits shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. A medical service corporation contract that provides hospital and medical expense benefits and is 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, shall provide coverage for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
These benefits shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. A health service corporation contract that provides hospital and medical expense benefits and is 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, shall provide coverage for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
These benefits shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. An individual health insurance policy that provides hospital and medical expense benefits and is 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, shall provide coverage for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
These benefits shall be provided to the same extent as for any other condition under the policy.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
5. A group health insurance policy that provides hospital and medical expense benefits and is 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, shall provide coverage for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
These benefits shall be provided to the same extent as for any other condition under the policy.
This section shall apply to those policies in which the insurer has reserved the right to change the premium.
6. An individual health benefits plan that is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), on or after the effective date of this act, shall provide coverage for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
These benefits shall be provided to the same extent as for any other condition under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. A small employer health benefits plan that is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), on or after the effective date of this act, shall provide coverage for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
These benefits shall be provided to the same extent as for any other condition under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. A certificate of authority to establish and operate a health maintenance organization for health care services in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.) shall not be issued or continued by the Commissioner of Banking and Insurance, on or after the effective date of this act, unless it provides health care services for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to an enrollee, when those anesthesiology services are determined to be appropriate by the enrollee's treating physician.
These health care services shall be provided to the same extent as for any other condition under the contract.
This section shall apply to those contracts for health care services under which the right to change the schedule of charges for enrollee coverage is reserved.
9. The State Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses incurred for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
10. This act shall take effect on the 60th day after enactment.
STATEMENT
This bill requires private health insurance carriers (hospital, medical and health service corporations, individual, small employer and larger group commercial insurers, and health maintenance organizations) and the State Health Benefits Program to provide coverage for anesthesiology services that are provided in connection with the performance of outpatient diagnostic screenings, including, but not limited to colonoscopies, with respect to a covered person, when those anesthesiology services are determined to be appropriate by the covered person's treating physician.
The bill takes effect on the 60th day after enactment and applies to all contracts and policies issued on or after the effective date.
