Bill Text: NJ S2793 | 2016-2017 | Regular Session | Amended

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Bill Title: Requires health insurers, SHBP and SEHBP to provide coverage for digital tomosynthesis for screening and diagnostic purposes related to breast cancer.

Spectrum: Moderate Partisan Bill (Democrat 15-3)

Status: (Enrolled - Dead) 2018-01-08 - Passed Assembly (Passed Both Houses) (70-0-0) [S2793 Detail]

Download: New_Jersey-2016-S2793-Amended.html

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[First Reprint]

SENATE, No. 2793

STATE OF NEW JERSEY

217th LEGISLATURE

 

INTRODUCED NOVEMBER 14, 2016

 

 

Sponsored by:

Senator  LORETTA WEINBERG

District 37 (Bergen)

 

Co-Sponsored by:

Senators A.R.Bucco and Lesniak

 

 

 

 

SYNOPSIS

     Requires health insurers, SHBP and SEHBP to provide coverage for digital tomosynthesis for screening and diagnostic purposes related to breast cancer.

 

CURRENT VERSION OF TEXT

     As reported by the Senate Budget and Appropriations Committee on June 1, 2017, with amendments.

  

An Act requiring health insurance coverage for digital tomosynthesis of the breast 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. 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 in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract ¹shall be applied¹. 

     c.     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. 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 in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract ¹shall be applied¹. 

     c.     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. 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 in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract ¹shall be applied¹. 

     c.     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.    a. 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 in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the policy ¹shall be applied¹.  

     c.     This section shall apply to those 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 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 in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the policy ¹shall be applied¹. 

     c.     This section shall apply to those 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 and medical expense benefits and is 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 by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the health benefits plan ¹shall be applied¹. 

     c.     This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.

 

     7.    a. A small employer health benefits plan that provides hospital and medical expense benefits and is 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 by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses incurred in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the health benefits plan ¹shall be applied¹. 

     c.     This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.

 

     8.    a.  A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-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 in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract ¹shall be applied¹. 

     c.     This section shall apply to those contracts for health care services under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.

 

     9.    a.  The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide coverage for expenses incurred in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract ¹shall be applied¹. 

 

     10.    a.  The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide coverage for expenses incurred in conducting digital tomosynthesis to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.

     b.    ¹[The benefits provided by this section shall be provided to the same extent and with] In the case of digital tomosynthesis conducted to detect or screen for breast cancer in women 40 years of age and over, no deductible, coinsurance or other cost sharing shall be applied; and in the case of digital tomosynthesis conducted for diagnostic purposes in women of any age,¹ the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract ¹shall be applied¹. 

 

     11.    This act shall take effect on the first day of the seventh month next following enactment.