STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Senator JON M. BRAMNICK
District 21 (Middlesex, Morris, Somerset and Union)
Senator ANTHONY M. BUCCO
District 25 (Morris and Passaic)
SYNOPSIS
"Health Insurance Claim Plain Language and Simplification Act."
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning certain health benefits forms and supplementing P.L.1999, c.155 (C.17B:30-26 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. This act shall be known and may be cited as the "Health Insurance Claim Plain Language and Simplification Act."
2. a. Every carrier issuing health benefits plans in this State shall provide a written explanation of benefits form to a covered person whenever a claim is generated under the covered person's health benefits plan. The explanation of benefits form shall contain all of the following information on the first page of the form:
(1) the name of the insured, the name of the health care provider, the date of service, the amount of the claim, the amount paid by the carrier, and the amount to be paid by the covered person;
(2) if a claim is paid in whole or in part, an explanation of the reasons that the claim was paid in whole or in part;
(3) if a claim is denied, an explanation of the reasons that the claim is denied; and
(4) instructions as to any action that the covered person is required to take with respect to the claim, or any option which may be available to the covered person with respect to the determination of benefits for that claim.
b. The information required pursuant to subsection a. of this section shall be the only information provided on the first page of the explanation of benefits form and shall be in 12-point font. The information shall be in simple, plain language that is clearly understandable to covered persons, in a manner consistent with the "Life and Health Insurance Policy Language Simplification Act," P.L.1979, c.167 (C.17B:17-17 et seq.).
3. This act shall take effect on the 90th day next following enactment.
STATEMENT
This bill, entitled the "Health Insurance Claim Plain Language and Simplification Act," requires health insurance carriers to provide explanation of benefits forms to covered persons which include certain information on the form in a certain format, and to use simple, plain language that is clearly understandable.
The bill requires every carrier issuing health benefits plans in this State to provide a written explanation of benefits form to a covered person whenever a claim is generated under the covered person's health benefits plan. The explanation of benefits form shall contain all of the following information on the first page of the form:
(1) the name of the insured, the name of the health care provider, the date of service, the amount of the claim, the amount paid by the carrier, and the amount to be paid by the covered person;
(2) if a claim is paid in whole or in part, an explanation of the reasons that the claim was paid in whole or in part;
(3) if a claim is denied, an explanation of the reasons that the claim is denied; and
(4) instructions as to any action that the covered person is required to take with respect to the claim or any option which may be available to the covered person with respect to the determination of benefits for that claim.
The bill requires this information to be the only information provided on the first page of the explanation of benefits form and requires the information to be in 12-point font. The bill also requires the information to be in simple, plain language that is clearly understandable to covered persons, in a manner consistent with the "Life and Health Insurance Policy Language Simplification Act," P.L.1979, c.167 (C.17B:17-17 et seq.).