A996

An Act requiring insurance coverage for exams for dyslexia 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 testing for suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the contract. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the contract.

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 testing for suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the contract. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the contract.

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 testing for suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the contract. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the contract.

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 testing for suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the policy. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the policy.

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 testing for suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the policy. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the policy.

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 testing for suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the plan. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the plan.

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 suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the plan. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the plan.

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 suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the contract. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the contract.

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 suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the contract. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the contract.

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 suspected dyslexia in accordance with this section and shall not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the contract. Coverage shall include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.

b. The benefits shall be provided to the same extent as for any other condition under the contract.

11. This act shall take effect on the first day of the sixth month next following enactment and shall apply to contracts, policies, and plans delivered, issued, executed, or renewed on or after that date.

STATEMENT

This bill requires health insurers (including insurance companies, hospital service corporations, medical service corporations, health service corporations, health maintenance organizations authorized to issue health benefits plans in New Jersey, and entities contracted to administer health benefits in connection with the State Health Benefits Program and School Employees’ Health Benefits Program) to provide coverage for testing for suspected dyslexia.

Specifically, the bill requires coverage for suspected dyslexia that may not exclude coverage for the screening, diagnosis, or treatment of medical conditions otherwise covered by the policy. Coverage is to include comprehensive neuropsychological examinations for the purposes of diagnosing dyslexia and determining the psychological, emotional, and educational wellness needs of the individual tested.