Sponsored by:
Assemblyman JOHN V. AZZARITI JR., M.D.
District 39 (Bergen)
Assemblywoman MARGIE DONLON, M.D.
District 11 (Monmouth)
SYNOPSIS
Prohibits health insurance carriers from assessing administrative fees or penalties on in-network health care facilities for providing inadvertent out-of-network services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning certain administrative fees or penalties for care involving out-of-network health care providers and supplementing P.L.2018, c.32 (C.26:2SS-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier shall not assess an administrative fee or penalty on an in-network health care facility that provides inadvertent out-of-network services to a covered person.
b. A violation of subsection a. of this section by a carrier shall be considered an unfair trade practice pursuant to N.J.S.17B:30-1 et seq. and shall be subject to penalties contained pursuant to N.J.S.17B:30-17.
2. This act shall take effect on the 90th day next following the date of enactment and shall apply to policies and contracts issued, executed, delivered, or renewed on or after the date of enactment.
STATEMENT
This bill prohibits health insurance carriers from assessing administrative fees or penalties on in-network health care facilities that provide inadvertent out-of-network services to covered persons. Under existing law, "inadvertent out-of-network services" means health care services that are: covered under a managed care health benefits plan that provides a network; and provided by an out-of-network health care provider in the event that a covered person utilizes an in-network health care facility for covered health care services and, for any reason, in-network health care services are unavailable in that facility. "Inadvertent out-of-network services" include laboratory testing ordered by an in-network health care provider and performed by an out-of-network bio-analytical laboratory.
A violation of the provisions of this bill by a carrier will be considered an unfair trade practice pursuant to State law and will be subject to penalties.