Sponsored by:
Senator LINDA R. GREENSTEIN
District 14 (Mercer and Middlesex)
SYNOPSIS
Requires availability of electronic fund transfers by health insurance carriers to reimburse covered persons.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning reimbursements for certain health insurance costs and supplementing Title 17B of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier, or the carrier's contracted vendor, shall allow payment to a covered person for reimbursement to include reimbursement through an electronic funds transfer.
b. A carrier shall include, as part of its health benefits plan, notification to a covered person:
(1) if a reimbursement payment through an electronic funds transfer has a fee associated with it; and
(2) of the instructions on the carrier's, or the carrier's contracted vendor's, website to select an electronic funds transfer as the means to receive a reimbursement payment.
c. Any violation of this act may be subject to enforcement by the Department of Banking and Insurance. The department shall provide the carrier notice and an opportunity to be heard, and upon a finding of a violation of the act, shall impose a civil penalty pursuant to the "Penalty Enforcement Law of 1999," P.L.1999, c.274 (C.2A:58-10 et seq.), and shall order the carrier to reimburse a covered person for any documented fees or charges reasonably incurred as a result of violation.
d. As used in this section:
“Carrier” means an insurance company; health service corporation; hospital service corporation; medical service corporation or health maintenance organization authorized to issue health benefit plans in this State, and a dental service corporation or dental plan organization authorized to issue dental plans in this State.
“Covered person” means a person on whose behalf a carrier offering the plan is obligated to pay benefits or provide services pursuant to the health benefits plan
“Health benefits plan” means a benefits plan which pays or
provides hospital and medical expense benefits for covered services and is
delivered or issued for delivery in this State by or through a carrier.
For the purposes of this act,
“health benefits plan” shall not include the following plans, policies, or
contracts: accident only; credit; disability; long-term care; Medicare
Supplement; Medicare Advantage; Medicaid; Civilian Health and Medical Program
for the Uniformed Services; CHAMPUS supplement coverage; coverage arising out
of a workers' compensation or similar law; automobile medical payment
insurance; personal injury protection insurance issued pursuant to P.L.1972,
c.70 (C.39:6A-1 et seq.); or hospital confinement indemnity coverage.
2. This act shall take effect on the 90th day next following the date of enactment and shall apply to claims for reimbursement submitted under a health benefits plan initiated or renewed on or after the effective date.
STATEMENT
This bill requires a carrier, or the carrier's contracted vendor, to allow payment to a covered person for reimbursement to include reimbursement through an electronic funds transfer. A carrier is to include, as part of its health benefits plan, notification to a covered person: (1) if a reimbursement payment through an electronic funds transfer has a fee associated with it; and (2) of the instructions on the carrier's, or the carrier's contracted vendor's, website to select an electronic funds transfer as the means to receive a reimbursement payment. Any violation of the bill’s provisions may be subject to enforcement by the Department of Banking and Insurance.