Sponsored by:
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
Assemblywoman ANGELA V. MCKNIGHT
District 31 (Hudson)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Assemblywoman LINDA S. CARTER
District 22 (Middlesex, Somerset and Union)
Co-Sponsored by:
Assemblyman Caputo, Assemblywomen Chaparro and Murphy
SYNOPSIS
Requires health benefits coverage of hearing aids and cochlear implants for insureds aged 21 or younger.
CURRENT VERSION OF TEXT
As introduced.
An Act requiring health benefits coverage for hearing aids and cochlear implants, amending P.L.2008, c.126 and supplementing P.L.2007, c.103 (C 52:14-17.46).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.2008, c.126 (C.17:48-6gg) is amended to read as follows:
2. 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 medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A hospital service corporation contract shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A hospital service corporation may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A hospital service corporation contract shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the contract.
e. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.2)
2. Section 3 of P.L.2008, c.126 (C.17:48A-7dd) is amended to read as follows:
3. 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 medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A medical service corporation contract shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A medical service corporation may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A medical service corporation contract shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provider who can provide any part, attachment, or accessory necessary to the continued function of a preexisting cochlear implant, the contract shall cover the part, attachment, or accessory when purchased from and provided by an out-of-network provider, and shall only impose cost sharing as if the out-of-network provider were part of the provider network.
d. The benefits shall be provided to the same extent as for any other condition under the contract.
e. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
(cf: P.L.2008, c.126, s.3)
3. Section 4 of P.L.2008, c.126 (C.17:48E-35.31) is amended to read as follows:
4. 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 al.), 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 medically necessary expenses incurred in the purchase of a hearing aid or cochlear implant for a covered person [15] 21 years of age or younger, as provided in this section.
b. A health service corporation contract shall provide coverage that includes the purchase of a hearing aid for each ear, when medically necessary and as prescribed or recommended by a licensed physician or audiologist. [A health service corporation may limit the benefit provided in this section to $1,000 per hearing aid for each hearing-impaired ear every 24 months. A covered person may choose a hearing aid that is priced higher than the benefit payable under this section and may pay the difference between the price of the hearing aid and the benefit payable under this section, without financial or contractual penalty to the provider of the hearing aid.]
c. (1) A health service corporation contract shall provide coverage of the cost of treatment related to cochlear implants, including procedures for the implantation of cochlear devices and costs for any parts, attachments, or accessories of the device.
(2) If a contract does not have in its network a provid