The bill amends New Jersey law to mandate that various health insurance and service corporation contracts provide coverage for orthotic and prosthetic appliances deemed medically necessary by a physician. This requirement applies to a wide range of entities, including hospital service corporations, health maintenance organizations, and state health benefits plans. Additionally, the bill allows for coverage of an extra appliance if it is necessary for physical and recreational activities, such as running or swimming.

Moreover, the bill establishes that reimbursement for these appliances must align with the federal Medicare reimbursement schedule, ensuring that benefits are provided comparably to other medical conditions under the respective contracts. It specifically amends section 18 of P.L.1991, c.512 (C.45:12B-18) to confirm that contracts purchased by the commission will reimburse for orthotic and prosthetic appliances at the same rate as Medicare. The act will take effect 90 days after enactment and will apply to policies or contracts issued or renewed thereafter.

Statutes affected:
Introduced: 17:48-6, 17:48A-7, 17:48E-35.30, 17B:26-2.1, 17B:27-46.1, 17B:27A-7.13, 17B:27A-19.17, 26:2J-4.31, 52:14-17.29
Advance Law: 17:48-6, 17:48A-7, 17:48E-35.30, 17B:26-2.1, 17B:27-46.1, 17B:27A-7.13, 17B:27A-19.17, 26:2J-4.31, 52:14-17.29
Pamphlet Law: 17:48-6, 17:48A-7, 17:48E-35.30, 17B:26-2.1, 17B:27-46.1, 17B:27A-7.13, 17B:27A-19.17, 26:2J-4.31, 52:14-17.29