The bill amends New Jersey law to mandate that various health insurance entities, including hospital service corporations, medical service corporations, health maintenance organizations (HMOs), and state health benefits plans, provide coverage for orthotic and prosthetic appliances. It requires these entities to cover expenses for obtaining such appliances from licensed professionals when deemed medically necessary by a physician. Additionally, the bill allows for coverage of an extra appliance if necessary for physical and recreational activities.

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 ensure that contracts purchased by the commission 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