The Health Insurance Claim Plain Language and Simplification Act mandates that health insurance carriers in New Jersey provide a clear and concise written explanation of benefits (EOB) form to covered individuals whenever a claim is processed. This EOB must include essential information such as the insured's name, healthcare provider's name, date of service, claim amount, amount paid by the carrier, and the amount owed by the covered person. Additionally, if a claim is partially or fully paid, the EOB must explain the reasons for the payment, and if denied, the reasons for denial must also be provided. The form must also include instructions for any required actions or options available to the covered person regarding the claim.

Furthermore, the bill stipulates that the first page of the EOB form should contain only the specified information and be presented in a 12-point font using simple, plain language that is easily understandable. This requirement aligns with the existing Life and Health Insurance Policy Language Simplification Act, ensuring that the information is accessible to all covered persons. The act is set to take effect 90 days after its enactment.