Sponsored by:
Assemblywoman ROSAURA "ROSY" BAGOLIE
District 27 (Essex and Passaic)
Assemblywoman SHANIQUE SPEIGHT
District 29 (Essex and Hudson)
Assemblywoman CARMEN THERESA MORALES
District 34 (Essex)
Co-Sponsored by:
Assemblywoman Flynn and Assemblyman Sampson
SYNOPSIS
Requires continuation of health benefits dependent coverage for certain children with disabilities who are 26 years of age or older.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning enrollment of certain adult children for health insurance coverage and amending P.L.1995, c.288.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1995, c.288 (C.17:48-6.15) is amended to read as follows:
1. a. A hospital service corporation contract which provides hospital or medical expense benefits under which dependent coverage is available shall continue to make that coverage available for an adult child until the child turns 26 years of age. A contract shall not deny coverage for a subscriber's child on the grounds that:
(1) The child was born out of wedlock;
(2) The child is not claimed as a dependent on the subscriber's federal tax return;
(3) The child does not reside with the subscriber or in the hospital service corporation's service area, provided that, in the case of a managed care plan, the child complies with the terms and conditions of the contract with respect to the use of specified providers;
(4) The child is married;
(5) The child has or adopts a child; or
(6) The child starts or leaves school.
b. If a child has coverage through a hospital service corporation contract of a noncustodial parent, the hospital service corporation shall:
(1) Provide such information to the custodial parent as may be necessary for the child to obtain benefits through the child's noncustodial parent's coverage;
(2) Permit the custodial parent, or the health care provider with the authorization of the custodial parent, to submit claims for covered services without the approval of the noncustodial parent; and
(3) Make payments on claims submitted in accordance with paragraph (2) of this subsection directly to the custodial parent, the health care provider or the Division of Medical Assistance and Health Services in the Department of Human Services which administers the State Medicaid program, as appropriate.
c. When a parent who is the subscriber is eligible for dependent coverage and is required by a court or administrative order to provide health insurance coverage for his child, the hospital service corporation shall:
(1) Permit the parent to enroll his child as a dependent, without regard to any open enrollment restrictions, including an adult child subject to subsection d. of this section;
(2) Permit the child's other parent, or the Division of Medical Assistance and Health Services as the State Medicaid agency or the Division of Family Development as the State IV-D agency, in the Department of Human Services, to enroll the child under the contract if the parent who is the subscriber fails to enroll the child; and
(3) Not terminate coverage of the child unless the parent who is the subscriber provides the hospital service corporation with satisfactory written evidence that: the court or administrative order is no longer in effect; or the child is or will be enrolled in a comparable health benefits plan whose coverage will be effective on the date of the termination of coverage.
d. Notwithstanding any law to the contrary, a contract shall provide coverage for an adult child who is 26 years of age or older if the child is:
(1) incapable of self-sustaining employment by reason of intellectual disability or physical handicap; and
(2) chiefly dependent upon the subscriber for support and maintenance.
(cf: P.L.2019, c.356, s.1)
2. Section 3 of P.L.1995, c.288 (C.17:48A-7.10) is amended to read as follows:
3. a. A medical service corporation contract which provides hospital or medical expense benefits under which dependent coverage is available shall continue to make that coverage available for an adult child until the child turns 26 years of age. A contract shall not deny coverage for a subscriber's child on the grounds that:
(1) The child was born out of wedlock;
(2) The child is not claimed as a dependent on the subscriber's federal tax return;
(3) The child does not reside with the subscriber or in the medical service corporation's service area, provided that, in the case of a managed care plan, the child complies with the terms and conditions of the contract with respect to the use of specified providers;
(4) The child is married;
(5) The child has or adopts a child; or
(6) The child starts or leaves school.
b. If a child has coverage through a medical service corporation contract of a noncustodial parent, the medical service corporation shall:
(1) Provide such information to the custodial parent as may be necessary for the child to obtain benefits through the child's noncustodial parent's coverage;
(2) Permit the custodial parent, or the health care provider with the authorization of the custodial parent, to submit claims for covered services without the approval of the noncustodial parent; and
(3) Make payments on claims submitted in accordance with paragraph (2) of this subsection directly to the custodial parent, the health care provider or the Division of Medical Assistance and Health Services in the Department of Human Services which administers the State Medicaid program, as appropriate.
c. When a parent who is the subscriber is eligible for dependent coverage and is required by a court or administrative order to provide health insurance coverage for his child, the medical service corporation shall:
(1) Permit the parent to enroll his child as a dependent, without regard to any open enrollment restrictions, including an adult child subject to subsection d. of this section;
(2) Permit the child's other parent, or the Division of Medical Assistance and Health Services as the State Medicaid agency or the Division of Family Development as the State IV-D agency, in the Department of Human Services, to enroll the child under the contract if the parent who is the subscriber fails to enroll the child; and
(3) Not terminate coverage of the child unless the parent who is the subscriber provides the medical service corporation with satisfactory written evidence that: the court or administrative order is no longer in effect; or the child is or will be enrolled in a comparable health benefits plan whose coverage will be effective on the date of the termination of coverage.
d. Notwithstanding any law to the contrary, a contract shall provide coverage for an adult child who is 26 years of age or older if the child is:
(1) incapable of self-sustaining employment by reason of intellectual disability or physical handicap; and
(2) chiefly dependent upon the subscriber for support and maintenance.
(cf: P.L.2019, c.356, s.2)
3. Section 5 of P.L.1995,