Requires oral agreements concerning health insurance be delivered in writing within 30 days of contract formation.

A1387

ASSEMBLY, No. 1387

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman ELLEN J. PARK

District 37 (Bergen)

SYNOPSIS

���� Requires oral agreements concerning health insurance
be delivered in writing within 30 days of contract formation.

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

An Act
concerning health insurance policies and supplementing
P.L.1975, c.101 (C.17B:30-13.1 et seq.).

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� a.� Following an oral
agreement to provide coverage pursuant to a health benefits plan, a carrier
shall:

���� (1)�� include language in the
health benefits plan contract that gives the covered person the right to, upon
request, receive any recording of the oral agreement made by the carrier, as
well as a written transcript of the oral agreement; and

���� (2)�� send a written copy of
the agreement to the covered person no later than 30 days after the oral
agreement�s formation.� The written copy shall comply with the �Life and Health
Insurance Policy Simplification Act,� P.L.1979, c.167 (C.17B:17-17 et seq.).

���� b.��� Failure to comply with
this act shall be a practice prohibited by N.J.S.17B:30-2.

���� c.���� Upon receipt of a
written copy of an oral agreement pursuant to subsection a. of this section, a
covered person shall have 30 days to notify the insurer of any difference
between the written contract and the oral agreement.

���� d.��� As used in this section:

���� �Carrier� means an insurance
company, health service corporation, hospital service corporation, medical
service corporation or health maintenance organization authorized to issue
health benefits plans in this State and a dental service corporation or dental
plan organization authorized to issue dental plans in this State.

���� �Health benefits plan� means a
benefits plan which pays or provides hospital and medical expense benefits for
covered services, and is delivered or issued for delivery in this State by or
through a carrier.� Health benefits plan includes, but is not limited to,
Medicare supplement coverage and risk contracts to the extent not otherwise
prohibited by federal law.

���� �Oral agreement� means an
agreement between a carrier and a covered person that was entered verbally for
purposes including, but not limited to, providing coverage pursuant to a health
benefits plan, expanding, decreasing, or revising coverage, and reimbursement
of claims.

���� 2.��� This act shall take
effect on the 90th day next following enactment.

STATEMENT

���� This bill requires health
insurance carriers to provide a covered person with a written copy of any oral
agreement entered with the covered person no less than 30 days after entering
an oral agreement with the person.� Such oral agreements include, but are not
limited to, initial agreements to provide coverage, any agreement to expand,
decrease, or revise coverage, and reimbursement of claims.� Currently, there is
no requirement that oral agreements concerning health insurance be put into
writing.� The bill also requires carriers include language in health benefits
plan contracts that gives covered individuals the right to, upon request,
receive any recording of the oral agreement that the carrier may have made,
along with a written transcript of the oral agreement.

���� The bill applies to health
insurance carriers, including health, hospital and medical service
corporations, commercial individual and group health insurers, health
maintenance organizations, and health benefits plans issued pursuant to the New
Jersey Individual Health Coverage and Small Employer Health Benefits Programs.