Extends time period in which to enroll newborn infant in health benefits coverage.

A2285

ASSEMBLY, No. 2285

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman MARGIE DONLON, M.D.

District 11 (Monmouth)

Assemblywoman ALIXON COLLAZOS-GILL

District 27 (Essex and Passaic)

Assemblywoman ANDREA KATZ

District 8 (Atlantic and Burlington)

Co-Sponsored by:

Assemblyman Miller, Assemblywomen Bagolie, Speight, Haider,
Swain, Assemblyman Tully and Assemblywoman Peterpaul

SYNOPSIS

���� Extends time period in which to enroll newborn infant
in health benefits coverage.

CURRENT VERSION OF TEXT

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

��

An Act
concerning enrollment of newborn infants in health
benefits coverage and amending various parts of the statutory law.

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

���� 1.��� Section 6 of P.L.1938,
c.366 (C.17:48-6) is amended to read as follows:

���� 6.��� Every individual
contract made by a corporation subject to the provisions of this chapter to
furnish services to a subscriber shall provide for the furnishing of services
for a period of 12 months, and no contract shall be made providing for the
inception of such services at a date later than 1 year after the actual date of
the making of such contract.� Any such contract may provide that it shall be
automatically renewed from year to year unless there shall have been at least
30 days' prior written notice of termination by either the subscriber or the
corporation.� In the absence of fraud or material misrepresentation in the
application for a contract or for reinstatement, no contract with an individual
subscriber shall be terminated by the corporation unless all contracts of the
same type, in the same group or covering the same classification of persons are
terminated under the same conditions.

���� No contract between any such
corporation and a subscriber shall entitle more than one person to services,
except that a contract issued as a family contract may provide that services
will be furnished to a husband and wife, or husband, wife and their dependent
child or children, or the subscriber and his (or her) dependent child or
children.� Adult dependent(s) of a subscriber may also be included for coverage
under the contract of such subscriber.

���� Whenever, pursuant to the
provisions of a subscription certificate or group contract issued by a
corporation, the former spouse of a named subscriber under such a certificate
or contract is no longer entitled to coverage as an eligible dependent by reason
of divorce, separate coverage for such former spouse shall be made available by
the corporation on an individual non-group basis under the following
conditions:

���� (a)�� Application for such
non-group coverage shall be made to the corporation by or on behalf of such
former spouse no later than 31 days following the date his or her coverage
under the prior certificate or contract terminated.

���� (b)�� No new evidence of
insurability shall be required in connection with the application for such
non-group coverage but any health exception, limitation or exclusion applicable
to said former spouse under the prior coverage may, at the option of the
corporation, be carried over to the new non-group coverage.

���� (c)�� The effective date of
the new coverage shall be the day following the date on which such former
spouse's coverage under the prior certificate or contract terminated.

���� (d)�� The benefits provided
under the non-group coverage issued to such former spouse shall be at least
equal to the basic benefits provided in contracts then being issued by the
corporation to new non-group applicants of the same age and family status.

���� Family type contracts shall
provide that the services applicable for children shall be payable with respect
to a newly-born child of the subscriber, or his or her spouse from the moment
of birth.� The services for newly-born children shall consist of coverage of
injury or sickness including the necessary care and treatment of medically
diagnosed congenital defects and abnormalities.� If a subscription payment is
required to provide services for a child, the contract may require that
notification of birth of a newly-born child and the required payment must be
furnished to the service corporation within
[
60
]

90

days after the date of birth in order to have the coverage continue beyond such

[
60
]

90
-day
period.

���� Nonfamily type contracts which
provide for services to the subscriber but not to family members or dependents
of that subscriber, shall also provide services to newly-born children of the
subscriber which shall commence with the moment of birth of each child and
shall consist of coverage of injury or sickness including the necessary care
and treatment of medically diagnosed congenital defects and abnormalities,
provided that application therefor and payment of the required subscription
amount are made to include in said contract the coverage described in the
preceding paragraph of this section within
[
60
]

90

days from the date of birth of a newborn child.

���� A contract under which
coverage of a dependent of a subscriber terminates at a specified age shall,
with respect to an unmarried child, covered by the contract prior to attainment
of age 19, who is incapable of self-sustaining employment by reason of an intellectual
disability or physical handicap and who became so incapable prior to attainment
of age 19 and who is chiefly dependent upon such subscriber for support and
maintenance, not so terminate while the contract remains in force and the
dependent remains in such condition, if the subscriber has within 31 days of
such dependent's attainment of the termination age submitted proof of such
dependent's incapacity as described herein.� The foregoing provisions of this
paragraph shall not apply retrospectively or prospectively to require a
hospital service corporation to insure as a covered dependent any child with an
intellectual disability or physically handicapped child of the applicant where
the contract is underwritten on evidence of insurability based on health
factors required to be set forth in the application.� In such cases any
contract heretofore or hereafter issued may specifically exclude such child
with an intellectual disability or physically handicapped child from coverage.

���� Every individual contract
entered into by any such corporation with any subscriber thereto shall be in
writing and a certificate stating the terms and conditions thereof shall be
furnished to the subscriber to be kept by him.� No such certificate form shall
be made, issued or delivered in this State unless it contains the following
provisions:

���� (a)�� A statement of the
contract rate, or amount payable to the corporation by or on behalf of the
subscriber for the original quarter-annual period of coverage and of the time
or times at which, and the manner in which, such amount is to be paid; and a
provision requiring 30 days' written notice to the subscriber before any change
in the contract, including a change in the amount of subscription rate, shall
take effect;

���� (b)�� A statement of the
nature of the services to be furnished and the period during which they will be
furnished; and if there are any services to be excepted, a detailed statement
of such exceptions printed as hereinafter specified;

���� (c)�� A statement of the terms
and conditions, if any, upon which the contract may be amended on approval of
the commissioner or canceled or otherwise terminated at the option of either
party.� Any notice to the subscriber shall be effective if sent by mail to the
subscriber's address as shown at the time on the plan's record, except that, in
the case of persons for whom payment of the contract is made through a
remitting agent, any such notice to the subscriber shall also be effective if a
personalized notice is sent to the remitting agent for delivery to the
subscriber, in which case it shall be the responsibility of the remitting agent
to make such delivery. The notice to the subscriber as herein required shall be
sent at least 30 days before the amendment, cancellation or termination of the
contract takes effect.� Any rider or endorsement accompanying such notice, and
amending the rates or other provisions of the contract, shall be deemed to be a
part of the contract as of the effective date of such rider or endorsement;

���� (d)�� A statement that the
contract includes the endorsements thereon and attached papers, if any, and
contains the entire contract for services;

���� (e)�� A statement that no
statement by the subscriber in his application for a contract shall void the
contract or be used in any legal proceeding thereunder, unless such application
or an exact copy thereof is included in or attached to such contract, and that
no agent or representative of such corporation, other than an officer or
officers designated therein, is authorized to change the contract or waive any
of its provisions;

���� (f)�� A statement that if the
subscriber defaults in making any payment under the contract, the subsequent
acceptance of a payment by the corporation or by one of its duly authorized
agents shall reinstate the contract, but with respect to sickness and injury may
cover such sickness as may be first manifested more than 10 days after the date
of such acceptance;

���� (g)�� A statement of the
period of grace which will be allowed the subscriber for making any payment due
under the contract.� Such period shall be not less than 10 days.

���� In every such contract made,
issued or delivered in this State:

���� (a)�� All printed portions
shall be plainly printed in type of which the face is not smaller than 10
point;

���� (b)�� There shall be a brief
description of the contract on its first page and on its filing back in type of
which the face is not smaller than 14 point;

���� (c)�� The exceptions of the
contract shall appear with the same prominence as the benefits to which they
apply; and

���� (d)�� If the contract contains
any provision purporting to make any portion of the articles, constitution or
bylaws of the corporation a part of the contract, such portion shall be set
forth in full.

(cf: P.L.2017, c.361, s.1)

���� 2.��� Section 2 of P.L.1964,
c.104 (C.17:48-6.1) is amended to read as follows:

���� 2.��� A hospital service
corporation may issue to a policyholder a group contract, covering at least two
employees or members at the date of issue, if it conforms to the following
description:

���� (a)�� A contract issued to an
employer or to the trustees of a fund established by one or more employers, or
issued to a labor union, or issued to an association formed for purposes other
than obtaining such contract, or issued to the trustees of a fund established
by one or more labor unions, or by one or more employers and one or more labor
unions, covering employees and members of associations or labor unions.

���� (b)�� A contract issued to
cover any other group which the Commissioner of Banking and Insurance
determines may be covered in accordance with sound underwriting principles.

���� Benefits may be provided for
one or more members of the families or one or more dependents of persons who
may be covered under a group contract referred to in (a) or (b) above.

���� Family type contracts shall
provide that the services applicable for children shall be payable with respect
to a newly-born child of the subscriber, or his or her spouse from the moment
of birth.� The services for newly-born children shall consist of coverage of
injury or sickness including the necessary care and treatment of medically
diagnosed congenital defects and abnormalities.� If a subscription payment is
required to provide services for a child, the contract may require that
notification of birth of a newly-born child and the required payment must be
furnished to the service corporation within
[
60
]

90

days after the date of birth in order to have the coverage continue beyond such

[
60
]

90
-day
period.

���� Group contracts which provide
for services to the subscriber but not to family members or dependents of that
subscriber, other than contracts which provide no dependent coverage whatsoever
for the subscriber's class, shall also provide services to newly-born children
of the subscriber which shall commence with the moment of birth of each child
and shall consist of coverage of injury or sickness including the necessary
care and treatment of medically diagnosed congenital defects and abnormalities,
provided that application therefor and payment of the required subscription
amount are made to include in said contract the coverage described in the
preceding paragraph of this section within
[
60
]

90

days from the date of birth of a newborn child.

���� A contract under which
coverage of such a dependent terminates at a specified age shall, with respect
to an unmarried child, covered by the contract prior to attainment of age 19,
who is incapable of self-sustaining employment by reason of intellectual disability
or physical handicap and who became so incapable prior to attainment of age 19
and who is chiefly dependent upon the covered employee or member for support
and maintenance, not so terminate while the coverage of the employee or member
remains in force and the dependent remains in such conditions, if the employee
or member has within 31 days of such dependent's attainment of the termination
age submitted proof of such dependent's incapacity as described herein.� The
foregoing provisions of this paragraph shall not apply retrospectively or
prospectively to require a hospital service corporation to insure as a covered
dependent any child with an intellectual disability or physical handicap of the
applicant where the contract is underwritten on evidence of insurability based
on health factors required to be set forth in the application.� In such cases
any contract heretofore or hereafter issued may specifically exclude such child
with an intellectual disability or physical handicap from coverage.

���� Any group contract which
contains provisions for the payment by the insurer of benefits for members of
the family or dependents of a person in the insured group shall provide that,
subject to payment of the appropriate premium, such family members or dependents
be permitted to have coverage continued for at least 180 days after the death
of the person in the insured group.

���� The contract may provide that
the term "employees" shall include as employees of a single employer
the employees of one or more subsidiary corporations and the employees,
individual proprietors and partners of affiliated corporations, proprietorships
and partnerships if the business of the employer and such corporations,
proprietorships or partnerships is under common control through stock
ownership, contract or otherwise.� The contract may provide that the term
"employees" shall include the individual proprietor or partners of an
individual proprietorship or a partnership. The contract may provide that the
term "employees" shall include retired employees. A contract issued
to trustees may provide that the term "employees" shall include the
trustees or their employees, or both, if their duties are principally connected
with such trusteeship.� A contract issued to the trustees of a fund established
by the members of an association of employers may provide that the term
"employees" shall include the employees of the association.

(cf: P.L.2017, c.361, s.2)

���� 3.��� Section 5 of P.L.1940,
c.74 (C.17:48A-5) is amended to read as follows:

���� 5.��� Every individual
contract made by any corporation subject to the provisions of this chapter to
provide payment for medical services shall provide for the payment of medical
services for a period of 12 months from the date of issue of the subscription
certificate.� Any such contract may provide that it shall be automatically
renewed from year to year unless there shall have been 1 month's prior written
notice of termination by either the subscriber or the corporation.� In the
absence of fraud or material misrepresentation in the application for contract
or for reinstatement, no contract with an individual subscriber shall be
terminated by the corporation unless all contracts of the same type, in the
same group or covering the same classification of persons are terminated under
the same conditions.� No contract between such corporation and subscriber shall
allow for the payment for medical services for more than one person, except
that a family contract may provide that payment will be made for medical services
rendered to a subscriber and any of those dependents defined in section 1 of
this act.

���� Whenever, pursuant to the
provisions of a subscription certificate or group contract issued by a
corporation, the former spouse of a named subscriber under such a certificate
or contract is no longer entitled to coverage as an eligible dependent by reason
of divorce, separate coverage for such former spouse shall be made available by
the corporation on an individual nongroup basis under the following conditions:

���� (a)�� Application for such
nongroup coverage shall be made to the corporation by or on behalf of such
former spouse no later than 31 days following the date his or her coverage
under the prior certificate or contract terminated.

���� (b)�� No new evidence of
insurability shall be required in connection with the application for such
nongroup coverage but any health exception, limitation or exclusion applicable
to said former spouse under the prior coverage may, at the option of the
corporation, be carried over to the new nongroup coverage.

���� (c)�� The effective date of
the new coverage shall be the day following the date on which such former
spouse's coverage under the prior certificate or contract terminated.

���� (d)�� The benefits provided
under the nongroup coverage issued to such former spouse shall be at least
equal to the basic benefits provided in contracts then being issued by the
corporation to new nongroup applicants of the same age and family status.

���� Family type contracts shall
provide that the services applicable for children shall be payable with respect
to a newly-born child of the subscriber, or his or her spouse from the moment
of birth.� The services for newly-born children shall consist of coverage of
injury or sickness including the necessary care and treatment of medically
diagnosed congenital defects and abnormalities.� If a subscription payment is
required to provide services for a child, the contract may require that
notification of birth of a newly-born child and the required payment shall be
furnished to the service corporation within
[
60
]

90

days after the date of birth in order to have the coverage continue beyond such

[
60
]

90
-day
period.

���� Nonfamily type contracts which
provide for services to the subscriber but not to family members or dependents
of that subscriber, shall also provide services to newly-born children of the
subscriber which shall commence with the moment of birth of each child and
shall consist of coverage of injury or sickness including the necessary care
and treatment of medically diagnosed congenital defects and abnormalities,
provided that application therefor and payment of the required subscription
amount are made to include in said contract the coverage described in the
preceding paragraph of this section within
[
60
]

90

days from the date of birth of a newborn child.

���� A contract under which
coverage of a dependent of a subscriber terminates at a specified age shall,
with respect to an unmarried child, covered by the contract prior to attainment
of age 19, who is incapable of self-sustaining employment by reason of intellectual
disability or physical handicap and who became so incapable prior to attainment
of age 19 and who is chiefly dependent upon such subscriber for support and
maintenance, not so terminate while the contract remains in force and the
dependent remains in such condition, if the subscriber has within 31 days of
such dependent's attainment of the termination age submitted proof of such
dependent's incapacity as described herein.� The foregoing provisions of this
paragraph shall not apply retrospectively or prospectively to require a medical
service corporation to insure as a covered dependent any child with an
intellectual disability or physical handicap of the applicant where the
contract is underwritten on evidence of insurability based on health factors,
required to be set forth in the application.� In such cases any contract
heretofore or hereafter issued may specifically exclude such child with an
intellectual disability or physical handicap from coverage.

(cf: P.L.2017, c.361, s.3)

���� 4.��� Section 1 of P.L.1964,
c.105 (C.17:48A-7.1) is amended to read as follows:

���� 1.��� A medical service
corporation may issue to a policyholder a group contract, covering at least 10
employees or members at the date of issue, if it conforms to the following
description:

���� (a)�� A contract issued to an
employer or to the trustees of a fund established by one or more employers, or
issued to a labor union, or issued to an association formed for purposes other
than obtaining such contract, or issued to the trustees of a fund established
by one or more labor unions or by one or more employers and one or more labor
unions, covering employees and members of associations or labor unions.

���� (b)�� A contract issued to
cover any other group which the Commissioner of Banking and Insurance
(hereinafter called the commissioner) determines may be covered in accordance
with sound underwriting principles.

���� Benefits may be provided for
one or more members of the families or one or more dependents of persons who
may be covered under a group contract referred to in (a) or (b) above.

���� Family type contracts shall
provide that the services applicable for children shall be payable with respect
to a newly-born child of the subscriber, or his or her spouse from the moment
of birth.� The services for newly-born children shall consist of coverage of
injury or sickness including the necessary care and treatment of medically
diagnosed congenital defects and abnormalities.� If a subscription payment is
required to provide services for a child, the contract may require that
notification of birth of a newly-born child and the required payment must be
furnished to the service corporation within
[
60
]

90

days after the date of birth in order to have the coverage continue beyond such

[
60
]

90
-day
period.

���� Group contracts which provide
for services to the subscriber but not to family members or dependents of that
subscriber, other than contracts which provide no dependent coverage whatsoever
for the subscriber's class, shall also provide services to newly-born children
of the subscriber which shall commence with the moment of birth of each child
and shall consist of coverage of injury or sickness including the necessary
care and treatment of medically diagnosed congenital defects and abnormalities,
provided that application therefor and payment of the required subscription
amount are made to include in said contract the coverage described in the
preceding paragraph of this section within
[
60
]

90

days from the date of birth of a newborn child.

���� A contract under which
coverage of such a dependent terminates at a specified age shall, with respect
to an unmarried child, covered by the contract prior to attainment of age 19,
who is incapable of self-sustaining employment by reason of intellectual disability
or physical handicap and who became so incapable prior to attainment of age 19
and who is chiefly dependent upon the covered employee or member for support
and maintenance, not so terminate while the coverage of the employee or member
remains in force and the dependent remains in such condition, if the employee
or member has within 31 days of such dependent's attainment of the termination
age submitted proof of such dependent's incapacity as described herein. The
foregoing provisions of this paragraph shall apply retrospectively or
prospectively to require a medical service corporation to insure as a covered
dependent any child with an intellectual disability or physical handicap of the
applicant where the contract is underwritten on evidence of insurability based
on health factors required to be set forth in the application.� In such cases
any contract heretofore or hereafter issued may specifically exclude such child
with an intellectual disability or physical handicap from coverage.

���� Any group contract which
contains provisions for the payment by the insurer of benefits for members of
the family or dependents of a person in the insured group shall, subject to
payment of the appropriate premium, provide that such family members or dependents
be permitted to have coverage continued for at least 180 days after the death
of the person in the insured group.

���� The contract may provide that
the term "employees" shall include as employees of a single employer
the employees of one or more subsidiary corporations and the employees,
individual proprietors and partners of affiliated corporations, proprietorships
and partnerships if the business of the employer and such corporations,
proprietorships or partnerships is under common control through stock
ownership, contract or otherwise.� The contract may provide that the term
"employees" shall include the individual proprietor or partners of an
individual proprietorship or a partnership. The contract may provide that the
term "employees" shall include retired employees.� A contract issued
to trustees may provide that the term "employees" shall include the
trustees or their employees, or both, if their duties are principally connected
with such trusteeship.� A contract issued to the trustees of a fund established
by the members of an association of employers may provide that the term
"employees" shall include the employees of the association.

(cf: P.L.2017, c.361, s.4)

���� 5.��� Section 20 of P.L.1985,
c.236 (C.17:48E-20) is amended to read as follows:

���� 20.� a.� Family type
individual contracts shall provide that the coverage applicable for children
shall be payable with respect to a newly-born child of the subscriber, or his
or her spouse, from the moment of birth.� Coverage for newly-born children
shall consist of coverage of injury or sickness, including the necessary care
and treatment of medically diagnosed congenital defects and abnormalities.� If
a subscription payment is required to provide coverage for a child, the
contract may require that notification of birth of a newly-born child and the
required payment must be furnished to the health service corporation within
[
60
]

90

days after the date of birth in order to have the coverage continue beyond such

[
60
]

90
-day
period.

���� b.��� Nonfamily type
individual contracts which provide for coverage to the subscriber but not to
family members or dependents of that subscriber shall also provide coverage to
newly-born children of the subscriber, which shall commence with the moment of
birth of each child and shall consist of coverage of injury or sickness
including the necessary care and treatment of medically diagnosed congenital
abnormalities, if application therefor and payment of the required subscription
amount are made to include in the contract the coverage described in subsection
a. of this section within
[
60
]

90

days from the date of birth of a newborn child.

(cf: P.L.2017, c.361, s.5)

���� 6.��� Section 28 of P.L.1985,
c.236 (C.17:48E-28) is amended to read as follows:

���� 28.� a.� Family type group
coverage shall provide that the coverage applicable for children shall be
payable with respect to a newly-born child of the subscriber, or his or her
spouse, from the moment of birth.� The coverage for newly-born children shall
consist of coverage of injury or sickness including the necessary care and
treatment of medically diagnosed congenital defects and abnormalities.� If a
subscription payment is required to obtain coverage for a child, the contract
may require that notification of birth of a newly-born child and the required
payment shall be furnished to the health service corporation within
[
60
]

90

days after the date of birth in order to have the coverage continue beyond that

[
60
]

90
-day
period.

���� b.��� Non-family type group
coverage, other than under contracts which provide no dependent coverage
whatsoever for the subscriber's class, shall also provide coverage for
newly-born children of the subscriber, which coverage shall commence with the
moment of birth of each child and shall consist of coverage of injury or
sickness, including the necessary care and treatment of medically diagnosed
congenital defects and abnormalities, if application therefor and payment of
the required subscription amount are made to include in the contract the
coverage described in subsection a. of this section within
[
60
]

90

days from the date of birth of a newborn child.

(cf: P.L.2017, c.361, s.6)

���� 7.��� N.J.S.17B:26-2 is
amended to read as follows:

���� 17B:26-2.� a.� No such policy
of insurance shall be delivered or issued for delivery to any person in this
State unless:

���� (1)�� The entire money and
other considerations therefor are expressed therein; and

���� (2)�� The time at which the
insurance takes effect and terminates is expressed therein; and

���� (3)�� It purports to insure
only one person, except that a policy may insure, originally or by subsequent
amendment, upon the application of an adult member of a family who shall be
deemed the policyholder, any two or more eligible members of that family, including
husband, wife, dependent children or any children under a specified age which
shall not exceed 19 years and any other person dependent upon the policyholder;
and

���� (4)�� The style, arrangement
and over-all appearance of the policy give no undue prominence to any portion
of the text, and unless every printed portion of the text of the policy and of
any endorsements or attached papers is plainly printed in light-faced type of a
style in general use, the size of which shall be uniform and not less than
10-point with a lower-case unspaced alphabet length not less than 120-point
(the "text" shall include all printed matter except the name and
address of the insurer, name or title of the policy, the brief description if
any, and captions and subcaptions); and

���� (5)�� The exceptions and
reductions of indemnity are set forth in the policy and, except those which are
set forth in sections 17B:26-3 to 17B:26-31 inclusive, are printed, at the
insurer's option, either included with the benefit provision to which they
apply, or under an appropriate caption such as "exceptions," or
"exceptions and reductions," provided that if an exception or
reduction specifically applies only to a particular benefit of the policy, a
statement of such exception or reduction shall be included with the benefit
provision to which it applies; and

���� (6)�� Each such form,
including riders and endorsements, shall be identified by a form number in the
lower left-hand corner of the first page thereof; and

���� (7)�� It contains no provision
purporting to make any portion of the charter, rules, constitution, or bylaws
of the insurer a part of the policy unless such portion is set forth in full in
the policy, except in the case of the incorporation of, or reference to, a
statement of rates or classification of risks, or short-rate table filed with
the commissioner.

���� b.��� A policy under which
coverage of a dependent of the policyholder terminates at a specified age
shall, with respect to an unmarried child covered by the policy prior to the
attainment of age 19, who is incapable of self-sustaining employment by reason
of intellectual disability or physical handicap and who became so incapable
prior to attainment of age 19 and who is chiefly dependent upon such
policyholder for support and maintenance, not so terminate while the policy
remains in force and the dependent remains in such condition, if the
policyholder has within 31 days of such dependent's attainment of the limiting
age submitted proof of such dependent's incapacity as described herein. The
foregoing provisions of this paragraph shall not require an insurer to insure a
dependent who is a child with an intellectual disability or physical handicap
where the policy is underwritten on evidence of insurability based on health
factors set forth in the application or where such dependent does not satisfy
the conditions of the policy as to any requirement for evidence of insurability
or other provisions of the policy, satisfaction of which is required for
coverage thereunder to take effect.� In any such case the terms of the policy
shall apply with regard to the coverage or exclusion from coverage of such
dependent.

���� c.���� Notwithstanding any
provision of a policy of health insurance, hereafter delivered or issued for
delivery in this State, whenever such policy provides for reimbursement for any
optometric service which is within the lawful scope of practice of a duly licensed
optometrist, the insured under such policy shall be entitled to reimbursement
for such service, whether the said service is performed by a physician or duly
licensed optometrist.

���� d.��� If any policy is issued
by an insurer domiciled in this State for delivery to a person residing in
another state, and if the official having responsibility for the administration
of the insurance laws of such other state shall have advised the commissioner
that any such policy is not subject to approval or disapproval by such
official, the commissioner may by ruling require that such policy meet the
standards set forth in subsection a. of this section and in sections 17B:26-3
to 17B:26-31 inclusive.

���� e.���� Notwithstanding any
provision of a policy of health insurance, hereafter delivered or issued for
delivery in this State, whenever such policy provides for reimbursement for any
psychological service which is within the lawful scope of practice of a duly licensed
psychologist, the insured under such policy shall be entitled to reimbursement
for such service, whether the said service is performed by a physician or duly
licensed psychologist.

���� f.���� Notwithstanding any
provision of a policy of health insurance, hereafter delivered or issued for
delivery in this State, whenever such policy provides for reimbursement for any
service which is within the lawful scope of practice of a duly licensed chiropractor,
the insured under such policy or the chiropractor rendering such service shall
be entitled to reimbursement for such service, when the said service is
performed by a chiropractor.� The foregoing provision shall be liberally
construed in favor of reimbursement of chiropractors.

���� g.��� All individual health
insurance policies which provide coverage for a family member or dependent of
the insured on an expense incurred basis shall also provide that the health
insurance benefits applicable for children shall be payable with respect to a newly
born child of that insured from the moment of birth.

���� (1)�� The coverage for newly
born children shall consist of coverage of injury or sickness including the
necessary care and treatment of medically diagnosed congenital defects and
birth abnormalities.

���� (2)�� If payment of a specific
premium is required to provide coverage for a child, the policy may require
that notification of birth of a newly born child and payment of the required
premium must be furnished to the insurer within
[
60
]

90
days after the date of
birth in order to have the coverage continue beyond such
[
60
]

90
-day
period.

���� h.��� All individual health
insurance policies which provide coverage on an expense incurred basis but do
not provide coverage for a family member or dependent of the insured on an
expense incurred basis shall nevertheless provide for coverage of newborn children
of the insured which shall commence with the moment of birth of each child and
shall consist of coverage of injury or sickness including the necessary care
and treatment of medically diagnosed congenital defects and birth
abnormalities, provided application therefor and payment of the required
premium are made to the insurer to include in said policy coverage the same or
similar to that of the insured, described in g. (1) above
[
60
]

90

days from the date of a newborn child.

���� i.���� Whenever, pursuant to
the provisions of an individual or group contract issued by an insurer, the
former spouse of a named insured is no longer entitled to coverage as an
individual dependent by reason of divorce, separate coverage for such former
spouse shall be made available by the insurer on an individual non-group basis
under the following conditions:

���� (1)�� Application for such
non-group coverage shall be made to the insurer by or on behalf of such former
spouse no later than 31 days following the date his or her coverage under the
prior certificate or contract terminated.

���� (2)�� No new evidence of
insurability shall be required in connection with the application for such
non-group coverage but any health exception, limitation or exclusion applicable
to said former spouse under the prior coverage may, at the option of the
insurer, be carried over to the new non-group coverage.

���� (3)�� The effective date of
the new coverage shall be the day following the date on which such former
spouse's coverage under the prior certificate or contract terminated.

���� (4)�� The benefits provided
under the non-group coverage issued to such former spouse shall be at least
equal to the basic benefits provided in contracts then being issued by the
insurer to acceptable new non-group applicants of the same age and family
status.

(cf: P.L.2017, c.361, s.7)

���� 8.��� N.J.S.17B:27-30 is
amended to read as follows:

���� 17B:27-30. Benefits of group
health insurance, except benefits for loss of time on account of disability,
may be provided for one or more members of the families or one or more
dependents of persons who may be insured under a group policy referred to in section
17B:27-27, 17B:27-28 or 17B:27-29. Any group health insurance policy which
contains provisions for the payment by the insurer of benefits for expenses
incurred on account of hospital, nursing, medical, or surgical services for
members of the family or dependents of a person in the insured group must,
subject to payment of the appropriate premium, permit such family members or
dependents to have coverage continued for at least 180 days after the death of
the person in the insured group, subject to the policy provision as to
termination of coverage with respect to family members or dependents for
reasons other than the death of the person in the insured group.

���� All group health insurance
policies which provide coverage for a family member or dependent of an insured
on an expense incurred basis shall also provide that the benefits applicable
for children shall be payable with respect to a newly-born child of that
insured from the moment of birth. The coverage for newly-born children shall
consist of coverage of injury or sickness including the necessary care and
treatment of medically diagnosed congenital defects and birth abnormalities.�
If payment of a specific premium is required to provide coverage for a child,
the policy may require that notification of birth of a newly-born child and
payment of the required premium must be furnished to the insurer within
[
60
]

90
days
after the date of birth in order to have the coverage continue beyond such
[
60
]

90
-day
period.

���� All group health insurance
policies which provide coverage on an expense incurred basis for the insured
but do not provide coverage for a family member or dependent of the insured on
an expense incurred basis, except such group policies as provide no dependent
coverage whatsoever for the insured's class, shall nevertheless provide for
coverage of newborn children of the insured which shall commence with the
moment of birth of each child and shall consist of coverage of injury or
sickness including the necessary care and treatment of medically diagnosed
congenital defects and birth abnormalities, provided application and payment of
the required premium are made to the insurer to include in said policy coverage
for a newly-born child as described in the previous paragraph of this section
within
[
60
]

90

days from the date of birth of a newborn child.

���� A policy under which coverage
of a dependent of an employee or other member of the insured group terminates
at a specified age shall, with respect to an unmarried child covered by the
policy prior to the attainment of age 19, who is incapable of self-sustaining
employment by reason of intellectual disability or physical handicap and who
became so incapable prior to attainment of age 19 and who is chiefly dependent
upon such employee or member for support and maintenance, not so terminate
while the insurance of the employee or member remains in force and the
dependent remains in such condition, if the insured employee or member has
within 31 days of such dependent's attainment of the termination age submitted
proof of such dependent's incapacity as described herein. The foregoing
provision of this paragraph shall not require an insurer to insure a dependent
who is a child with an intellectual disability or physical handicap of an
employee or other member of the insured group where such dependent does not satisfy
the conditions of the group policy as to any requirements for evidence of
insurability or other provisions as may be stated in the group policy required
for coverage thereunder to take effect.� In any such case the terms of the
policy shall apply with regard to the coverage or exclusion from coverage of
such dependent.

(cf: P.L.2017, c.361, s.8)

���� 9.��� This act shall take
effect 60 days following enactment and shall apply to contracts, policies, and
plans delivered, issued, executed, or renewed after that date.

STATEMENT

���� This bill extends the time
period in which newly born children are covered under their parents� health
benefits coverage to 90 days after birth.� Current law limits the coverage of
newly born children to 60 days from their birth.� At the conclusion of the 60
days, the child will be without coverage, unless the parents enroll the child
in a private health benefits coverage policy or in a State or federal program,
such as NJ FamilyCare.