Requires automobile insurers to provide notice that Medicare and Medicaid may not be used as primary coverage for PIP benefits.

S4380

SENATE, No. 4380

STATE OF NEW JERSEY

222nd LEGISLATURE

�

INTRODUCED JUNE 1, 2026

Sponsored by:

Senator� ROBERT W. SINGER

District 30 (Monmouth and Ocean)

Senator� JOSEPH A. LAGANA

District 38 (Bergen)

SYNOPSIS

���� Requires automobile insurers to provide notice that
Medicare and Medicaid may not be used as primary coverage for PIP benefits.

CURRENT VERSION OF TEXT

���� As introduced.

��

An Act
concerning automobile insurance and amending P.L.1983,
c.362.

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

���� 1.��� Section 13 of P.L.1983, c.362
(C.39:6A-4.3) is amended to read as follows:

���� 13.� Personal injury
protection coverage options. With respect to personal injury protection
coverage provided on an automobile in accordance with section 4 of P.L.1972,
c.70 (C.39:6A-4), the automobile insurer shall provide the following coverage
options:

���� a.���� Medical expense benefit
deductibles in amounts of $500.00, $1,000.00, $2,000.00 and $2,500.00 for any
one accident;

���� b.��� The option to exclude
all benefits offered under subsections b., c., d., and e. of section 4
of
P.L.1972, c.70 (C. 39:6A-4)
;

���� c.���� (Deleted by amendment,
P.L.1988, c.119.)

���� d.���
(1)
� For policies
issued or renewed on or after January 1, 1991, the option that other health
insurance coverage or benefits of the insured, including health care services
provided by a health maintenance organization and any coverage or benefits
provided under any federal or State program, are the primary coverage in regard
to medical expense benefits pursuant to section 4 of P.L.1972, c.70
(C.39:6A-4).� If health insurance coverage or benefits are primary, an
automobile insurer providing medical expense benefits under personal injury
protection coverage shall be liable for reasonable medical expenses not covered
by the health insurance coverage or benefits up to the limit of the medical
expense benefits coverage.� The principles of coordination of benefits shall
apply to personal injury protection medical expense benefits coverage pursuant
to this subsection
.

����
(2)�� An automobile insurer
shall provide a notice in plain language that coverage provided through
Medicare or Medicaid may not be used as primary coverage pursuant to this subsection:

����
(a)�� at the time the
option for health insurance coverage as primary coverage is offered;

����
(b)�� between 15 and 60
days before a covered person turns 65 years of age; and

����
(c)�� if a policyholder is
of 65 years of age or older, annually upon renewal of the policy
;

���� e.���� Medical expense
benefits in amounts of $150,000, $75,000, $50,000 or $15,000 per person per
accident; except that, medical expense benefits shall be paid in an amount not
to exceed $250,000 for all medically necessary treatment of permanent or
significant brain injury, spinal cord injury or disfigurement or for medically
necessary treatment of other permanent or significant injuries rendered at a
trauma center or acute care hospital immediately following the accident and
until the patient is stable, no longer requires critical care and can be safely
discharged or transferred to another facility in the judgment of the attending
physician.� The coverage election form shall contain a statement, clearly
readable and in 12-point bold type, in a form approved by the commissioner,
that election of any of the aforesaid medical expense benefits options results
in less coverage than the $250,000 medical expense benefits coverage mandated
prior to the effective date of P.L.1998, c.21.

���� If none of the aforesaid
medical expense benefits options is affirmatively chosen in writing, the policy
shall provide $250,000 medical expense benefits coverage;

���� f.���� The insurer shall
provide an appropriate reduction from the territorial base rate for personal
injury protection coverage for those electing any of the options in subsections
a., b., d. and e. of this section.

���� Any named insured who chooses
the option provided by subsection d. of this section shall provide proof that
he and members of his family residing in his household are covered by health
insurance coverage or benefits in a manner and to an extent approved by the
commissioner. Nothing in this section shall be construed to require a health
insurer, health maintenance organization or governmental agency to cover
individuals or treatment which is not normally covered under the applicable
benefit contract or plan.� If it is determined that an insured who selected or
is otherwise covered by the option provided in subsection d. of this section
did not have such health coverage in effect at the time of an accident, medical
expense benefits shall be payable by the person's automobile insurer and shall
be subject to any deductible required by law or otherwise selected as an option
pursuant to subsection a. of this section, any copayment required by law and an
additional deductible in the amount of $750.

���� An option elected by the named
insured in accordance with this section shall apply only to the named insured
and any resident relative in the named insured's household who is not a named
insured under another automobile insurance policy, and not to any other person
eligible for personal injury protection benefits required to be provided in
accordance with section 4 of P.L.1972, c.70 (C.39:6A-4).

���� Medical expense benefits
payable in any amount between the deductible selected pursuant to subsection a.
of this section and $5,000.00 shall be subject to the copayment provided in the
policy, if any.

���� No insurer or health provider
providing benefits to an insured who has elected a deductible pursuant to
subsection a. of this section shall have a right of subrogation for the amount
of benefits paid pursuant to a deductible elected thereunder or any applicable
copayment.

���� The Commissioner of Banking
and Insurance shall adopt rules and regulations to effectuate the purposes of
this section and may promulgate standards applicable to the coordination of
personal injury protection medical expense benefits coverage.

(cf: P.L.1998, c.22, s.3)

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

STATEMENT

���� This bill requires automobile
insurers to provide a notice in plain language that Medicare and Medicaid may
not be used as primary coverage for personal injury protection medical expense
benefits.

���� Current law requires
automobile insurers in New Jersey to give insureds the option that other health
insurance coverage or benefits may be used as the primary coverage for medical
expense benefits.� An insured who uses other coverage as the primary coverage for
medical expense benefits receives a discount in personal injury protection
premiums.

���� Insureds may not select any
coverage or benefits provided pursuant to Medicare or Medicaid as primary
coverage for personal injury protection medical expense benefits.� This bill
requires the automobile insurer to provide a notice in plain language that
coverage provided through Medicare or Medicaid may not be used as primary
coverage:

���� (1)�� at the time the option
for health insurance coverage as primary coverage is offered;

���� (2)�� between 15 and 60 days
before a covered person turns 65 years of age; and

���� (3)�� annually upon renewal of
the policy, if a policyholder is of 65 years of age or older.