17B:27-46.1u - Coverage for certain dental procedures for the severely disabled or child age five or under by group health insurance policy
17B:27-46.1u. Coverage for certain dental procedures for the severely disabled or child age five or under by group health insurance policy
5. a. No group health insurance policy providing hospital or medical benefits shall be delivered, issued, executed or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this amendatory and supplementary act, unless the policy provides benefits to any person covered thereunder who is severely disabled or a child age five or under for expenses incurred for: (1) general anesthesia and hospitalization for dental services; or (2) a medical condition covered by the contract which requires hospitalization or general anesthesia for dental services rendered by a dentist regardless of where the dental services are provided.
b.A group health insurance policy may require prior authorization of hospitalization for dental services in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions.
c.This section shall apply to all group health insurance policies in which the insurer has reserved the right to change the premium.
L.1999,c.49,s.5.
17B:27-46.1v Group health insurers to provide coverage for biologically-based mental illness.
5. a. Every group health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act shall provide benefits for biologically-based mental illness under the same terms and conditions as provided for any other sickness under the policy. "Biologically-based mental illness" means a mental or nervous condition that is caused by a biological disorder of the brain and results in a clinically significant or psychological syndrome or pattern that substantially limits the functioning of the person with the illness, including but not limited to, schizophrenia, schizoaffective disorder, major depressive disorder, bipolar disorder, paranoia and other psychotic disorders, obsessive-compulsive disorder, panic disorder and pervasive developmental disorder or autism. "Same terms and conditions" means that the insurer cannot apply different copayments, deductibles or benefit limits to biologically-based mental health benefits than those applied to other medical or surgical benefits.
b.Nothing in this section shall be construed to change the manner in which the insurer determines:
(1)whether a mental health care service meets the medical necessity standard as established by the insurer; or
(2)which providers shall be entitled to reimbursement for providing services for mental illness under the policy.
c.The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
L.1999,c.106,s.5.