New Jersey Senate Bill S1692

New Jersey 2022-2023 Regular Session

• Introduced: 2/28/22
• Refer: 2/28/22

Caption

"Breann's Law" requires health insurers, SHBP and NJ FamilyCare to provide "out of network" coverage for children with catastrophic illnesses.

Impact

The legislation aims to eliminate gaps in healthcare access for children with critical health needs, ensuring that families can receive necessary care without being limited solely to in-network providers. This could significantly affect state laws regarding health insurance coverage, particularly relating to how out-of-network services are reimbursed and what constitutes essential medical care for children facing severe health challenges. The bill is expected to bring a more comprehensive approach to health coverage within the state's healthcare system, granting parents the flexibility to seek the best possible care for their children without fear of high out-of-pocket costs associated with out-of-network providers.

Summary

S1692, also known as 'Breann's Law', is designed to enhance healthcare coverage for children diagnosed with catastrophic illnesses in New Jersey. This bill mandates that health insurers, including the State Health Benefits Plan and NJ FamilyCare, provide benefits for services delivered by out-of-network providers, under specific circumstances. It requires insurers to cover out-of-network services for children with catastrophic illnesses, provided these services have been referred by an in-network provider. The definition of 'catastrophic illness' includes acute or prolonged illnesses that are life-threatening or carry the potential for serious residual disability.

Contention

While the intent of S1692 is broadly supported for its focus on children's health, some concerns may arise regarding the potential for increased insurance premiums or a shift in provider networks as insurers adapt to these requirements. Opponents may argue that the mandate could lead to higher costs for the insurance systems and could incentivize providers to opt-out of in-network agreements. Additionally, questions about the adequacy of care and variation in treatment standards among out-of-network providers may provoke debate amongst policymakers and stakeholders in the healthcare sector. The bill represents a significant step towards improving healthcare for vulnerable populations but could face scrutiny as it navigates the complexities of the existing healthcare ecosystem.