New Jersey Assembly Bill A1763

New Jersey 2024-2025 Regular Session

• Introduced: 1/9/24
• Refer: 1/9/24

Caption

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

Impact

If enacted, Breann's Law will adjust health insurance practices by requiring that out-of-network healthcare providers be covered for catastrophic illnesses. This legislative move is designed to prevent disruptions in care caused by insurers’ refusal to reimburse for care from specialists who are not within their network. It will require health plans to enhance coverage definitions to include necessary out-of-network services when prescribed by a healthcare provider, thereby expanding the range of treatment options available to children dealing with severe health issues.

Summary

Assembly Bill A1763, known as 'Breann's Law', mandates that health insurers, along with the State Health Benefits Program and NJ FamilyCare, must provide out-of-network coverage for children diagnosed with catastrophic illnesses after receiving a referral from an in-network provider. This bill stems from a personal story involving a young girl who suffered from a life-threatening condition but was denied necessary out-of-network services. The aim of the legislation is to ensure that children facing severe health challenges have the same access to healthcare options as those treated within their insurance networks.

Contention

There may be opposition to the bill from health insurers who could argue that expanding coverage for out-of-network services may lead to higher operational costs and potential fee increases for the insured. Critics may contend that this could also drive up premiums, affecting the affordability of coverage for all insured individuals. On the other hand, supporters of the bill highlight the critical need for specialized medical services that might not be available within the in-network offerings, calling it a necessary focusing on children’s health and well-being.