New Jersey § 26:2j-4

§ 26:2j-4.

A certificate of authority to establish and operate a health maintenance organization

in this State shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of P.L.2005, c. 248 ( C.17:48E-35.27 et al.) 1 unless the health maintenance organization offers health care services to any enrollee

which include: a. Screening by blood lead measurement for lead poisoning for children, including

confirmatory blood lead testing as specified by the Department of Health pursuant to section 7 of P.L.1995, c. 316 ( C.26:2-137.1 ); and medical evaluation and any necessary medical follow-up and treatment for lead

poisoned children. b. All childhood immunizations as recommended by the Advisory Committee on Immunization

Practices of the United States Public Health Service and the Department of Health pursuant to section 7 of P.L.1995, c. 316 ( C.26:2-137.1 ). A health maintenance organization shall notify its enrollees, in writing, of any

change in the health care services provided with respect to childhood immunizations

and any related changes in premium. The notification shall be in a form and manner to be determined by the Commissioner of

Banking and Insurance. c. Screening for newborn hearing loss by appropriate electrophysiologic screening

measures and periodic monitoring of infants for delayed onset hearing loss, pursuant

to P.L.2001, c. 373 ( C.26:2-103.1 et al.). Payment for this screening service shall be separate and distinct from payment for

routine new baby care in the form of a newborn hearing screening fee as negotiated

with the provider and facility. The health care services provided pursuant to this section shall be provided to the

same extent as for any other medical condition under the contract, except that a deductible

shall not be applied for services provided pursuant to this section; however, with

respect to a contract that qualifies as a high deductible health plan for which qualified

medical expenses are paid using a health savings account established pursuant to section 223 of the federal Internal Revenue Code of 1986 ( 26 U.S.C. s.223 ), a deductible shall not be applied for any services provided pursuant to this section

that represent preventive care as permitted by that federal law, and shall not be

applied as provided pursuant to section 12 of P.L.2005, c. 248 ( C.26:2J-4.29 ). This section shall apply to all contracts under which the health maintenance organization

has reserved the right to change the schedule of charges for enrollee coverage. 1

L.2005, c. 248, eff. Dec. 31, 2005.