New Jersey § 26:2ss-7

§ 26:2ss-7.

a. If a covered person receives medically necessary services at any health care facility

on an emergency or urgent basis as defined by the Emergency Medical Treatment and

Active Labor Act, 42 U.S.C. s.1395dd et seq. and section 14 of P.L.1992, c. 160 ( C.26:2H-18.64 ), the facility shall not bill the covered person in excess of any deductible, copayment,

or coinsurance amount applicable to in-network services pursuant to the covered person's

health benefits plan. b. If a covered person receives medically necessary services at an out-of-network

health care facility on an emergency or urgent basis as defined by the Emergency Medical

Treatment and Active Labor Act, 42 U.S.C. s.1395dd et seq. and section 14 of P.L.1992, c. 160 ( C.26:2H-18.64 ), and the carrier and facility cannot agree on the final offer as a reimbursement

rate for these services pursuant to section 9 of this act 1 , the carrier, health care facility, or covered person, as applicable, may initiate

binding arbitration pursuant to section 10 2 or 11 3 of this act. c. If a health care facility is in-network with respect to any health benefits plan,

the facility shall ensure that all providers providing services in the facility on

an emergency or inadvertent basis are provided notification of the provisions of this

act and information as to each health benefits plan with which the facility has a

contract to be in-network. d. A health care facility that contracts with a carrier to be in-network with respect

to any health benefits plan shall annually report to the Department of Health the

health benefits plans with which the facility has an agreement to be in-network. e. Subsections a. and b. of this section shall only apply to providers providing services

to members of entities providing or administering a self-funded health benefits plan

and its plan members if the entity elects to be subject to section 9 of this act pursuant

to subsection d. of that section. f. The Department of Health shall make the information collected pursuant to subsection

d. of this section available to the Department of Banking and Insurance. 1

N.J.S.A. § 26:2SS-9. 2

N.J.S.A. § 26:2SS-10. 3

N.J.S.A. § 26:2SS-11.