New Jersey § 52:14-17

§ 52:14-17.

a. The State Health Benefits Commission shall ensure that every contract purchased

by the commission on or after the effective date of this act 1 that provides hospital or medical expense benefits shall provide coverage, without

requiring any cost sharing, for the following preventive services: (1) evidence-based items or services that have in effect a rating of “A” or “B” in

the current recommendations of the United States Preventive Services Task Force; (2) immunizations that have in effect a recommendation from the Advisory Committee

on Immunization Practices of the Centers for Disease Control and Prevention; (3) with respect to infants, children, and adolescents, evidence-informed preventive

care and screenings provided for in the comprehensive guidelines supported by the

Health Resources and Services Administration; and (4) with respect to women, any additional preventive care and screenings not described

in paragraph (1) as provided for in the comprehensive guidelines supported by the

Health Resources and Services Administration. b. (1) Except as provided in paragraph (2) of this subsection, nothing in this section

shall: (a) require a contract which has a network of providers to provide benefits for items

or services described in subsection a. of this section that are delivered by an out-of-network

provider; or (b) preclude a contract which has a network of providers from imposing cost-sharing

requirements for items or services described in subsection a. of this section that

are delivered by an out-of-network provider. (2) If a contract does not have in its network a provider who can provide an item

or service described in subsection a. of this section, the contract shall cover the

item or service when performed by an out-of-network provider, and shall not impose

cost sharing with respect to that item or service. c. (1) A contract shall provide coverage for an item or service described in subsection

a. of this section for plan years that begin on or after the date that is one year

after the date the recommendation or guideline is issued. (2)(a) Except as provided in subparagraph (b) of this paragraph, a contract that is

required to provide coverage for an item or service described in subsection a. of

this section on the first day of a plan year shall provide coverage for that item

or service through the last day of the plan year. (b) The commissioner may remove a coverage requirement for an item or service during

a plan year if the recommendation or guideline changes or is no longer described in

subsection a. of this section. 1

L.2019, c. 360, eff. April 15, 2020.