"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
The enactment of this bill significantly alters the landscape of health insurance coverage for pediatric patients facing dire health challenges. It ensures that when a child suffering from a catastrophic illness is referred by an in-network provider to receive care from an out-of-network provider, the coverage for those services is equivalent to that of in-network benefits. This provision helps mitigate the financial burden on families needing specialized care that may not be available from in-network options.
Summary
Assembly Bill A2822, known as 'Breann's Law', mandates that health insurers in New Jersey, including the State Health Benefits Program and NJ FamilyCare, are required to provide coverage for out-of-network medical services for children diagnosed with catastrophic illnesses. This bill is named after Breann LaManna, a young girl who faced denial for out-of-network coverage during her treatment for a life-threatening condition. The law defines a 'catastrophic illness' as an acute or prolonged condition considered life-threatening or likely to pose serious residual disability.
Contention
While the bill has been touted as a necessary reform by many advocates and families affected by similar circumstances, it does raise concerns regarding the potential financial implications for insurers and the healthcare system at large. Opponents may argue that this could lead to increased premiums or strained resources as insurers adjust to these expanded coverage mandates. There could be debates around the cost-effectiveness of such regulations and its long-term sustainability within the health insurance market.
Carry Over
"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.