What Do You Mean It's Not Covered: How One State Regulates Health Coverage
In late 1993, New Jersey insurance law began requiring insurance companies to offer basic, inexpensive insurance plans. Every plan had to offer a guaranteed benefits package.
This package included very low copayments:
preventive and primary care (including prenatal and well-baby care, immunizations, pelvic exams, mammograms and cholesterol screening): $10 copayment;
outpatient diagnostic services: $25 copayment; $RB emergency services: $25 copayment where applicable;
inpatient hospital care: 60 days a year with one-day deductible plus 20 percent copayment;
prescriptive/corrective lenses for children: $10 copayment;
preventive and acute dental care for children: $10 copayment;
maternity care: including pregnancy-related services and family planning services, such as birth control;
hospice and home health care: Pays for 60 days, then reassessed after 60 days;
physical, occupational and speech therapy: reassessed after 60 days;
prescription drugs: $250 a year deductible, 20 percent copayment;
mental health and substance abuse: 30 days a year maximum inpatient with 50 percent copayment. There will be an as yet undisclosed number of visits allowed per year with 50 percentcopayment.
The growing number of insurance consumer-rights laws passed in recent years gives many policyholders high hopes about citing this kind of passage in a dispute with their company. But courts and arbitrators will scrutinize these changes very carefully -- and award new or unmentioned benefits conservatively.
