17:48E-35.30 Health service corporation to provide benefits for orthotic and prosthetic appliances.
3. a. Every health service corporation contract that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, C. 236 (C. 17:48E-1 et al.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred in obtaining an orthotic or prosthetic appliance from any licensed orthotist or prosthetist, or any certified pedorthist, as determined medically necessary by the covered person’s physician.
As used in this section, “orthotic appliance,” “prosthetic appliance,” “licensed orthotist” and “licensed prosthetist” have the meaning assigned to them in section 3 of P.L.1991, C. 512 (45:12B-3 Definitions relative to orthotics and prostheticS.) and “certified pedorthist” has the meaning assigned to it in subsection j. of section 18 of P.L.1991, C. 512 (45:12B-18 Inapplicability of act.).
b. On and after the effective date of this act, a health service corporation contract shall reimburse for orthotic and prosthetic appliances at the same rate as reimbursement for such appliances under the federal Medicare reimbursement schedule.
C. The benefits shall be provided to the same extent as for any other medical condition under the contract.
d. The provisions of this section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.
L.2007, C. 345, S.3.
Original Text maintained by the State of New Jersey:
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