Moving to safeguard the privacy of patients with sensitive health concerns, legislation sponsored by Assembly Majority Leader Lou Greenwald (D-Camden, Burlington) and Assemblywomen Carol Murphy (D-Burlington) and Valerie Vainieri Huttle (D-Bergen) to require health insurance carriers and the State Health Benefits and School Employees’ Health Benefits programs to withhold sensitive health information on an explanation of benefits (EOB) form was approved Monday by the Assembly Financial Institutions and Insurance Committee.
“People should not have to choose between their privacy and their health coverage,” said Greenwald. “A dependent mother fleeing abuse, a sexually abused pregnant woman, or someone needing much needed mental health treatment are all situations where current law leaves their sensitive health care information vulnerable. This bill encourages people to seek care without fear of their private information being shared.”
The bill (A-4455) would provide that the Commissioner of Banking and Insurance shall prescribe by regulation a standardized explanation of benefits form designed to be clearly understandable to covered persons in a manner consistent with the “Life and Health Insurance Policy Language Simplification Act.” Except for certain protections related to sensitive services, the standardized explanation of benefits form should include, but not be limited to, a summary of benefits for current services, including: the cost of the health care service; the amount paid by the carrier; the amount to be paid by the covered person; and an explanation of the reason for benefit denial, if any.
“Thanks to a provision in the Affordable Care Act, young adults are able to remain covered as dependents under their parents’ health care plan until age 26,” said Murphy. “While expanded access to health coverage may help youth dependents save on health care costs as they enter adulthood, it also allows the policyholder of their plan – likely their parents – to access sensitive health information. It’s even more challenging for dependents who have been victimized by a policyholder, and fear for their safety if it’s revealed they sought medical treatment. Under this bill, they will not have to worry about sensitive information being revealed without their consent.”
Additionally, the bill would require a carrier issuing health benefits plans in New Jersey to provide a written explanation of benefits to each covered person separately, but not to any other covered person, whenever a claim under the health benefits plan is generated by that person.
Under the measure, an explanation of benefits would not contain information about sensitive services unless requested by the covered person who is legally allowed to consent to that care.
“It’s easy to understand why someone may want to keep some health issues private, including pregnancy, family planning, sexually transmitted diseases, domestic violence, sexual assault or substance or alcohol abuse,” said Vainieri Huttle. “No one should be afraid to get medical attention because of privacy concerns. This bill will allow everyone enrolled in a health plan to seek medical treatment without fear of private matters being disclosed.”