New Jersey

There are many sections of the state insurance law related to parity. They are summarized in three parts. Here, we have listed the relevant sections. The summaries are below the listed sections.

17:48-6v; 17:48A-7u; 17:48E-35.20; 17B:26-2.1s; 17B:27-46.1v; 17B:27A-7.5; 17B:27A-19.7; 26:2J-4.20; 52:14-17.29d and 52:14-17.29e) (all of these are identical except for language about to which plan they apply)

17:48-6a; 17:48A-7a; 17:48E-34; 17B:26-2.1; 17B:27-46.1 (all of these are identical except for language about to which plan they apply)

17:48-6ii; 17:48A-7ff; 17B:26-2.1cc; 17B:27-46.1ii; 17B:27A-7.16; 17B:27A-19.20; 26-2J-4.34; §52:14-17.29p; 52:14-17.46.6b (all of these are identical except for language about to which plan they apply)

Instructions for how to find the relevant sections of the insurance law are listed above

These sections of the insurance law require individual plans, small employer fully-insured plans, large employer fully-insured plans and state employee plans to cover services for the following mental health conditions:

• Schizophrenia
• Schizoaffective disorder
• Major depressive disorder
• Bipolar disorder
• Paranoia and other psychotic disorders
• Obsessive-compulsive disorder
• Panic disorder
• Pervasive developmental disorder or autism

Plans cannot use different copayments, deductibles, and “benefit limits” for these conditions than what are in place for other medical conditions (“benefit limits” could mean treatment limitations or financial requirements, but it is not explicitly defined in these sections).

These sections specifically state that they have no impact on how plans make medical necessity determinations for mental health services and which providers plans decide to reimburse for mental health services.

Instructions for how to find the relevant sections of the insurance law are listed above

These sections require individual plans, small employer fully-insured plans, and large employer fully-insured plans to provide coverage for alcohol use disorder services “to the same extent” as coverage for other medical services. The following services are specifically listed:

• Inpatient care
• Outpatient care
• Detoxification
• Residential treatment

Instructions for how to find the relevant sections of the insurance law are listed above

These sections require individual plans, small employer fully-insured plans, large employer fully-insured plans , state employee plans, and public school employee plans to cover autism services.

Plans must cover medically necessary occupational therapy, physical therapy, and speech therapy. For children and young adults through age 20, plans must cover applied behavior analysis.

Coverage for autism services must be “to the same extent” as coverage for other medical services, but there cannot be any visit limits for outpatient care.

Plans must cover an annual maximum of $36,000 that can be adjusted for inflation each year.

Plans can review a child’s treatment plan once every 6 months.