State Codes and Statutes

Statutes > New-jersey > Title-17b > Section-17b-27 > 17b-27-50

17B:27-50.  Reimbursement for service of physician or practicing psychologist
    a.  Notwithstanding any provision of a policy or contract of group health insurance, hereafter delivered or issued for delivery in this State, whenever such a policy or contract provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed practicing psychologist,  a person covered under such group health policy or contract shall be entitled  to reimbursement for such service whether the said service is performed by a  physician or duly licensed practicing psychologist.

    b.  The foregoing provision shall be liberally construed in favor of reimbursement and no claim for reimbursement shall be denied by reason of:

    (1) The fact that physical delivery of a policy or contract of group health  insurance or any package of insurance of which group health insurance is a  part, or of a contract, certificate or other evidence of insurance coverage  drawn thereunder, was made outside this State, provided, the member of the  group covered is, at the time of delivery or at any time thereafter to the time  of reimbursement, either (a) a resident of this State, or (b) a nonresident  employed in this State and the said policy or contract is related to or arose  out of such employment;  or

    (2) The inclusion in such policy or contract of a description or designation  of the person rendering the services for which reimbursement is sought as a   "physician"  or  "psychiatrist,"  or other professional designation;  or

    (3) The fact that the psychiatric or psychologist services rendered by a licensed psychologist for which reimbursement is sought are such as might also be lawfully rendered by a physician or psychiatrist as medical care, services or treatment under the laws of this State.

    c.  Any person insured under any policy or contract of group health insurance or blanket insurance, whether written separately or as part of a package policy, which policy or contract is issued, delivered, amended, renewed, or ratified on or after 3 months from the effective date of this act, and, in any event, any person insured under any policy or contract of group health insurance or blanket insurance, written separately or as part of a package policy, which is in effect on or after July 1, 1974, shall be entitled to reimbursement for any service rendered by a practicing psychologist, provided, reimbursement is authorized in such policy or contract for services of the same or similar nature and scope, and further provided, the services for  which reimbursement is claimed are within the lawful scope of practice of a  practicing psychologist, whether the service is performed by a physician or a  psychiatrist or duly licensed practicing psychologist at any time while the policy is in effect;  and further provided (1) such person is a resident of this State, or, (2) the policy or contract is related to or arises out of employment and the member of the group seeking reimbursement is engaged in such  employment in this State, or (3) the policy or contract, or certificate of  insurance thereunder, or amendment, renewal, or notification thereof, is either  issued or delivered in this State.

     L.1971, c. 144, s. 17B:27-50.  Amended by 1973, c. 340, s. 1, eff. Dec. 27, 1973.