State Codes and Statutes
Statutes > New-jersey > Title-52 > Section-52-14 > 52-14-17-46-652:14-17.46.6 Benefits required for coverage under contract; terms defined.
36. a. Notwithstanding the provisions of any other law to the contrary, the commission shall not enter into a contract under the School Employees' Health Benefits Program Act, sections 31 through 41 of P.L.2007, c.103 (C.52:14-17.46.1 through C.52:14-17.46.11), for the benefits provided pursuant to the act, unless the level of benefits provided under the contract entered into is equal to or exceeds the level of benefits provided in this section, or as modified pursuant to section 40 of that act (C.52:14-17.46.10). Only benefits for medically necessary services that are not deemed experimental, investigative or otherwise not eligible medical services shall be provided. The determination that services are not "eligible medical services" shall be made by the commission consistent with the best interests of the State, participating employers and those persons covered hereunder. Benefits for services provided pursuant to the School Employees' Health Benefits Act shall be subject to limits or exclusions consistent with those that apply to benefits provided pursuant to the New Jersey State Health Benefits Program Act. The services provided pursuant to this section shall include all services, subject to applicable limits and exclusions, provided through the State Health Benefits Program as of July 1, 2007. The list of services in subsection b. of this section is not intended to be exclusive or to require that any limits or exclusions be exceeded.
b.The services covered hereunder by the School Employees' Health Benefits Program shall include:
(1)Physician services, including:
(a)Inpatient services, including:
(i)medical care including consultations;
(ii)surgical services and services related thereto; and
(iii)obstetrical services including normal delivery, cesarean section, and abortion.
(b)Outpatient/out-of-hospital services, including:
(i)office visits for covered services and care;
(ii)allergy testing and related diagnostic/therapy services;
(iii) dialysis center care;
(iv)