New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 49 - MANDATED DIABETES BENEFITS
Section 11:4-49.3 - Benefits
Universal Citation: NJ Admin Code 11:4-49.3
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The diabetes benefits set forth in this subsection shall be included in all health benefits plans.
1. All equipment and supplies for the
treatment of diabetes if recommended or prescribed by a physician or nurse
practitioner/clinical nurse specialist as follows:
i. Blood glucose monitors and blood glucose
monitors for the legally blind;
ii.
Test strips for glucose monitors and visual reading and urine testing
strips;
iii. Insulin;
iv. Injection aids;
v. Cartridges for the legally
blind;
vi. Syringes;
vii. Insulin pumps and appurtenances
thereto;
viii. Insulin infusion
devices; and
ix. Oral agents for
controlling blood sugar; and
2. All expenses incurred for diabetes
self-management education, including information on proper diet. "Diabetes
self-management education" as used in this paragraph means education to ensure
that a person with diabetes is educated as to the proper self-management and
treatment of their diabetic condition, including information on proper diet.
i. All self-management and diet education
shall be provided by a dietitian registered by a nationally recognized
professional association of dietitians, a health care professional recognized
as a Certified Diabetes Educator by the American Association of Diabetes
Educators, or a registered pharmacist in the State qualified with regard to
management education for diabetes by any institution recognized by the Board of
Pharmacy of the State of New Jersey.
ii. Benefits for self-management education
related to diet shall be limited to visits medically necessary upon the
diagnosis of diabetes, upon diagnosis by a State licensed physician or nurse
practitioner/clinical nurse specialist of a significant change in the
subscriber's or other covered person's symptoms or conditions which necessitate
changes in that person's self-management, and upon determination of a State
licensed physician or nurse practitioner/clinical nurse specialist that
re-education or refresher education is necessary.
(b) The benefits required to be provided pursuant to this subchapter shall be provided to the same extent as benefits are provided for services and supplies for any other sickness under the policy or contract. There shall be no separate deductible, coinsurance or maximum limit applicable to the services and supplies set forth in (a) above.
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