N.J. Admin. Code § 11:4-49.3

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:4-49.3 - Benefits

(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.

N.J. Admin. Code § 11:4-49.3