S.534

Health Insurance Claim Plain Language and Simplification Act mandates clear, plain language explanations of benefits forms for health insurance.

The Health Insurance Claim Plain Language and Simplification Act requires health insurance carriers in New Jersey to provide explanation of benefits forms that include specific information in a clear, understandable format. The required information includes the insured's name, health care provider's name, date of service, claim amount, carrier payment amount, and amount due from the insured. If a claim is paid in whole or in part, or denied, the form must explain the reasons.