NJ Insurance Code 148 – Everything You Need to Know

When it comes to insurance regulations in New Jersey, the state uses a unique coding system. One of the most important codes for both insurance providers and consumers is Code 148. In this article, we’ll cover everything you need to know about NJ Insurance Code 148, from what it is and how it works to common FAQs and more.

What is NJ Insurance Code 148?

NJ Insurance Code 148 is a regulation that requires insurance companies to offer coverage for certain medically necessary expenses related to the treatment of autism spectrum disorders (ASD). This coverage is commonly referred to as autism coverage and is a requirement for all fully-insured small employer health benefit plans in the state of NJ.

Under this code, insurance companies are required to offer coverage for the following types of treatment for ASD:

• Behavioral interventions and ABA (applied behavioral analysis)
• Speech therapy
• Occupational therapy
• Physical therapy

This coverage is required for children under the age of 21 who have been diagnosed with ASD by a licensed healthcare professional. The coverage must be medically necessary and prescribed by a licensed healthcare professional as part of a comprehensive treatment plan for the individual.

How Does NJ Insurance Code 148 Work?

Under NJ Insurance Code 148, insurance companies are required to offer coverage for the types of treatment listed above. However, there are some specific requirements and limitations to be aware of.

First, the coverage must be offered as a benefit for all fully-insured small employer health benefit plans. This means that if you are an employer in NJ and you offer health insurance to your employees, you must include this coverage as part of the plan.

Second, the coverage must be medically necessary and prescribed by a licensed healthcare professional as part of a comprehensive treatment plan for the individual. This means that you cannot simply choose to receive this coverage without a diagnosis or prescription from a licensed healthcare professional.

Third, there are limits to the amount of coverage that insurance companies are required to offer. Specifically, insurance companies are only required to provide up to $62,000 of coverage per year for ABA therapy. There are also limits on the number of visits per year for other types of therapy.

What are the Specific Requirements for NJ Insurance Code 148?

There are a few specific requirements that insurance companies must meet under NJ Insurance Code 148. These include:

• Providing coverage for the diagnosis and treatment of ASD
• Providing coverage for ABA therapy up to $62,000 per year
• Limiting the number of visits for speech, occupational, and physical therapy
• Requiring that the treatment be prescribed by a licensed healthcare professional as part of a comprehensive treatment plan
• Requiring that the treatment be medically necessary

If you are a parent of a child with ASD or you have been diagnosed with ASD yourself, it’s important to understand these requirements and to work with your healthcare provider and insurance company to ensure that you receive the coverage you need.

FAQs About NJ Insurance Code 148

How do I know if my insurance plan includes coverage for ASD treatment?

If you have a fully-insured small employer health benefit plan in NJ, your plan is required to include coverage for ASD treatment under NJ Insurance Code 148. However, you should check with your insurance provider to confirm the specific details of your coverage.

What is ABA therapy?

ABA (applied behavior analysis) is a type of therapy that is often used to treat individuals with ASD. It is a structured, scientifically-proven therapy that focuses on the principles of learning theory to help individuals with ASD develop new skills and improve their behavior.

What other types of therapy are covered under NJ Insurance Code 148?

In addition to ABA therapy, NJ Insurance Code 148 requires insurance companies to offer coverage for speech, occupational, and physical therapy as part of a comprehensive treatment plan for individuals with ASD.

What if my insurance company denies coverage for ASD treatment?

If your insurance company denies coverage for ASD treatment that you believe is covered under NJ Insurance Code 148, you may file a complaint with the New Jersey Department of Banking and Insurance. You may also consider contacting an attorney who specializes in insurance law for assistance.

Is NJ Insurance Code 148 only applicable to children?

No, NJ Insurance Code 148 is applicable to individuals of all ages who have been diagnosed with ASD by a licensed healthcare professional. However, there are specific limitations on the amount and type of coverage based on the individual’s age and diagnosis.

Conclusion

NJ Insurance Code 148 is an important regulation in New Jersey that requires insurance companies to offer coverage for certain medically necessary expenses related to the treatment of ASD. If you or a loved one has been diagnosed with ASD, it’s important to understand your insurance coverage and to work with your healthcare provider and insurance company to ensure that you receive the coverage you need.