{"data":{"id":"us-nj/n.j.-stat.-26-2ss-4","jurisdiction":"us-nj","citation":"N.J. Stat. § 26:2SS-4","heading":"Disclosures by health care facility.","body":"4. a. Prior to scheduling an appointment with a covered person for a non-emergency or elective procedure and in terms the covered person typically understands, a health care facility shall:\n(1)\tdisclose to the covered person whether the health care facility is in-network or out-of-network with respect to the covered person's health benefits plan;\n(2)\tadvise the covered person to check with the physician arranging the facility services to determine whether or not that physician is in-network or out-of-network with respect to the covered person's health benefits plan and provide information about how to determine the health plans participated in by any physician who is reasonably anticipated to provide services to the covered person;\n(3)\tadvise the covered person that at a health care facility that is in-network with respect to the person's health benefits plan:\n(a)\tthe covered person will have a financial responsibility applicable to an in-network procedure and not in excess of the covered person's copayment, deductible, or coinsurance as provided in the covered person's health benefits plan;\n(b)\tunless the covered person, at the time of the disclosure required pursuant to this subsection, has knowingly, voluntarily, and specifically selected an out-of-network provider to provide services, the covered person will not incur any out-of-pocket costs in excess of the charges applicable to an in-network procedure;\n(c)\tany bills, charges or attempts to collect by the facility, or any health care professional involved in the procedure, in excess of the covered person's copayment, deductible, or coinsurance as provided in the covered person's health benefits plan in violation of subparagraph (b) of this paragraph should be reported to the covered person's carrier and the relevant regulatory entity; and\n(d)\tthat if the covered person's coverage is provided through an entity providing or administering a self-funded health benefits plan that does not elect to be subject to the provisions of section 9 of this act, that:\n(i)\tcertain health care services may be provided on an out-of-network basis, including those services associated with the health care facility;\n(ii)\tthe covered person may have a financial responsibility applicable to health care services provided by an out-of-network provider, in excess of the covered person's copayment, deductible, or coinsurance, and the covered person may be responsible for any costs in excess of those allowed by the person's self-funded health benefits plan; and\n(iii) the covered person should contact the covered person's self-funded health benefits plan sponsor for further consultation on those costs; and\n(4)\tadvise the covered person that at a health care facility that is out-of-network with respect to the covered person's health benefits plan:\n(a)\tcertain health care services may be provided on an out-of-network basis, including those health care services associated with the health care facility;\n(b)\tthe covered person may have a financial responsibility applicable to health care services provided at an out-of-network facility, in excess of the covered person's copayment, deductible, or coinsurance, and the covered person may be responsible for any costs in excess of those allowed by their health benefits plan; and\n(c)\tthat the covered person should contact the covered person's carrier for further consultation on those costs.\nb.\tIn a form that is consistent with federal guidelines, a health care facility shall make available to the public a list of the facility's standard charges for items and services provided by the facility.\nc.\tA health care facility shall post on the facility's website:\n(1)\tthe health benefits plans in which the facility is a participating provider;\n(2)\ta statement that:\n(a)\tphysician services provided in the facility are not included in the facility's charges;\n(b)\tphysicians who provide services in the facility may or may not participate with the same health benefits plans as the facility;\n(c)\tthe covered person should check with the physician arranging for the facility services to determine the health benefits plans in which the physician participates; and\n(d)\tthe covered person should contact their carrier for further consultation on those costs;\n(3)\tas applicable, the name, mailing address, and telephone number of the hospital-based physician groups that the facility has contracted with to provide services including, but not limited to, anesthesiology, pathology, and radiology; and\n(4)\tas applicable, the name, mailing address, and telephone number of physicians employed by the facility and whose services may be provided at the facility, and the health benefits plans in which they participate.\nd.\tIf, between the time the notice required pursuant to subsection a. of this section is provided to the covered person and the time the procedure takes place, the network status of the facility changes as it relates to the covered person's health benefits plan, the facility shall notify the covered person promptly.\ne.\tThe Department of Health shall specify in further detail the content and design of the disclosure form and the manner in which the form shall be provided.\nL.2018, c.32, s.4.","path":["TITLE 26 HEALTH AND VITAL STATISTICS"],"source_url":"https://pub.njleg.state.nj.us/statutes/STATUTES-TEXT.zip","current_through":"P.L.2025, c.405, and J.R.22","vintage":"","retrieved_at":"2026-08-27T17:54:13Z","sha256":"afcfd6b3246e106c317c5e1601c132bdd9ae775748bfb3a6a26a1997922f4c14","source_id":"us-nj","stale":true,"prev":"us-nj/n.j.-stat.-26-2ss-3","next":"us-nj/n.j.-stat.-26-2ss-5"},"notice":"GroundRules: Original legal text. Not legal advice."}