Preventive Care Services in New Jersey and the Implementation of the Health Wellness Promotion Act: Report of Stakeholder Perceptions

EXECUTIVE SUMMARY 
 

INTRODUCTION 
To improve financial access to preventive care, the state of New Jersey passed the Health Wellness Promotion Act (HWPA). This law, which was originally passed in 1993 and amended in 1999, requires all health insurers to cover eighteen preventive care tests and actions (specified by age, gender, and frequency) for adults in all purchased commercial policies and contracts offered in the state, except those specifically excluded in the law. Initially the 1993 law required only that health insurers offer purchasers contracts covering the schedule of preventive health benefits described in the law. In 1999, the law was amended to mandate that insurers cover these benefits in all contracts. The purpose of this report is to estimate the number of people affected and assess stakeholders' perceptions of the initial impact of the HWPA based on a review of the literature, publicly available data, and interviews with carrier medical directors and practicing physicians in the state. 
 

ESTIMATED NUMBER OF PEOPLE AFFECTED BY THE HWPA 
Given the ERISA exemption of self-insured plans from state regulation, the HWPA only applies to non-self-insured purchased health contracts or policies offered in the state. In addition, health policies provided through government payers and through the individual and small group markets (i.e., businesses with less than 50 employees) are not obligated to offer any of the preventive care benefits mandated under the HWPA. Thus, the HWPA expands coverage only for persons insured through large employers (more than 50 employees) that do not self-insure or did not previously cover these specific services. This represents a relatively small number of policies in the state. 

CONCLUSION 
In summary, the HWPA has done little to expand coverage for preventive health benefits under managed care or health insurance policies. The limited sample of practicing physicians contacted is unaware of the law. So long as the schedule in the law deviates from nationally recognized preventive health guidelines or HEDIS measures, carriers are unlikely to undertake any voluntary efforts to promote the benefits mandated under the HWPA. The concept embodied in the HWPA is recognized as an important one, and the legislation is recognized as innovative. If the problems surrounding the specific schedule can be resolved, the HWPA may serve as a model for other states and help heighten awareness of preventive care in New Jersey and around the country.