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a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act 1 that provides hospital or medical expense benefits shall provide coverage for expenses incurred in the provision of pasteurized donated human breast milk, which may include human milk fortifiers if indicated by the prescribing licensed medical practitioner, provided that:
(1) the covered person is an infant under the age of six months;
(2) the milk is obtained from a human milk bank that meets quality guidelines established by the Department of Health; and
(3) a licensed medical practitioner has issued an order for an infant who is medically or physically unable to receive maternal breast milk or participate in breast feeding or whose mother is medically or physically unable to produce maternal breast milk in sufficient quantities or participate in breast feeding despite optimal lactation support; or
(4) a licensed medical practitioner has issued an order for an infant who meets any of the following conditions:
(a) a body weight below healthy levels determined by the licensed medical practitioner;
(b) a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis; or
(c) a congenital or acquired condition that may benefit from the use of donor breast milk as determined by the Department of Health.
b. Nothing in this section shall preclude the carrier from performing utilization review, including periodic review of the medical necessity of a particular service.
c. The benefits shall be provided to the same extent as for any other prescribed items under the contract.
d. If there is no supply of human breast milk that meets the requirements of paragraph (2) of subsection a. of this section, the carrier shall not be required to provide coverage of expenses pursuant to this section.
Cite this article: FindLaw.com - New Jersey Statutes Title 52. State Government, Departments and Officers 52 § 14-17.46.6k - last updated February 19, 2021 | https://codes.findlaw.com/nj/title-52-state-government-departments-and-officers/nj-st-sect-52-14-17-46-6k/
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