New Jersey - PIP Coverage & Telemedicine

Published: 04.27.2020

Automobile Insurance Policies that Provide Medical Expense Benefits under the Personal Injury Protection (PIP) Coverage must Establish Telemedicine and Telehealth Processes during the COVID-19 Pandemic.

When: Effective immediately and for the duration of the state of emergency and public health emergency declared pursuant to New Jersey Governor Phil Murphy’s Executive Order 103.
How:     The New Jersey Department of Banking and Insurance (“Department”) issued New Jersey Bulletin No. 20-19.
What:   Bulletin 20-19 declared that all automobile carriers that provide medical expense benefits under Personal Injury Protection (“PIP”) coverage must implement telemedicine and telehealth procedures during the COVID-19 pandemic. 

The Department is requiring that PIP carriers: 
  • Review or establish their telemedicine and telehealth networks to ensure adequacy given the increased demand;
  • Encourage network providers to utilize telemedicine or telehealth services wherever possible and clinically appropriate to diagnose and treat PIP injuries during the ongoing public health emergency, in order to minimize exposure of provider staff and other patients to those who may have the COVID-19 virus; 
  • Update their procedures to include reimbursement for telehealth services that are provided by a provider in any manner that is practicable and appropriate, including by telephone.  PIP carriers should disseminate information on their website, or other reasonable means, to notify individuals of these updates. This would include the use of telephone-only communications to establish a physician-patient relationship and the expanded use of telehealth for the diagnosis, treatment, ordering of tests, and prescribing.  PIP carriers are required to update telehealth policies to include telephone-only services within the definition of telehealth;
  • Reimburse providers that deliver covered services to claimants via telemedicine or telehealth in accordance with this guidance;
  • Ensure that the payment to providers for telemedicine or telehealth services are not lower than would typically be paid for traditional services (i.e., in-person) methods, and PIP carriers must notify providers of any instructions that are necessary to facilitate billing for such telehealth services;
  • May not impose any restriction on the reimbursement for telehealth or telemedicine that requires that the provider who is delivering the services be licensed in a particular state, so long as the provider is in compliance with P.L. 2020, c. 4 and this guidance; and
  • May not impose additional prior authorization requirements on medically necessary treatment that is delivered via telemedicine or telehealth, instead of via traditional methods, during this public health emergency. 
New Jersey Bulleting 20-19: