New Jersey Program Requires Insurers to Provide Free Physicals

The New Jersey Health Wellness Promotion Act, which requires HMOs, PPOs or traditional fee-for-service insurers to provide "free, comprehensive annual physicals" to about 3.7 million New Jerseyans, took effect this month and is being touted as the "first of its kind in the nation," the AP/Bergen Record reports. Individuals ages 20 or older who are HMO, PPO or traditional fee-for-service insurance customers are entitled to "periodic standard tests" for cancer, diabetes, heart disease, anemia and glaucoma. Participating physicians and nurse practitioners also must talk to patients about breast or testicular self-examination, smoking cessation, weight control, seat-belt use and back-strengthening exercises. The cost of the physical is capped at an average of $220 this year; in future years, the state will adjust the reimbursement rate for inflation. The program's founder, Dr. Donald Louria of the University of Medicine and Dentistry of New Jersey, spent 20 years developing the program and another 10 years to "persuade the state government to mandate" it. Former Gov. Jim Florio (D) signed legislation in 1993 to institute the screening program, but the plan did not take effect because health plans "tried to make it a rider to policies -- and charge extra," the AP/Record reports. Eventually, state Assembly member John Kelly (R) introduced an amended version of the bill that required insurers to include the program as part of basic coverage. This revised legislation took effect Nov. 6. However, more than 4 million New Jerseyans are exempt from the law, as they are customers of Medicare, Medicaid, "self-insured" plans funded directly by a company or plans purchased by individuals or by businesses with 50 or fewer employees. Louria said he will work to extend the program's benefits to those currently not covered under the law, including children and adolescents, as well as to the rest of the country. He said, "If we can effectively implement it [in New Jersey], it could be a model for the nation. We're going to start a push for this to be national policy immediately." American Public Health Association Executive Director Dr. Mohammad Akhter called the program "really revolutionary," adding that it "will be very good for patients and doctors, too," as physicians will be able to catch more illnesses early (Johnson, AP/Bergen Record, 11/25).