This New Jersey bill requires health insurance plans and providers to ensure their networks include enough mental health providers so that every covered person can access care. It mandates that 100% of policyholders must have access to either in-person mental health services within 15 miles and 30 days of requesting care, or telehealth services within 30 days if in-person options are unavailable. Insurance plans must cover telehealth mental health services with no higher deductibles, copays, or coinsurance than in-person visits, and reimburse providers at least the Medicaid rate. The law applies to all health insurance plans, including Medicaid managed care organizations, and self-funded plans may choose to comply.
This bill requires New Jersey's Department of Banking and Insurance (DOBI) to conduct a one-time confidential review of health insurance coverage for hormone replacement therapy (HRT). The review will examine how insurers administer HRT coverage under the "New Jersey Menopause Coverage Act" and whether there has been an aggregate increase in coverage since that law took effect. DOBI will analyze data on prior authorization and step therapy decisions for HRT, as well as other insurer-collected information, and must report its findings to the Legislature within six months. This review directly affects health insurance carriers (by requiring them to provide data) and DOBI (as the reviewing agency), but does not change current coverage requirements.
This New Jersey bill (A 3117) requires all health insurance plans sold in the state - including hospital service contracts, medical service plans, individual policies, group plans, and health maintenance organizations - to cover BRCA1 and BRCA2 genetic testing at no additional cost to the patient. It directly affects individuals seeking testing for these breast cancer-related genes, as well as all health insurers operating in New Jersey. The law mandates coverage "to the same extent as for any other medical condition," meaning patients won’t face extra out-of-pocket costs for this specific testing. It applies to all plans issued or renewed in New Jersey after the bill’s effective date.
This bill amends New Jersey law to extend the deadline for enrolling newborn infants in health benefits coverage from 60 to 90 days after birth. It directly affects newborns and their parents, requiring health insurance corporations to allow enrollment within this longer timeframe. The key provision states that parents must notify the insurer and pay the required subscription amount within 90 days to maintain coverage beyond that period. The bill was withdrawn as it was already enacted into law through P.L.2025, c.194.
This bill requires health insurance carriers in New Jersey to cover all hospitalization costs for patients diagnosed with COVID-19 without any out-of-pocket expenses, such as deductibles, copayments, or coinsurance. It applies to all health insurance plans offered by companies, health maintenance organizations, and state-run programs like the State Health Benefits Program. The law takes effect immediately for health plans issued or renewed on or after its effective date, ensuring no cost-sharing for eligible hospitalizations related to the virus.
This bill requires healthcare providers to order ultrasounds of both breasts at the same time as mammograms when medically indicated, and mandates health insurers to cover both tests together. It directly affects women receiving breast cancer screenings (particularly those with dense breast tissue, family history, or other risk factors) and their insurance providers. The key provision eliminates the need for separate authorization for ultrasounds ordered concurrently with mammograms, streamlining coverage for diagnostic testing. This applies to all health insurance contracts in New Jersey that cover breast cancer screening, aligning with existing guidelines for dense breast tissue and other risk factors.
This bill requires workers' compensation, personal injury protection (PIP) auto insurance, and health insurance plans in New Jersey to cover medical cannabis costs for qualifying patients under existing law (P.L.2009, c.307). It directly affects workers with job-related injuries, auto accident victims, and health plan enrollees diagnosed with qualifying conditions like chronic pain or cancer. Key provisions mandate insurers to pay dispensaries directly or reimburse patients upon proof of payment, while allowing federal intervention under the Controlled Substances Act to override coverage. The bill does not require coverage for recreational use or affect federal drug laws beyond the specified exception.
This New Jersey bill requires health insurance companies to provide clear, written "explanation of benefits" forms to policyholders whenever a claim is processed. The form must display key details on the first page in 12-point plain language: the insured's name, provider, service date, claim amount, payments made by insurer and patient, reasons for claim decisions (payment or denial), and required next steps. It mandates that only this simplified information appear on the first page, avoiding complex jargon. The law applies to all health insurance carriers in New Jersey and takes effect 90 days after enactment. The bill is currently pending before the Assembly Financial Institutions and Insurance Committee.
Bill A 612 requires New Jersey health insurers (including hospital, medical, health service corporations, and individual health insurance policies) to cover prescribed combination antiretroviral drug regimens for HIV/AIDS treatment. It mandates coverage for either single-tablet or multi-tablet regimens based on clinical effectiveness and patient adherence, as determined by healthcare providers. Insurers must process prior authorization requests within 14 days, with automatic approval if they miss the deadline. This bill directly affects people with HIV/AIDS seeking treatment and the insurers providing coverage under New Jersey law.
This bill prohibits health insurers, third-party administrators, and state health benefit programs (like the State Health Benefits Program and School Employees’ Health Benefits Program) from requiring pre-approval or precertification for prenatal ultrasounds that are already covered under a health plan and prescribed by a licensed provider. It directly affects patients seeking covered prenatal care by removing administrative delays, ensuring payment occurs without insurer or administrator review. The key provision states that coverage for these screenings cannot be conditioned on pre-approval, streamlining access to a specific medical service. The bill applies to all health plans issued or purchased on or after its effective date.
