Healthcare (Insurance) in New Jersey

in committee · New Jersey · General Assembly Jan 13, 2026

A 943: Requires health insurance coverage of prescribed anti-obesity medication.

This bill (A 943) requires all health insurance plans sold in New Jersey - including hospital service contracts, medical service corporations, individual policies, group plans, and health maintenance organizations - to cover FDA-approved anti-obesity medications for chronic weight management. It mandates that coverage for these medications be provided "to the same extent as for any other medical condition" under the policy, meaning no additional cost-sharing or restrictions beyond standard medical coverage. The law applies to all plans issued or renewed in New Jersey after its effective date, affecting millions of residents enrolled in private health insurance. It specifically defines covered medications as those approved by the FDA for obesity treatment, not lifestyle products. The bill does not change premiums or create new funding mechanisms - it simply requires existing insurance plans to include these medications in standard coverage.

Topics ✓ Healthcare

Sub-Topics Hospitals Insurance

died · New Jersey · General Assembly Jan 13, 2026

A 3126: Provides health care benefits to disabled members of TPAF and PERS.

This bill (A3126) amends New Jersey law to provide disability insurance coverage for members of the Teachers’ Pension and Annuity Fund (TPAF) and Public Employees’ Retirement System (PERS) who become disabled. It replaces previous disability retirement allowances with group insurance coverage, funded through a special "Teachers Group Disability Insurance Premium Fund" paid by employers. The policy provides a monthly benefit equal to 60% of a member’s base salary (minimum $50) for total disability starting before age 60, covering up to age 70, while excluding pregnancy, war injuries, and self-inflicted harm. The bill was withdrawn on January 13, 2026, as it was already enacted as P.L.2025, c.370.

Topics ✓ Healthcare ✓ Labor & Employment

Sub-Topics Insurance

in committee · New Jersey · General Assembly Jan 13, 2026

A 1503: Establishes additional health insurance carrier network adequacy standards with respect to certain physician specialists.

This bill requires New Jersey health insurance carriers to meet new standards ensuring policyholders have reasonable and timely access to specific physician specialists at in-network hospitals. It mandates regulations covering access to anesthesiologists, radiologists, pathologists, emergency medicine physicians, and their supervised services. The rules, to be developed by the Commissioner of Banking and Insurance, will address network adequacy regarding specialist availability, geographic coverage, and in-network access. These requirements apply directly to health insurance companies offering managed care plans in New Jersey.

Topics ✓ Healthcare

Sub-Topics Insurance

in committee · New Jersey · General Assembly Jan 13, 2026

A 921: Prohibits health insurance carriers from placing time limit on anesthesia services used for medical or surgical procedures.

This bill prohibits New Jersey health insurance carriers from imposing time limits on anesthesia services provided during medical or surgical procedures. It requires coverage to be based on actual time used (defined as when a licensed anesthesiologist or nurse anesthetist is present with the patient), calculated using a formula combining base units and time units multiplied by a network-specific conversion factor. The law directly affects patients requiring extended anesthesia due to complications, surgical delays, or training scenarios, and ensures coverage isn't denied based on arbitrary duration. It aligns with standard medical billing practices by banning exclusions of "anesthesia time" and requiring continuous coverage during procedures.

Topics ✓ Healthcare

Sub-Topics Healthcare Workforce Insurance

in committee · New Jersey · General Assembly Jan 13, 2026

A 2251: Establishes limited medical benefit program for individuals losing NJ FamilyCare coverage under "One Big Beautiful Bill Act"; establishes medical relief fund in Treasury; appropriates funds.

This bill creates a temporary medical relief program in New Jersey for individuals who lose NJ FamilyCare coverage due to specific provisions of the federal "One Big Beautiful Bill Act" (OBBBA). It establishes a state fund to provide eligible individuals with an electronic payment card for qualifying medical services like emergency care, prescriptions, and behavioral health - covering costs up to a 12-month period. The program automatically enrolls affected residents provisionally upon disenrollment, with benefits determined annually based on available funds. Unspent benefits after 12 months must be returned to the state Treasury, and the program does not replace comprehensive health insurance.

Topics ✓ Budget & Taxes ✓ Healthcare

Sub-Topics Insurance Mental Health

in committee · New Jersey · General Assembly Jan 13, 2026

A 2107: Requires Department of Treasury and DHS to annually identify State funds available for NJ FamilyCare, evaluate program, and create prioritized list of initiatives to improve quality of care under program.

This bill requires New Jersey's Department of Treasury and Department of Human Services to annually identify unspent state funds available for NJ FamilyCare, evaluate care quality for beneficiaries, and create a prioritized list of the 12 most urgent improvements needed to address deficiencies. It directly affects low-income residents enrolled in NJ FamilyCare (which covers Medicaid and Children’s Health Insurance Program services) by mandating state agencies to report findings to the Governor and Legislature each year. The key mechanism involves compiling a list of specific policy changes or legislative actions requiring state funding to fix quality-of-care issues, alongside the estimated costs for each initiative. The report must include all available unallocated funds for the current fiscal year to support these improvements. This annual process aims to improve program oversight without changing eligibility or funding levels.

Topics ✓ Budget & Taxes ✓ Healthcare

Sub-Topics Insurance Medicaid

in committee · New Jersey · General Assembly Jan 13, 2026

A 2191: Requires health insurance coverage of standard fertility preservation services for individuals with certain menstrual disorders resulting in infertility.

This bill requires health insurance plans covering groups of 50+ people in New Jersey to cover standard fertility preservation services (like egg or embryo freezing) for individuals diagnosed with specific menstrual disorders - such as endometriosis, heavy bleeding, or uterine fibroids - that may cause infertility. It mandates coverage when a medically necessary treatment could cause infertility or for those with qualifying disorders, applying the same copays, deductibles, and benefit limits as other medical conditions. Insurers cannot deny coverage based on age, sex, sexual orientation, or other personal characteristics. The law amends existing insurance regulations to ensure equitable access to these services for affected individuals.

Topics ✓ Healthcare

Sub-Topics Insurance

in committee · New Jersey · General Assembly Feb 19, 2026

A 4255: Requires health insurance coverage of postpartum pelvic floor physical therapy.

This bill requires all health insurance plans in New Jersey to cover pelvic floor physical therapy for one year after childbirth. It applies to hospital service, medical service, health service, individual, group, and health benefits plans. The coverage must be provided at the same level as for other medical conditions, meaning no higher out-of-pocket costs or restrictions than standard medical care. This directly affects women who have given birth and are covered by these insurance plans during the postpartum period.

Topics ✓ Healthcare ✓ Labor & Employment

Sub-Topics Hospitals Insurance

in committee · New Jersey · General Assembly Feb 19, 2026

A 4209: Requires health insurers, SHBP and SEHBP to provide coverage for diagnosis, evaluation and treatment of lymphedema.

This bill requires all health insurers operating in New Jersey - including hospital service corporations, medical service corporations, health service corporations, individual health insurance policies, group health plans, and individual health benefits plans - to cover the diagnosis, evaluation, and treatment of lymphedema when deemed medically necessary by a patient’s physician. It applies to all such insurance contracts delivered, issued, or renewed in New Jersey after the bill’s effective date, mandating coverage at the same level and cost-sharing (like deductibles and coinsurance) as for other similar medical services. The bill directly affects patients with lymphedema and insurers by ensuring this specific condition is treated as a standard covered service under existing policies. It does not alter overall coverage limits or introduce new funding, but expands mandatory benefits to include lymphedema care.

Topics ✓ Healthcare

Sub-Topics Hospitals Insurance

in committee · New Jersey · Senate Feb 19, 2026

S 3569: Prohibits pharmacy benefits managers from requiring covered persons to use mail service pharmacies.

This bill prohibits pharmacy benefits managers (PBMs) from requiring individuals covered by health insurance plans to use mail-order pharmacies or automatically enrolling them in such programs without consent. It directly affects people covered under private health insurers, prescription benefit plans, or New Jersey's State Health Benefits Program and School Employees' Health Benefits Program. The key provision requires PBMs to offer a choice between mail and non-mail pharmacies, with written consent required before using a mail service option. The law takes effect January 1, 2027, ensuring covered persons can select their preferred pharmacy type without forced enrollment.

Topics ✓ Healthcare

Sub-Topics Insurance Prescription Drugs

All healthcare bills