Healthcare (Insurance)

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 ✓ HealthcareSupports HealthcareMandates insurance coverage for fertility preservation services, expanding access to healthcare for individuals with qualifying menstrual disorders causing infertility.95% confidence

Sub-Topics Insurance

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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 ✓ HealthcareSupports HealthcareMandates insurance coverage for postpartum pelvic floor therapy, expanding access without higher out-of-pocket costs, directly advancing healthcare coverage for maternal health services.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentMandates health insurance coverage for postpartum pelvic floor therapy, expanding worker benefits and supporting maternal health access without added costs.95% confidence

Sub-Topics Hospitals Insurance

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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 ✓ HealthcareSupports HealthcareMandates insurers to cover lymphedema diagnosis/treatment, expanding patient access to necessary care under insurance coverage.95% confidence

Sub-Topics Hospitals Insurance

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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 ✓ HealthcareSupports HealthcareRequires PBMs to offer pharmacy choice, protecting patient access and rights by preventing forced mail-order enrollment without consent.95% confidence

Sub-Topics Insurance Prescription Drugs

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

A 503: "Consumer Freedom From Unwanted Expense in Health Insurance Coverage Act."

This bill (A 503) allows New Jersey residents to purchase health insurance policies sold by insurers licensed in other states ("foreign health insurers"). It directly affects New Jersey residents (defined as those living in the state for at least six months annually) and their employers, who may reimburse employees for these out-of-state policies. Key provisions require that such purchases satisfy any legal requirement for health insurance coverage, and employers may cover the costs of these policies. The bill takes effect 90 days after enactment, expanding insurance purchasing options beyond New Jersey’s regulated market.

Topics ✓ HealthcareSupports HealthcareExpands health insurance access by permitting out-of-state policies, reducing costs for residents and employers, aligning with improved patient access indicators.85% confidence

Sub-Topics Insurance

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

A 2775: Requires health insurers, SHBP, and SEHBP to cover mammograms for women over 35 and women under 35 under certain circumstances.

This bill requires health insurers, the State Health Benefits Program (SHBP), and the State Employees Health Benefits Program (SEHBP) to cover specific mammogram screenings. It mandates one baseline mammogram for women aged 35 and annual screenings for women 35 and older, while also requiring coverage for women under 35 with breast cancer risk factors (like family history) as determined by their provider. Additional tests like ultrasounds or MRIs are covered if needed due to dense breast tissue, abnormal results, or other risk factors. The law applies to all health insurance plans in New Jersey, ensuring these screenings are covered without additional out-of-pocket costs for eligible individuals.

Topics ✓ HealthcareSupports HealthcareMandates insurers to cover mammograms for specified groups, expanding preventive care access and aligning with coverage expansion indicators.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentMandates mammogram coverage under state health programs, expanding employee health benefits for workers in SEHBP.85% confidence

Sub-Topics Insurance

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

A 3128: Requires health insurance coverage of diagnostic and supplemental breast examinations without cost-sharing.

New Jersey bill A3128 requires all health insurance plans sold in the state to cover diagnostic and supplemental breast examinations with no out-of-pocket costs to patients. It applies to group and individual health insurance contracts, mandating that insurers pay for these exams without deductibles, copays, or coinsurance. Diagnostic exams evaluate abnormalities found during screenings or detected another way, while supplemental exams screen high-risk patients (e.g., those with dense breasts or family history) when no abnormality is present. The law aligns with National Comprehensive Cancer Network Guidelines and applies to all plans except those specifically structured as medical savings accounts under federal law. This directly affects all New Jersey residents with health insurance who may need these breast exams.

Topics ✓ HealthcareSupports HealthcareMandates no cost-sharing for breast exams, expanding insurance coverage and improving patient access to preventive care as per bill summary.95% confidence

Sub-Topics Insurance

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

A 4438: Requires health insurance coverage of prenatal genetic test during first trimester of pregnancy.

This bill requires all health insurance plans in New Jersey to cover specific prenatal genetic tests during the first trimester of pregnancy. It applies to hospital service, medical service, health service, individual, and group insurance policies issued in the state. Covered tests include carrier screening (a blood or cheek swab test for inherited disorders), nuchal translucency screening, and chorionic villus sampling. Insurance plans must provide this coverage at the same level as other medical conditions, meaning no additional out-of-pocket costs for patients beyond standard coverage.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for prenatal genetic tests, expanding access to essential healthcare services without cost-sharing.95% confidence

Sub-Topics Hospitals Insurance

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

A 996: Requires health insurers to provide coverage for testing for suspected dyslexia.

This bill requires all health insurance plans in New Jersey (including individual, group, and small employer plans) to cover comprehensive neuropsychological testing for suspected dyslexia. It mandates that insurers cannot exclude this coverage, ensuring testing for diagnosis and related psychological/emotional assessments is provided at the same level as other medical conditions. The law applies to all covered health insurance contracts issued or renewed in New Jersey after its effective date, directly affecting patients seeking dyslexia evaluations and insurers offering these plans. It does not create new funding but requires existing insurance policies to include this specific service. The bill is currently pending before the Assembly Financial Institutions and Insurance Committee.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for dyslexia testing, expanding access to diagnostic services under health insurance requirements95% confidence

Sub-Topics Insurance

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

A 2201: Authorizes health care professionals to engage in the use of remote patient monitoring devices; requires health care insurance coverage by certain insurers for remote patient monitoring devices.

This New Jersey bill (A-2201) requires health insurance companies to cover remote patient monitoring devices - like those tracking vital signs - from patients' homes on the same terms as in-person medical visits. It mandates that insurers pay the same reimbursement rate for remote monitoring as they would for in-person care and cannot charge higher deductibles, copays, or coinsurance for these services. The law also prohibits insurers from restricting how providers use technology (e.g., audio-only calls) or limiting coverage for routine remote check-ins, as long as care standards match in-person services. This directly affects health insurers, patients using remote monitoring, and healthcare providers delivering these services in New Jersey.

Topics ✓ HealthcareSupports HealthcareMandates insurers cover remote monitoring devices at same rate as in-person visits, expanding patient access without higher costs or restrictions.95% confidence ✓ TechnologySupports TechnologyMandates insurance coverage for remote patient monitoring devices, requires equal reimbursement, and prohibits restrictions on technology use, advancing healthcare technology adoption.90% confidence

Sub-Topics Insurance Telehealth

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