This New Jersey bill (A2287) requires health insurance plans covering groups of 50+ people to include coverage for fertility preservation services when medical treatments (like cancer therapy) may cause infertility. It specifically adds storage of sperm or oocytes to existing coverage, but excludes individuals under 21 years old. Insurers must cover these services under the same terms as other medical treatments and cannot deny coverage based on personal characteristics like age, gender, or health conditions. The bill applies to hospital, medical, and health service corporation contracts approved in New Jersey.
This New Jersey bill (A2116) requires all health insurance plans sold in the state - covering hospital, medical, and group policies - to include coverage for Alzheimer's disease and related dementia screening for people aged 65 or older. It mandates that this coverage be provided "to the same extent as for any other condition" under the plan, meaning no extra costs or restrictions beyond standard medical coverage. The law applies to all insurance types (including HMOs and health benefits plans) delivered, issued, or renewed in New Jersey after the bill's effective date. It defines "Alzheimer's disease and related disorders" as dementia causing significant impairment in daily functioning. The bill does not create new costs for insurers but ensures existing coverage must include these screenings for seniors.
This New Jersey bill (A 238) prohibits health insurance payers from downcoding claims to reduce payments to healthcare providers. It directly affects providers (like doctors and hospitals) and insurers by requiring payers to reimburse for the actual service performed, not a lower-cost code. The law bans adjusting claims to "less complex or lower cost service" codes to cut payments, defining downcoding as using remark codes to downgrade claims. It applies to all health insurance carriers, health maintenance organizations, and their agents operating in New Jersey. The Department of Banking and Insurance will create implementing regulations.
This bill would expand Medicare coverage to all New Jersey residents, regardless of age, health, or disability status, replacing current Medicaid and other state/local health programs with a unified New Jersey Medicare program. It requires the state to apply to federal Centers for Medicare & Medicaid Services (CMS) for a waiver to modify Medicare rules, with CMS estimating costs and adjusting premiums based on existing Medicare/Medicaid payments. The bill prohibits health insurers from offering plans covering services already provided by Medicare to prevent duplication. This would directly affect all New Jersey residents and health insurance providers in the state, as it would eliminate redundant coverage options.
Bill A3596 establishes a 30-day minimum special enrollment period for New Jersey health insurance policyholders when their in-network provider leaves their health plan's network during the policy term. It requires the Department of Banking and Insurance to set this enrollment window and mandates insurers to notify affected individuals about the opportunity to switch plans. The bill directly impacts people whose current healthcare providers are no longer covered under their insurance plan. This policy change ensures individuals have a defined timeframe to adjust their coverage without waiting for the next standard enrollment period.
This bill establishes a state-run insulin assistance program under New Jersey's Department of Human Services. It provides free insulin and related supplies to uninsured individuals who prove financial inability to pay for prescribed insulin, through participating pharmacies that are fully reimbursed by the state. To qualify, individuals must apply to DHS, lack health insurance, and demonstrate financial need; approved participants receive coverage for 90-day periods with the option to reapply. The program operates only if funds are available and requires pharmacies to register with the state to participate.
This bill (NJ A2749) requires health insurance plans and Medicaid (NJ FamilyCare) to cover preventive behavioral health services for children under 18, including screenings and early intervention without requiring a formal mental health diagnosis. It mandates insurers to accept "at-risk diagnosis" billing - using Social Determinants of Health Z-codes instead of standard mental health codes - to pay for preventive care like therapy or screenings for children showing potential behavioral health needs. The coverage must be provided at the same level as other medical services, applying to all health plans sold in New Jersey, state employee health programs, and Medicaid managed care organizations. The bill was withdrawn after being approved as P.L.2025, c.369.
ACR 113 proposes a constitutional amendment to prohibit New Jersey health insurance carriers from denying coverage or excluding benefits based on a person's preexisting health condition. This would apply to private insurers, health maintenance organizations (HMOs), health service corporations, and state-run programs like the State Health Benefits Program. The amendment explicitly excludes self-funded employer health plans, which are governed by federal law. If approved by voters, it would become part of the state constitution, requiring insurers regulated by New Jersey to cover preexisting conditions without restrictions.
This New Jersey bill (A 2649) requires all health insurance plans sold in the state to cover annual mental health screenings as part of standard coverage for mental health conditions and substance use disorders. It applies to hospital service, medical service, and health service insurance contracts, mandating that insurers provide this coverage under the same terms and conditions as physical health care - meaning no stricter copays, deductibles, or review processes for mental health than for other medical services. The law aligns with federal parity requirements and specifically adds the annual screening as a covered benefit. This directly affects all health insurance companies operating in New Jersey and their policyholders, ensuring access to preventative mental health care without additional cost barriers.
This bill requires all health insurance policies in New Jersey - covering hospital, medical, and individual/group plans - to cover diagnosis and treatment for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). It mandates coverage for specific treatments including antibiotics, behavioral therapies, immunomodulating medicines, plasma exchange, and intravenous immunoglobulin therapy, as prescribed by a physician. Insurance plans must provide this coverage "to the same extent as for any other condition," meaning no additional cost-sharing or limitations beyond standard coverage. The requirement applies to all relevant policies renewed or issued in New Jersey after the bill's effective date.
