This bill requires New Jersey health insurance companies (carriers) to maintain networks with sufficient physicians so that all plan members can access care within reasonable distance and time. Specifically, it mandates that 100% of members live within 20 minutes or 10 miles (whichever is less) of at least three primary care physicians per specialty, and within 30 minutes or 15 miles for specialists. The law also sets access timelines (e.g., emergency care triaged within 1 hour, routine appointments within 2 weeks) and prohibits counting telehealth or non-physician providers toward network adequacy requirements. Carriers must publicly display plain-language network descriptions and face penalties for noncompliance, with patients able to file complaints about network access.
This bill prohibits health insurance carriers from reducing payments to network providers during the term of their contracts. It directly affects health insurance companies and healthcare providers (like doctors and hospitals) who have existing agreements with insurers. The key provision states carriers cannot unilaterally lower reimbursement rates for providers while a contract is active. This applies to all new or renewed contracts starting three months after the bill takes effect.
This bill requires health insurance plans in New Jersey to cover oral anticancer medications on the same financial terms as intravenous (IV) anticancer medications. It directly affects cancer patients enrolled in health insurance plans governed by hospital service, medical service, health service, or individual health insurance policies. The key provision bans additional upfront costs, copayments, deductibles, or coinsurance for oral medications that aren't applied to IV medications, ensuring patients pay no more for oral treatments than for IV ones. Plans cannot offset this requirement by increasing patient costs for any covered anticancer drugs. The law applies to all relevant insurance contracts renewed or issued after its effective date.
This New Jersey bill (S 3264) requires health insurance companies to use the federal Medicare/Medicaid resource-based relative value scale (RBRVS) when setting payment rates for specific doctor visits. It specifically applies to evaluation and management services (coded 99202-99499) that include modifier 25, which identifies a significant, separate visit occurring on the same day as another procedure. The law mandates that insurers base reimbursement payments on the federal RBRVS system, which calculates rates based on the resources needed to deliver care. This affects all health insurance carriers in New Jersey and directly impacts healthcare providers who bill for these specific types of visits.
This bill creates the "Health Care for Child Care Program" to provide state-funded health insurance coverage for employees at licensed New Jersey child care centers. It appropriates $10 million from the General Fund to cover the full premium costs for eligible workers - those employed at least 30 hours weekly for 90 days at a licensed center or registered family child care home - through New Jersey’s gold-level health plan. The program eliminates out-of-pocket costs for workers and their employers, with the Department of Banking and Insurance administering the fund. It directly affects child care workers, who often lack employer-provided health benefits, and aims to stabilize the sector by reducing financial strain on centers.
This bill requires all health insurance plans in New Jersey - including Medicaid - to cover planned home births at the same level as hospital-based care. It mandates coverage for services provided by certified midwives, doulas, and related medical supplies, such as equipment and medications. The law applies to hospital service contracts, medical service contracts, health service contracts, and individual health insurance policies issued in New Jersey. This policy change directly affects pregnant individuals seeking home births and their insurance providers by eliminating coverage barriers for this birth option.
This bill requires all health insurance policies in New Jersey to cover at-home rehabilitation services for people recovering from injury or illness. It applies to every type of health plan - including individual policies, group plans, HMOs, and health benefits plans - mandating that coverage must be provided "to the same extent as for any other medical condition." The law defines "at-home rehabilitation" as treatment using medical equipment within a person's home for functional physical or mental impairments. This change directly affects insurers (who must include this coverage) and patients needing such services, eliminating gaps in coverage for home-based care.
This bill (S 3549) requires all health insurance plans sold in New Jersey to cover specific obesity treatments, including preventive care, nutrition counseling, behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medications. It applies to hospital service corporations, medical service corporations, health service corporations, and individual or group health insurance policies. Insurance plans must cover these treatments "to the same extent as for any other medical condition," without additional cost-sharing. The law affects all insurers operating in New Jersey that provide hospital or medical expense benefits, ensuring comprehensive coverage for obesity treatment as a standard medical service.
This bill prohibits health insurance carriers from denying coverage for nonopioid pain medications in favor of opioids or requiring patients to try opioids first. It requires insurers to treat FDA-approved nonopioid drugs equally to opioids in formularies, meaning coverage restrictions, prior authorization, and cost-sharing tiers must be no more restrictive for nonopioid drugs. The law applies to state health benefit plans, school employee health programs, and Medicaid for acute pain treatment. It takes effect January 1, 2026, directly affecting insurers and patients covered by these plans.
This New Jersey bill (A3979) requires all health insurance plans sold in the state - including hospital, medical, and health service corporation contracts - to cover specific lipedema treatments. It mandates coverage for compression garments, manual lymphatic drainage, medical nutrition therapy, mental health care, medically necessary lipectomies, and related appointments. Insurers must accept physician diagnoses and surgeon-provided photos for verification, cannot deny coverage based solely on photos, and must cover the full number of lipectomies deemed necessary by a surgeon. The coverage must align with existing cost-sharing structures (deductibles, coinsurance) and standard medical care for lipedema.
