Healthcare (Insurance)

in committee · New Jersey · General Assembly Jun 4, 2026

A 5195: Requires health insurance coverage for coronary artery calcium screening under certain circumstances.

This New Jersey bill mandates that health insurance plans cover coronary artery calcium screening tests for eligible members. It applies to individuals aged 45 and older or those with an intermediate risk of heart disease as determined by a doctor using standard medical scoring tools. Insurance companies must provide this coverage every five years, or more often if a healthcare provider recommends it due to specific health conditions. The law requires these screenings to be treated with the same coverage benefits as other medical conditions across various types of health insurance contracts.

Topics ✓ HealthcareSupports HealthcareBill mandates insurance coverage for coronary artery calcium screening, expanding access to preventive heart care for eligible members.95% confidence

Sub-Topics Insurance

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in committee · New Jersey · General Assembly Jun 4, 2026

A 5209: Requires health insurers to provide reason for denial of coverage for private duty nursing.

This New Jersey bill requires health insurers to explain in detail why they deny coverage for private duty nursing services that a patient's doctor has deemed medically necessary. When an insurer rejects such a request, it must provide a full description of the reason, specifically explaining why the doctor's assessment is invalid if medical necessity is the issue. Additionally, the law mandates that insurers share the criteria they use to evaluate these requests and give examples of approved cases along with the required documentation. These provisions aim to increase transparency in the approval process for private duty nursing by ensuring patients receive clear rationales for denials. The changes will take effect 90 days after the bill is enacted.

Topics ✓ HealthcareSupports HealthcareBill protects patient access to medically necessary private duty nursing by requiring insurers to justify denials.90% confidence

Sub-Topics Insurance

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in committee · New Jersey · General Assembly Jun 23, 2026

A 5302: Permits greater diversity in creation of new health sharing ministries and establishes and exempts certain mandates and reporting requirements.

This bill updates New Jersey's rules for health care sharing ministries to allow for greater diversity in how these organizations are formed. It removes a federal requirement that such ministries must have existed since 1999, arguing that this rule is outdated and allows some groups to exploit loopholes. The legislation also adds transparency by requiring these ministries to publish annual reports on their membership numbers and participant counts online. Additionally, the bill clarifies that individuals who join these ministries are exempt from state health insurance mandates, provided the organizations meet specific audit standards.

Topics ✓ HealthcareSupports HealthcareBill modernizes health sharing ministry rules, removes outdated restrictions, and increases transparency to protect consumer access and rights.85% confidence

Sub-Topics Insurance

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in committee · New Jersey · Senate Jun 22, 2026

S 4504: Requires health insurance carriers to provide opportunity to clinical laboratory and laboratory services provider to participate as preferred or contracting provider in carriers' provider network.

This bill requires health insurance carriers in New Jersey to allow clinical laboratories and laboratory services providers to join their provider networks as preferred or contracting partners. To achieve this, the law mandates that insurance contracts must not deny these providers participation if they meet standard licensing requirements and agree to the same terms and conditions as other providers in the network. Additionally, the legislation ensures that subscribers choosing a participating laboratory are not subject to higher copayments or fees than those who select other options within the plan. The bill also includes provisions to prevent discriminatory audit practices and restricts restrictions on pharmacies charging for additional services like counseling.

Topics ✓ HealthcareSupports HealthcareBill mandates insurance carriers include clinical labs in their networks, improving patient access to essential diagnostic services.90% confidence

Sub-Topics Insurance

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in committee · New Jersey · General Assembly Jun 8, 2026

A 5226: Requires employees who do not select or waive coverage to be enrolled in lowest cost SHBP or SEHBP health plan.

This bill requires state and school employees in New Jersey who do not actively choose or waive health insurance to be automatically enrolled in the plan with the lowest overall costs. An Evaluation Committee, working with the State Health Benefits Commission and School Employees' Health Benefits Commission, will determine which plan offers the lowest combined costs for both members and the government before each plan year begins. If no single plan minimizes costs for both parties simultaneously, employees will be enrolled in the option that is cheapest for the government. The legislation also allows these commissions to adjust the selected plan at any time during the year if cost conditions change.

Topics ✓ HealthcareSupports HealthcareBill mandates automatic enrollment in the lowest-cost health plan, expanding coverage access and reducing financial barriers for state employees.85% confidence ✓ Labor & EmploymentSupports Labor & EmploymentBill mandates automatic enrollment in the lowest-cost health plan, expanding access to affordable benefits for state and school employees.85% confidence

Sub-Topics Insurance

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in committee · New Jersey · Senate May 14, 2026

S 4283: Prohibits health insurance carriers from denying coverage of nonopioid prescription drugs in favor of opioid prescription drugs.

This New Jersey bill prohibits health insurance carriers from refusing to cover nonopioid pain medications when a doctor prescribes them instead of opioids. It specifically bans insurers from requiring patients to try opioids first or from placing nonopioid drugs on higher cost tiers than opioid drugs in their coverage plans. The law also applies to state-run health benefit contracts for hospital and medical expenses, ensuring these nonopioid options are treated fairly regarding coverage rules and patient costs. While the bill prevents nonopioid drugs from being disadvantaged compared to opioids, it still allows insurers to prefer one type of drug over another within the same category.

Topics ✓ HealthcareSupports HealthcareBill protects patient access to nonopioid pain medications and prevents insurers from restricting coverage or prioritizing opioids.95% confidence

Sub-Topics Hospitals Insurance Substance Abuse

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in committee · New Jersey · General Assembly May 7, 2026

A 5020: Prohibits pharmacy benefit manager from using spread pricing as model of prescription drug pricing; requires transparency in provision of pharmacy benefits management services.

This bill prohibits pharmacy benefit managers in New Jersey from using spread pricing, a model where patients pay more at the pharmacy counter than the plan's negotiated rate, and requires full transparency in how these companies are compensated. Under the new rules, any rebates or fees received by these managers must be passed entirely to the health plan or carrier, while the managers can still charge a standard administrative fee for their services. The legislation also mandates that carriers closely monitor the managers' activities and ensures that patients never pay more at the point of sale than they would if they bought the medication without insurance. To enforce these changes, pharmacy benefit managers must submit detailed financial statements and audits to the state department on a quarterly and annual basis, and the department will publish a yearly report on how these pricing practices affect overall health plan costs.

Topics ✓ HealthcareSupports HealthcareBill prohibits harmful spread pricing and mandates transparency, protecting patients from overcharges and improving healthcare affordability.95% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · New Jersey · General Assembly May 7, 2026

A 4925: Concerns health care services provided to incarcerated individuals.

This New Jersey bill ensures that incarcerated individuals do not have to pay for medical care, dental services, or prescription drugs provided while in state or county facilities. The legislation removes the ability to charge inmates for these essential health services and allows the state and counties to seek reimbursement directly from the inmates' health insurance plans instead. By shifting the financial responsibility to insurance providers, the bill aims to guarantee access to necessary treatment without burdening prisoners with costs during their incarceration.

Topics ✓ Criminal JusticeSupports Criminal JusticeBill ensures incarcerated individuals receive essential health services without cost, improving access to care and supporting rehabilitation and civil rights within the criminal justice system.85% confidence ✓ HealthcareSupports HealthcareBill ensures free medical care for inmates and shifts costs to insurers, expanding access and protecting patient rights.95% confidence

Sub-Topics Corrections Insurance

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in committee · New Jersey · Senate May 11, 2026

S 4200: Provides Commissioner of Human Services temporary discretion to apply certain State-optional NJ FamilyCare benefits under certain circumstances.

This bill grants the New Jersey Commissioner of Human Services temporary authority to suspend certain optional NJ FamilyCare benefits for individuals who do not receive federally mandated Medicaid coverage. The suspension can only apply to benefits created on or after January 1, 2024, and explicitly excludes essential services such as primary care, pediatric care, gynecological health, and behavioral health. To use this power, the commissioner must provide the Legislature with at least 30 days of advance notice and submit biennial reports detailing how long each benefit was suspended. The law is contingent on continued federal funding for the state's Medicaid and Children's Health Insurance Program and will expire three years after it takes effect.

Topics ✗ HealthcareOpposes HealthcareBill allows suspension of optional NJ FamilyCare benefits, restricting coverage and limiting patient access to non-essential services.85% confidence

Sub-Topics Children's Health Insurance Medicaid

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in committee · New Jersey · Senate May 11, 2026

S 4188: Requires SHBP, SEHBP, and NJ FamilyCare to cover kidney disease education services; Requires DOH to develop policies and procedures regarding kidney disease education services.

This bill mandates that New Jersey's state health insurance programs, including SHBP, SEHBP, and NJ FamilyCare, cover specific education services for individuals with kidney disease who need dialysis or a transplant. Under the legislation, the Department of Health must first create detailed rules outlining how these services should be delivered, which will include verbal counseling on managing other health conditions, preventing complications, and understanding different treatment options. The covered education must be provided by a healthcare professional before a patient's appointment and must ensure the patient has the opportunity to actively participate in choosing their treatment path.

Topics ✓ HealthcareSupports HealthcareBill mandates coverage for kidney disease education services and requires policy development to improve patient care and access.95% confidence

Sub-Topics Insurance

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