This bill requires insurance carriers offering individual or small employer health plans through New Jersey's state-based exchange to file rate changes with the state insurance commissioner for review. It mandates that silver-level plan pricing must align with historical enrollment distribution among cost-sharing variants (like 94% or 87% actuarial value plans) and requires carriers to offer both gold and silver level plans in the same geographic areas. The commissioner must evaluate rates based on federal Affordable Care Act requirements, including factors like consumer purchasing power for subsidy-eligible individuals and plan design changes. This directly affects health insurance carriers selling plans on New Jersey's exchange and impacts consumers purchasing these specific plans.
This bill (S 2232) expands membership on two New Jersey health benefits commissions. It increases the State Health Benefits Commission from 5 to 9 members (adding more employee representatives from the AFL-CIO) and the School Employees' Health Benefits Commission from 9 to 13 members (adding more appointed representatives from education unions and school boards). The bill also creates a new 12-member State Health Benefits Plan Design Committee to make decisions on specific health plan components, requiring 7 affirmative votes for approval. These changes directly affect state and school employees covered by these health benefit programs by altering how their health insurance plans are designed and administered.
This bill requires New Jersey health insurance plans to cover at least one abuse-deterrent opioid analgesic drug per active ingredient on their prescription formulary. It limits patient cost-sharing for these drugs to no more than the lowest cost-sharing level for equivalent non-abuse-deterrent opioids. The bill also prohibits prior authorization requirements from forcing patients to try non-abuse-deterrent opioids first before accessing abuse-deterrent options. This directly affects health insurers (carriers) and patients prescribed opioid pain medications for moderate to severe pain.
This bill requires all health insurance plans sold in New Jersey to cover non-invasive prenatal testing (NIPT), a blood test performed starting at 10 weeks of pregnancy to screen for Down syndrome and other chromosomal abnormalities. It directly affects pregnant people in New Jersey and applies to all major insurance types, including hospital service corporations, medical service corporations, health maintenance organizations, and individual/group health plans. Insurers must cover the test "to the same extent as for any other medical condition" and follow American College of Obstetricians and Gynecologists guidelines for testing methods. The law applies to contracts where insurers reserve the right to adjust premiums.
S 564 requires all health insurance plans sold in New Jersey - including hospital service contracts, medical service plans, individual policies, group plans, and HMOs - to cover prenatal genetic testing during the first trimester of pregnancy. It specifically mandates coverage for three test types: carrier screening (blood/tissue tests for inherited disorders), nuchal translucency screening, and chorionic villus sampling. The law states coverage must be provided "to the same extent as for any other medical condition," meaning no additional out-of-pocket costs for these tests. This bill directly affects pregnant individuals seeking genetic screening and all health insurers operating in New Jersey, though it remains pending in the Senate Commerce Committee after introduction on January 13, 2026.
This bill requires health insurance plans in New Jersey to cover enrollment in recovery high school alternative education programs as part of mental health/substance use disorder treatment. It applies when a certified counselor, physician, or school official determines placement is clinically appropriate using standard medical criteria. Insurance must cover these programs under the same terms as other medical benefits, without stricter limits than those applied to general medical care. The law amends existing insurance coverage requirements to include this specific educational option for students with substance use disorders. It directly affects students seeking recovery-focused education and health insurers providing coverage in New Jersey.
This bill establishes a state fund to provide lifetime health insurance coverage for live kidney donors in New Jersey. It requires the state to cover all premiums for a gold-level health plan (including prescription drugs) through the New Jersey Individual Health Coverage Program, with no cost to donors or their employers. The Kidney Donor Insurance Fund, created in the Department of Banking and Insurance, will pay for these premiums using state funds. The coverage applies to all live kidney donations occurring on or after the bill's effective date.
This bill requires all health insurance carriers in New Jersey (including major health plans and state programs) to cover hospitalization costs for coronavirus (COVID-19) without any cost-sharing. It directly affects individuals hospitalized due to COVID-19 by eliminating deductibles, copayments, and coinsurance for these expenses. The key provision mandates that insurers cover all related hospitalization costs for eligible patients as defined in the bill. This applies immediately to all health plans issued or purchased on or after the effective date. The policy change removes financial barriers for COVID-19 hospital care.
This New Jersey bill (S 2998) requires health insurers to cover all FDA-approved contraceptive drugs, devices, and related services without cost-sharing. It specifically mandates no deductibles, copays, or prior authorization for over-the-counter contraceptives at the point of sale, while also covering prescription options and related services like counseling and device insertion. The law applies to all hospital and medical service corporations offering health insurance in New Jersey, directly affecting subscribers who use contraception. Insurers must cover these services at the same level as other preventive care, with no medical necessity review needed for over-the-counter products.
This bill requires health insurance plans in New Jersey to cover medically necessary ovarian cancer screening for symptomatic women or those at high risk. It mandates coverage for specific tests including annual pelvic exams, ultrasounds, and blood marker tests, on the same terms as other medical conditions. The law applies to individual/group health insurance policies, health maintenance organizations (HMOs), and state health benefit plans purchased by the State Health Benefits Commission. It takes effect for policies issued or renewed after the bill's effective date.
