Healthcare (Insurance)

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

A 2604: Requires private health insurers, SHBP, SEHBP, Medicaid, and NJ FamilyCare to cover wigs under certain circumstances.

This bill requires private health insurers, the State Health Benefits Program (SHBP), State Employees Health Benefits Program (SEHBP), Medicaid, and NJ FamilyCare to cover the cost of wigs when prescribed by a dermatologist, oncologist, or physician for medical reasons. Insurers must cover wigs as "durable medical equipment" for subscribers diagnosed with illness, chronic conditions, or injury, provided the doctor certifies medical necessity. Coverage is limited to once every 36 months and cannot be restricted to chemotherapy patients only. The law applies to all health insurance contracts delivered, issued, or renewed in New Jersey after its effective date.

Topics ✓ HealthcareSupports HealthcareMandates insurers to cover medically necessary wigs as durable medical equipment, expanding health insurance benefits for patients with qualifying conditions.95% confidence

Sub-Topics Insurance Medicaid

Track

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

A 998: Directs DHS to establish Children's Partial Hospitalization Pilot Program.

This bill establishes a 36-month pilot program allowing New Jersey's NJ FamilyCare health insurance program to reimburse non-hospital-based partial hospitalization services for children aged 5-14 with mental health needs. It directly affects low-income children requiring intensive outpatient mental health care and providers who can apply to participate. The key provision changes current reimbursement rules - previously requiring services to occur in a hospital - to permit care at non-hospital locations, while maintaining all other federal and state eligibility requirements. The program requires the Department of Human Services to select one provider, monitor outcomes, and report findings to the Governor and Legislature within 36 months of selection.

Topics ✓ HealthcareSupports HealthcareExpands mental health coverage for low-income children by enabling NJ FamilyCare reimbursement for non-hospital partial hospitalization services, improving access to intensive outpatient care.95% confidence

Sub-Topics Hospitals Insurance Mental Health

Track

in committee · New Jersey · General Assembly Jun 30, 2026

A 4357: Extends certain pay parity regarding telemedicine and telehealth.*

This bill permanently requires New Jersey health insurance carriers to pay the same reimbursement rate for telemedicine and telehealth services as they do for in-person visits, provided the service is otherwise covered. It ensures patients face no higher deductibles, copays, or coinsurance for telehealth compared to in-person care. The law prohibits insurers from restricting where telehealth services can occur, limiting which technology platforms providers can use, or denying coverage for routine remote monitoring. It directly affects health insurance companies, healthcare providers offering telehealth, and patients receiving covered telehealth services. The policy change applies to all health benefits plans in New Jersey without time limits.

Topics ✓ HealthcareSupports HealthcareRequires equal insurance reimbursement for telehealth vs in-person care, removing financial barriers and expanding access to healthcare services.95% confidence ✓ TechnologySupports TechnologyRequires equal reimbursement for telehealth vs in-person care, prohibits insurer restrictions on technology platforms, enabling broader adoption of telehealth technology.95% confidence

Sub-Topics Insurance Telehealth

Track

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

A 3284: Requires 90 days' notice of cancellation or nonrenewal of stop loss insurance for small employer health benefits plans.

This bill requires insurers to provide small employers with at least 90 days' written notice before canceling or refusing to renew stop loss insurance policies for their self-funded health plans. Stop loss insurance protects small employers from unexpectedly high medical costs for their employees' health coverage. The notice must be in a format set by New Jersey's Banking and Insurance Commissioner and applies to policies issued or renewed 90 days after the law takes effect. This directly affects small business health plan sponsors who rely on this coverage to manage financial risk.

Topics ✓ HealthcareSupports HealthcareRequires 90-day notice for stop loss insurance cancellations, protecting small employers' stable health coverage and preventing abrupt disruptions in employee health benefits.90% confidence

Sub-Topics Insurance

Track

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

A 2822: "Breann's Law" requires health insurers, the State Health Benefits Program and NJ FamilyCare to provide "out of network" coverage for children with catastrophic illnesses.

"Breann's Law" (Bill A-2822) requires health insurers, the State Health Benefits Program, and NJ FamilyCare to cover out-of-network medical services for children diagnosed with catastrophic illnesses - defined as life-threatening conditions or those posing serious disability risks - when services are provided by referral from an in-network provider. The law mandates that coverage for these out-of-network services must be provided at the same level as in-network care under the same health plan. It applies to specific health insurance contracts, including hospital service, medical service, health service corporation plans, and group health insurance policies issued in New Jersey. This policy change directly affects families of children with severe illnesses who previously faced barriers to accessing specialized care outside their insurance network.

Topics ✓ HealthcareSupports HealthcareMandates insurers to cover out-of-network care for children with catastrophic illnesses at in-network levels, expanding access and protecting patient rights under insurance plans.95% confidence

Sub-Topics Hospitals Insurance

Track

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

AR 26: Urges Congress to deschedule marijuana as Schedule I controlled substance under federal "Controlled Substances Act."

This New Jersey Assembly Resolution (AR 26) urges Congress to remove marijuana from Schedule I of the federal Controlled Substances Act. It directly affects medical marijuana patients and businesses in New Jersey (and 37 other states) who face barriers due to federal classification, including lack of insurance coverage, banking restrictions, and high costs ($350-$500 monthly for patients). The resolution highlights that marijuana's Schedule I status conflicts with its accepted medical use in many states and scientific evidence of health benefits. It seeks to protect public safety by ending federal restrictions that force dispensaries to handle large cash amounts, increasing crime risks. The bill does not change current law but calls for congressional action to align federal policy with state legalization.

Topics ✓ Criminal JusticeSupports Criminal JusticeDescheduling marijuana reduces federal criminalization, aligning with criminal justice reform by eliminating barriers for medical users and ending federal prohibition conflicts.95% confidence ✓ HealthcareSupports HealthcareRemoves federal barrier to medical marijuana, enabling insurance coverage and reducing patient costs ($350-$500 monthly), directly improving healthcare access and patient rights.95% confidence

Sub-Topics Drug Policy Insurance

Track

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

A 1571: Requires certain health benefits coverage for diagnosing and treating autism and other developmental disabilities.

This New Jersey bill (A1571) requires health insurance companies to cover diagnosis and treatment for autism and certain developmental disabilities. It directly affects health insurers operating in New Jersey and individuals with these conditions, mandating coverage for screening, diagnosis, and therapies like speech, occupational, and physical therapy without denying benefits based on "non-restorative" treatment. The bill sets annual benefit limits ($36,000 in 2011, adjusted yearly after 2012 for inflation) and requires treatment plans specifying therapies, frequency, and goals. It clarifies that coverage doesn’t replace school-based services but ensures insurance pays for related costs.

Topics ✓ HealthcareSupports HealthcareMandates health insurers to cover autism/developmental disability diagnosis/treatment, expands coverage without 'non-restorative' denials, directly improves patient access to essential services.95% confidence

Sub-Topics Insurance

Track

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

A 4270: Requires Medicaid and health insurance network contracts to provide participating health care providers with certain notifications.

This bill (A4270) requires Medicaid programs and health insurance carriers in New Jersey to give participating healthcare providers at least six months' written notice before changing policies that could lead to denial of coverage for services provided to patients. It directly affects doctors, clinics, and other healthcare providers who contract with Medicaid or private health plans. The key provision mandates that carriers must notify providers well in advance of any policy changes impacting coverage eligibility, ensuring providers have time to adjust. This applies to all managed care plans under New Jersey's Medicaid program, FamilyCare Health Coverage, and authorized health insurers.

Topics ✓ HealthcareSupports HealthcareRequires 6-month notice before coverage policy changes, preventing abrupt denials and protecting provider-patient continuity in healthcare services.90% confidence

Sub-Topics Insurance Medicaid

Track

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

A 1937: Requires health insurance companies to cover lead screenings for children 16 years of age or younger.

This bill requires health insurance companies in New Jersey to cover lead screenings for all children 16 years of age or younger. It mandates that healthcare providers (including doctors, nurses, and facilities serving children) perform these screenings unless parents object in writing, and follow up with families if elevated lead levels are detected. The Department of Health must establish regulations based on CDC guidelines, including screening schedules, follow-up protocols, and public education campaigns about lead poisoning risks. The law directly affects children under 16, their families, healthcare providers, and health insurers.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for pediatric lead screenings, expanding preventive care access and aligning with CDC public health guidelines.95% confidence

Sub-Topics Insurance

Track

in committee · New Jersey · Senate Feb 12, 2026

S 3477: Requires health benefits plan and carriers to meet certain requirements concerning network adequacy and mental health care.

This bill (S 3477) requires health insurance carriers in New Jersey - including Medicaid, private plans, and self-funded employer plans - to ensure mental health care access for all covered individuals. It mandates that carriers maintain sufficient mental health providers in their networks, guaranteeing 100% of enrollees can access in-person care within 15 miles and 30 days, or telehealth/telemedicine care within 30 days if in-person options are unavailable. Insurers must cover telehealth mental health services on the same terms as in-person visits, with no higher deductibles/copays and reimbursement rates at least matching Medicaid rates. The law applies to all health benefits plans (excluding accident-only, disability, or workers' compensation coverage) and establishes penalties for noncompliance.

Topics ✓ HealthcareSupports HealthcareMandates mental health network adequacy and telehealth access, improving patient access to care per bill requirements.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentMandates mental health coverage access for employees, strengthening workplace benefits and worker health protections under employment standards.95% confidence

Sub-Topics Insurance Medicaid Mental Health

Track