S 2346 extends health insurance coverage for adult children with disabilities beyond the typical age limit of 26. It requires health plans to continue coverage for individuals 26 or older who have an intellectual disability or physical handicap and are chiefly dependent on their parent for support. The law prohibits health plans from denying coverage based on factors like marriage, having a child, or not living with the parent. This applies to hospital, medical, and health service corporation contracts in New Jersey, ensuring continuous coverage for a specific group of disabled adults who rely on parental support.
This bill requires health insurance plans in New Jersey to cover specific treatments for lipedema, a chronic fat disorder. It mandates coverage for compression garments, manual lymphatic drainage, medical nutrition therapy, mental health care, and medically necessary lipectomies (including pre- and post-surgery appointments). Insurers must base coverage decisions on physician diagnoses and surgeon documentation (including photos for lipectomies), cannot deny coverage solely based on photos, and must honor prior authorizations for lipectomies for one year. The coverage must match the same deductibles, coinsurance, and standards of care as other similar medical treatments. This directly affects insured residents diagnosed with lipedema and their health insurance providers.
This bill (S 2587) requires New Jersey health insurance companies to cover mental health treatment and therapy for domestic violence victims as "medically necessary," eliminating any policy provision that would deny such coverage. It directly affects domestic violence victims seeking mental health care and applies to all health insurance policies (group, individual, and health service contracts) sold in New Jersey. The law mandates that insurers provide full coverage for these services at the same level as other medically necessary treatments, with no separate co-pays or denials based on the domestic violence context. The bill amends existing insurance statutes to explicitly prohibit coverage denials for mental health care related to domestic violence, ensuring victims receive equal treatment under their insurance plans.
This bill automatically enrolls New Jersey residents who lose Medicaid due to income changes (but lack employer-based health coverage) into a state health insurance plan through the NJ FamilyCare exchange. It requires the Department of Human Services to share eligibility data with the Department of Banking and Insurance, triggering enrollment in the lowest-cost silver plan (for incomes ≤200% of federal poverty level) or best-value plan (for higher incomes) before Medicaid ends. The bill also mandates that the state publicly post monthly data on NJ FamilyCare renewal processing times, call center wait times, and eligibility termination reasons. These changes directly affect individuals transitioning from Medicaid to private coverage due to income shifts.
This bill creates the Office of the New Jersey Consumer Insurance Advocate within the Division of Insurance. The advocate, appointed by the Governor with Senate approval for a four-year term, will represent consumers before state government branches on all insurance matters covered by New Jersey law. The position requires a bachelor's degree and five years of experience in property/casualty or life/health insurance. This office directly serves New Jersey consumers by providing dedicated advocacy on insurance issues, including before the Legislature and courts. The advocate will focus on consumer interests across all insurance lines regulated in the state.
This New Jersey bill (S 1976) prohibits hospitals from charging patients for medical transport between hospitals when no alternative transport options (like private vehicles) are clinically appropriate for the patient's condition. It directly affects patients requiring such transport who have no other safe or medically suitable choices. Hospitals may still bill health insurance plans for these services, and the bill does not apply to nonvolunteer ambulance services responding to 911 calls for transport to the nearest appropriate hospital. The law would take effect immediately upon passage.
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.
