This bill (S 3048) would limit health insurance plan costs for patients receiving follow-up care after surgery or illness. It requires insurers to allow patients to pay only **one co-payment or deductible** for all covered follow-up visits with participating providers within any 180-day period, regardless of how many visits occur. The rule applies only if patients follow their plan’s preauthorization rules for in-network care. It directly affects patients with managed care health insurance plans in New Jersey who need ongoing post-surgical or illness treatment. The bill is currently pending in the Senate Commerce Committee and would take effect for new/renewed insurance contracts after enactment.
This New Jersey bill (S 2716) requires health insurers, State Health Benefits Program (SHBP), and State Employees Health Benefits Program (SEHBP) plans to cover mammograms for all women aged 35 and older annually, and for women under 35 with specific risk factors like family history of breast cancer or dense breast tissue. It mandates coverage for baseline mammograms at age 35, annual screenings for those 35+, and additional tests (like ultrasounds or MRIs) when medically necessary due to abnormal results or risk factors. The law applies to all group and individual health insurance policies in New Jersey, ensuring coverage for these services without additional cost-sharing for patients. Insurers may review the medical necessity of additional tests but must cover them if deemed appropriate by a healthcare provider.
S 3020 requires New Jersey health insurance plans to cover all childhood immunizations recommended by the state Department of Health (DOH) without patients paying copays or deductibles. The DOH bases these recommendations on the federal Advisory Committee on Immunization Practices (ACIP), and the bill updates state law to align insurance coverage with these guidelines. Insurers must provide this coverage as part of preventive care and notify policyholders in writing of any changes to immunization coverage. This applies to all health insurance plans offering medical benefits in New Jersey, directly affecting insurers and policyholders.
This bill (S 756) mandates that health insurance plans in New Jersey (including hospital, medical, and health service corporation contracts) cover specific preventive services without requiring copayments or deductibles. It covers services rated "A" or "B" by the U.S. Preventive Services Task Force, CDC-recommended immunizations, pediatric preventive care per federal guidelines, and women’s preventive services. Plans must provide these services at least once annually within the calendar year (January 1-December 31), with coverage for out-of-network care if no in-network provider is available. The bill was withdrawn on January 13, 2026, as it had already been enacted as P.L.2025, c.386.
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.
