Healthcare (Insurance)

in committee · New Jersey · Senate Jan 13, 2026

S 377: Prohibits health insurance carriers from obtaining pharmacy benefits manager licenses.

This bill prohibits health insurance carriers (like major insurance companies) from obtaining or renewing licenses to operate as pharmacy benefits managers (PBMs). PBMs are entities that manage prescription drug programs for insurers, and this law specifically blocks insurers from holding these licenses. The bill amends existing licensing rules to require PBMs to meet strict standards for conflicts of interest, anti-competitive practices, and consumer protection, but explicitly bars health insurance carriers from applying for or maintaining such licenses. It does not affect existing PBM licenses held by non-insurer entities.

Topics ✓ HealthcareSupports HealthcareBlocks health insurers from owning PBMs to prevent conflicts of interest and enforce consumer protections, strengthening oversight in pharmacy benefit management.90% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · New Jersey · Senate Jan 13, 2026

S 2890: Requires 90 days' notice of cancellation or nonrenewal of stop loss insurance for small employer health benefits plans.

This bill requires health insurance companies to provide small employers with at least 90 days' written notice before canceling or refusing to renew their stop loss insurance policies. Stop loss insurance protects small employers from unexpectedly high medical costs in self-funded health plans for their employees. The notice must be in a specific format set by the state insurance regulator, and the rule applies to policies issued or renewed 90 days after the bill becomes law. It directly affects small employers using self-funded health plans and their insurance providers in New Jersey.

Topics ✓ HealthcareSupports HealthcareRequires 90 days' notice for stop loss insurance cancellation, protecting small employers from sudden coverage disruptions and ensuring stability in health insurance for employees.90% confidence ✓ Labor & EmploymentSupports Labor & EmploymentRequires 90-day notice for stop loss insurance cancellations, preventing abrupt loss of employer health benefits for employees and ensuring coverage stability.92% confidence

Sub-Topics Insurance

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in committee · New Jersey · Senate Jan 13, 2026

S 1972: Lowers age at which certain insurers are required to provide coverage for mammograms.

This bill (S 1972) lowers the required age for routine mammogram coverage from 40 to 35 for most women under New Jersey insurance plans. It requires all group and individual health insurance contracts (including hospital service, medical service, and health service corporation plans) to cover one baseline mammogram at age 35, followed by annual mammograms for women aged 35 and older. Women under 35 with family history or other breast cancer risk factors continue to receive coverage as deemed medically necessary by their provider. The law also maintains existing coverage for additional tests like ultrasounds or MRIs when medically indicated due to dense breast tissue or other risk factors. This change directly affects insurers and policyholders by expanding access to preventive breast cancer screening earlier.

Topics ✓ HealthcareSupports HealthcareLowers mammogram coverage age from 40 to 35, expanding preventive care access and strengthening insurance coverage for women under New Jersey plans.95% confidence

Sub-Topics Hospitals Insurance

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died · New Jersey · Senate Jan 13, 2026

S 1422: Extends time period in which to enroll newborn infant in health benefits coverage.

S 1422 extends the deadline for enrolling a newborn infant in health benefits coverage from 60 to 90 days after birth. This change directly affects parents or guardians enrolled in family health insurance plans who must submit birth notification and required payments to maintain continuous coverage for their newborn. The bill modifies existing law to provide an additional 30 days for completing enrollment, ensuring families have more time to secure coverage without gaps. This adjustment applies specifically to family-type health insurance contracts under New Jersey's statutory framework.

Topics ✓ HealthcareSupports HealthcareExtends newborn enrollment deadline from 60 to 90 days, reducing coverage gaps and improving access to health benefits for families.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentExtends health coverage enrollment deadline for newborns, reducing gaps in family health benefits tied to employer-sponsored plans, aligning with worker benefit protections.90% confidence

Sub-Topics Insurance

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in committee · New Jersey · Senate Jan 13, 2026

S 2892: Requires Commissioner of Banking and Insurance to develop standard prior authorization form for prescription drug benefits for use by network providers.

This bill requires New Jersey's Commissioner of Banking and Insurance to create a single, standardized form for network providers (like doctors and pharmacies) to request prior authorization for prescription drug coverage. Payers (insurance companies) must accept this standard form in both paper and electronic formats for all prescription drug benefit requests. The law directly affects providers needing authorization and payers handling those requests, replacing inconsistent forms with a uniform system. It aims to simplify the process for healthcare providers seeking insurance coverage approval for medications. The bill takes effect immediately upon enactment.

Topics ✓ HealthcareSupports HealthcareStandardizes prior authorization forms for prescriptions, reducing administrative delays and improving patient access to medication coverage through streamlined insurance processes.85% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · New Jersey · Senate Jan 13, 2026

S 2812: Requires DOH to maintain emergency stockpile of insulin and authorizes dispensing of emergency supply of insulin to certain patients.

This bill requires New Jersey's Department of Health to maintain an emergency insulin stockpile with the 10 most common insulin types used by residents, reevaluated quarterly. It creates a program to provide one emergency 30-day insulin supply per year at cost to residents whose supply runs out before their next prescription, with reimbursement options from health plans. The bill also updates insurance coverage requirements to mandate benefits for one emergency insulin supply annually under health plans. It applies directly to New Jersey residents facing insulin shortages and establishes clear limits on emergency dispensing to prevent overuse.

Topics ✓ HealthcareSupports HealthcareMandates insulin stockpile, emergency supply program, and insurance coverage for emergency insulin access, improving patient access to critical medication.95% confidence

Sub-Topics Insurance Prescription Drugs

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in committee · New Jersey · Senate Jan 13, 2026

S 988: Prohibits pre-approval or precertification of prenatal ultrasound screenings covered under health benefits plans.

This bill prohibits health insurers, third-party administrators, and state health benefit programs from requiring prior approval or precertification for covered prenatal ultrasounds. It applies only when the ultrasound is prescribed by a licensed provider and already covered under a health plan. The law directly affects insurance companies, state programs like the State Health Benefits Program, and school employee health plans. It takes effect immediately for new health benefit plans.

Topics ✓ HealthcareSupports HealthcareRemoves insurer barriers for covered prenatal ultrasounds, improving patient access to existing covered services without restricting coverage.95% confidence

Sub-Topics Insurance

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in committee · New Jersey · Senate Jan 13, 2026

S 1022: Prohibits downcoding in health insurance claims.

This bill prohibits health insurance companies and other payers in New Jersey from "downcoding" claims - meaning they cannot adjust claims to a lower-cost service code to pay providers less than what is owed for the actual service performed. It directly affects healthcare providers (like doctors and hospitals) who submit claims for services, ensuring they can collect full payment for the care they delivered. The law requires payers to reimburse providers based on the actual service documented, not a downcoded version, and mandates the Department of Banking and Insurance to create implementing regulations. Downcoding typically occurs when insurers dispute a service code, but this bill prevents them from using it to reduce payments unfairly.

Topics ✓ HealthcareSupports HealthcareProhibits downcoding to ensure full reimbursement for providers, protecting their ability to deliver care and maintain service quality without insurer underpayment.95% confidence

Sub-Topics Insurance

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in committee · New Jersey · Senate Jan 13, 2026

S 3109: Requires DOBI to monitor, evaluate, and submit annual report concerning mental health parity.

S 3109 requires New Jersey health insurance carriers to submit annual reports to the Department of Banking and Insurance (DOBI) by March 1st. These reports must detail how carriers apply medical necessity criteria and non-quantitative treatment limitations (NQTLs) to mental health and substance use disorder benefits, comparing them to medical/surgical benefits to ensure parity. Key provisions include analyzing whether processes for mental health coverage are applied no more stringently than for other medical services, covering NQTLs like step therapy, network design, and formulary rules. The bill directly affects all health insurers operating in New Jersey, mandating transparency to verify compliance with federal mental health parity laws. This is a procedural requirement focused on monitoring, not altering coverage.

Topics ✓ HealthcareSupports HealthcareRequires insurers to report on mental health parity compliance, preventing discriminatory coverage and strengthening patient access to mental health services per NQTL analysis.95% confidence

Sub-Topics Insurance Mental Health Substance Abuse

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in committee · New Jersey · Senate Jan 13, 2026

S 2478: Requires DHS to create English and Spanish-language Internet websites to promote enrollment in affordable health care plans.

S 2478 requires New Jersey's Department of Human Services to create two dedicated websites promoting enrollment in Medicaid and NJ FamilyCare programs. One website will be in English, listing health navigators and community centers that assist with health insurance enrollment, including the languages spoken at each location. A second website will provide identical content entirely in Spanish with a Spanish-language domain name to improve access for Spanish-speaking residents. This bill directly affects New Jersey residents, particularly those with limited English proficiency, by making health care enrollment resources more accessible and culturally responsive.

Topics ✓ HealthcareSupports HealthcareCreates language-accessible websites to improve enrollment in Medicaid/NJ FamilyCare, expanding access for Spanish speakers in healthcare coverage programs.90% confidence ✓ ImmigrationSupports ImmigrationCreates Spanish-language health care enrollment resources, directly improving access to immigrant services for Spanish-speaking residents without restricting immigration or enforcement.95% confidence ✓ TechnologySupports TechnologyCreates multilingual health care websites to improve access for Spanish speakers, promoting digital equity and internet access as part of service enrollment.90% confidence

Sub-Topics Insurance Medicaid

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