Bill

Bill > S2759


NJ S2759

Requires health insurers, SHBP and SEHBP to provide coverage for diagnosis, evaluation and treatment of lymphedema.


summary

Introduced
02/15/2024
In Committee
02/15/2024
Crossed Over
Passed
Dead

Introduced Session

2024-2025 Regular Session

Bill Summary

This bill requires health insurers and health maintenance organizations, as well as health benefits plans or contracts which are issued or purchased pursuant to the New Jersey Individual Health Coverage Program, New Jersey Small Employer Health Benefits Program, State Health Benefits Program, and School Employees' Health Benefits Program, to provide coverage for expenses incurred in the diagnosis, evaluation, and treatment of lymphedema that is determined to be medically necessary by the treating physician. Lymphedema is caused by an abnormality of the lymphatic system leading to excessive build-up of tissue fluid that forms lymph, known as interstitial fluid. Interstitial fluid can build up in any area of the body that has inadequate lymph drainage and cause lymphedema. Left untreated, lymphedema leads to chronic inflammation, infection and hardening of the skin that, in turn results in further lymph vessel damage and distortion of the shape of affected body parts. Lymphedema is a condition that develops slowly and once present is usually progressive. Although some people are born with abnormalities in the lymphatic system, a condition known as Primary Lymphedema, most lymphedema in the United States is Secondary Lymphedema. This type of lymphedema occurs from damage to the lymphatic system, commonly from cancer and its treatment, but also from trauma to the skin such as from burns or infections. Lymphedema can occur as a result of breast cancer, melanoma, gynecologic cancer, head and neck cancer, and sarcoma. Early diagnosis of lymphedema is important since treatment is most effective when commenced at the earliest stage of the disease. Lymphedema has no cure, but can be successfully managed when properly diagnosed and treated. Every patient diagnosed with lymphedema should have access to established effective treatment.

AI Summary

This bill requires health insurers, the State Health Benefits Program (SHBP), and the School Employees' Health Benefits Program (SEHBP) to provide coverage for the diagnosis, evaluation, and treatment of lymphedema, a condition caused by an abnormality in the lymphatic system leading to fluid buildup and swelling. The coverage must be provided to the same extent and with the same cost-sharing as similar services under the respective insurance plans, and the bill applies to plans that allow the insurer to change the premium. The bill aims to ensure that patients with lymphedema have access to the necessary medical care to manage this progressive condition.

Committee Categories

Business and Industry

Sponsors (1)

Last Action

Introduced in the Senate, Referred to Senate Commerce Committee (on 02/15/2024)

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