Bill
Bill > S4309
NJ S4309
Requires health insurance coverage of diagnostic and supplemental breast examinations without cost-sharing.
summary
Introduced
05/12/2025
05/12/2025
In Committee
05/12/2025
05/12/2025
Crossed Over
Passed
Dead
Introduced Session
2024-2025 Regular Session
Bill Summary
This bill requires health insurance carriers (insurance companies, health, hospital, and medical service corporations, health maintenance organizations, and State and School Employees' Health Benefits Program contracts) to provide coverage for diagnostic and supplemental breast examinations without cost-sharing. Under the bill, "diagnostic breast examination" means a medically necessary and appropriate, in accordance with National Comprehensive Cancer Network Guidelines, examination of the breast (including, but not limited to, such an examination using contrast-enhanced mammography, diagnostic mammography, breast magnetic resonance imaging, breast ultrasound, or molecular breast imaging) that is used to evaluate an abnormality: (1) seen or suspected from a screening examination for breast cancer; or (2) detected by another means of examination. Under the bill, "supplemental breast examination" means a medically necessary and appropriate, in accordance with National Comprehensive Cancer Network Guidelines, examination of the breast (including, but not limited to, such an examination using contrast-enhanced mammography, breast magnetic resonance imaging, breast ultrasound, or molecular breast imaging) that is: (1) used to screen for breast cancer when there is no abnormality seen or suspected; and (2) based on personal or family medical history or additional factors that increase the individual's risk of breast cancer (including heterogeneously or extremely dense breasts).
AI Summary
This bill requires all health insurance carriers in New Jersey, including hospital service corporations, medical service corporations, health service corporations, individual and group health insurance policies, health benefits plans, health maintenance organizations, and state and school employee health programs, to provide full coverage for diagnostic and supplemental breast examinations without any cost-sharing requirements. The bill defines "diagnostic breast examination" as a medically necessary breast examination (such as mammography, MRI, ultrasound, or molecular imaging) used to evaluate an abnormality detected during a cancer screening or by other means, and "supplemental breast examination" as a medically necessary breast examination used to screen for cancer when no abnormality is present, based on personal or family medical history or risk factors like breast density. These provisions apply to virtually all types of health insurance plans in the state, with some specific exceptions for high-deductible and medical savings account plans, and will take effect on the first day of the fourth month following enactment. The goal of the bill is to ensure that individuals can access important breast cancer screening and diagnostic services without facing financial barriers like deductibles, copayments, or other out-of-pocket expenses.
Committee Categories
Business and Industry
Sponsors (4)
Last Action
Introduced in the Senate, Referred to Senate Commerce Committee (on 05/12/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.njleg.state.nj.us/bill-search/2024/S4309 |
| BillText | https://pub.njleg.gov/Bills/2024/S4500/4309_I1.HTM |
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