Bill
Bill > A5542
NJ A5542
Requires health insurance coverage of diagnostic and supplemental breast examinations without cost-sharing.
summary
Introduced
04/10/2025
04/10/2025
In Committee
04/10/2025
04/10/2025
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 maintenance organizations, and state and school employee health benefit programs, to provide coverage for diagnostic and supplemental breast examinations without imposing any cost-sharing requirements. A diagnostic breast examination is defined as a medically necessary breast examination (such as mammography, MRI, ultrasound, or molecular breast imaging) used to evaluate an abnormality detected during a screening or by another means, in accordance with National Comprehensive Cancer Network Guidelines. A supplemental breast examination is similarly defined as a medically necessary breast examination used to screen for cancer when no abnormality is detected, based on personal or family medical history or other risk factors like dense breast tissue. The bill applies to most types of health plans, including high-deductible and catastrophic plans, to the maximum extent permitted by federal law, and will take effect on the first day of the fourth month following its enactment, applying to all new and renewed insurance contracts and policies.
Committee Categories
Business and Industry
Sponsors (4)
Last Action
Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 04/10/2025)
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/A5542 |
| BillText | https://pub.njleg.gov/Bills/2024/A6000/5542_I1.HTM |
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