Bill > A5790

This bill requires various types of health insurance providers in New Jersey to provide comprehensive coverage for the treatment of lipedema, a medical condition characterized by abnormal fat accumulation in the limbs. The bill mandates that health insurance plans cover expenses including compression garments, manual lymphatic drainage, medical nutrition therapy, mental health care, medically necessary lipectomy (surgical fat removal), and related pre- and post-surgical medical appointments. Insurance providers can only require documentation from a physician diagnosing lipedema and, if applicable, supporting photographs from a surgeon. The bill prohibits insurers from denying coverage solely based on submitted photographs and requires them to cover the full number of lipectomies deemed medically necessary by the patient's surgeon. Additionally, the bill updates prior authorization procedures for lipectomy procedures to align with the "Ensuring Transparency in Prior Authorization Act" and requires that these benefits be provided with the same cost-sharing as similar services and consistent with current medical standards for lipedema treatment. The legislation applies to various types of health insurance contracts, including hospital service corporations, medical service corporations, health service corporations, individual and group health insurance policies, health maintenance organizations, and state health benefits plans. The act will take effect six months after enactment and apply to contracts entered into or renewed after that date.

Budget and Finance, Business and Industry

https://www.njleg.state.nj.us/bill-search/2024/A5790