Bill > S374

This bill mandates that various health insurance plans and contracts in New Jersey, including those from hospital service corporations, medical service corporations, health service corporations, individual and group health insurance policies, health benefits plans for individuals and small employers, health maintenance organizations (HMOs), and contracts purchased by the State Health Benefits Commission and the School Employees' Health Benefits Commission, must cover the treatment of lipedema. This coverage is to include expenses for compression garments, manual lymphatic drainage, medical nutrition therapy, mental health care, and medically necessary lipectomy (surgical removal of fat), along with pre- and post-operative appointments. To obtain coverage, individuals will need a physician's diagnosis of lipedema and, if applicable, documentation from their surgeon including supporting photographs and the number of lipectomies deemed necessary. The bill also specifies that prior authorization for lipectomies will be handled according to the "Ensuring Transparency in Prior Authorization Act" and that coverage terms, including deductibles and coinsurance, will be consistent with similar services and the current standard of care for lipedema.