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Bill > S1275
NJ S1275
NJ S1275Requires health insurance coverage of diagnostic and supplemental breast examinations without cost-sharing.
summary
Introduced
01/13/2026
01/13/2026
In Committee
01/13/2026
01/13/2026
Crossed Over
Passed
Dead
Introduced Session
2026-2027 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 mandates that health insurance carriers, including various types of corporations and state-administered health programs, must cover diagnostic and supplemental breast examinations without requiring any cost-sharing from the insured. A "diagnostic breast examination" is defined as a medically necessary exam, following National Comprehensive Cancer Network Guidelines, used to investigate a breast abnormality detected through screening or other means, and can include advanced imaging like contrast-enhanced mammography or MRI. A "supplemental breast examination" is also a medically necessary exam, following the same guidelines, but is used for screening when no abnormality is suspected, based on risk factors such as family history or dense breast tissue. This coverage applies to new and renewed insurance contracts and policies, with specific provisions for high-deductible and catastrophic health plans to align with federal law.
Committee Categories
Business and Industry
Sponsors (4)
Last Action
Introduced in the Senate, Referred to Senate Commerce Committee (on 01/13/2026)
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/2026/S1275 |
| BillText | https://pub.njleg.gov/Bills/2026/S1500/1275_I1.HTM |
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