New Jersey Assembly Bill A5542

New Jersey 2024-2025 Regular Session

• Introduced: 4/10/25
• Refer: 4/10/25

Caption

Requires health insurance coverage of diagnostic and supplemental breast examinations without cost-sharing.

Impact

If enacted, A5542 would significantly alter the insurance landscape by improving access to critical health services for breast cancer screening and diagnosis, especially for individuals with a personal or familial history of breast cancer. The bill aims to ensure that individuals do not face financial barriers to obtaining necessary medical evaluations. By eliminating cost-sharing, it may motivate more individuals to seek out preventive care, which could lead to earlier diagnoses and improved health outcomes.

Summary

Assembly Bill A5542 introduces a mandate for health insurance carriers in New Jersey to provide coverage for both diagnostic and supplemental breast examinations without imposing any cost-sharing requirements on the insured. Specifically, the bill defines 'diagnostic breast examination' and 'supplemental breast examination' in alignment with recognized medical guidelines and mandates that these services be covered as medical conditions free of deductibles, coinsurance, or copayments. The bill aims to ensure comprehensive care for those most at risk of breast cancer and is positioned as a crucial enhancement to women's health rights within the state.

Contention

While the bill aims to improve healthcare access and prevent potential financial burdens associated with breast examinations, there may be debates surrounding its implications for insurance costs overall. Critics might argue that mandating coverage without cost-sharing could lead to higher premiums for all insured individuals as carriers adjust their pricing models to cope with the increased healthcare expenditure. There are concerns about the long-term financial sustainability of such mandates, particularly how they would affect small employers and individual plans. Advocates emphasize that investing in preventive measures now can reduce long-term healthcare costs by catching diseases earlier.