New Jersey Assembly Bill A5785

New Jersey 2024-2025 Regular Session

• Introduced: 6/16/25
• Refer: 6/16/25

Caption

Requires certain preventive services to be provided on calendar year basis.

Impact

If enacted, A5785 would affect numerous healthcare policies, particularly those related to coverage for preventive services. By mandating that insurers cover these services without cost-sharing, the bill aims to remove barriers that may prevent individuals from seeking timely and necessary medical attention. This shift is expected to result in improved public health outcomes by facilitating greater access to preventive care. However, it may also lead to increased costs for insurers, who may have to adjust their premium rates to accommodate the expanded coverage requirements.

Summary

Assembly Bill A5785 aims to amend existing laws concerning preventive health services by requiring health insurers in New Jersey to provide coverage for certain preventive services without imposing cost-sharing requirements. This includes services rated 'A' or 'B' by the United States Preventive Services Task Force, immunizations recommended by the Advisory Committee on Immunization Practices, and additional preventive care for various demographics, including women and children. The bill seeks to enhance access to preventive care, allowing insured individuals to access necessary health services without the financial burden of copays or deductibles.

Contention

Despite its potential benefits, the bill may face opposition from various stakeholders, including insurance providers who may argue about the financial implications of such mandates. There is concern that requiring coverage without cost-sharing could lead to higher premiums for policyholders as insurers adapt to the new regulations. Furthermore, the bill's influence on out-of-network benefits is a point of contention, as it stipulates conditions under which insurers cannot impose additional charges for out-of-network preventive services, which might complicate existing provider agreements.