Summary of Bill S 965

Bill Number: S 965

Title: Requires insurers to provide insurance coverage for rare diseases, life-threatening conditions or diseases, degenerative and disabling conditions, or diagnoses involving medically fragile children

Status: Referred to Insurance

Introduced: January 08, 2025

Classification: Bill

Purpose and Intent

Bill S 965 aims to ensure that individuals suffering from rare diseases, life-threatening conditions, degenerative and disabling conditions, or those with medically fragile children receive adequate insurance coverage. The bill seeks to address gaps in health insurance that often leave these vulnerable populations without necessary medical support and treatment options.

Key Provisions

• Insurance Coverage Mandate: The bill mandates that health insurance providers include coverage for:

  • Rare diseases
  • Life-threatening conditions
  • Degenerative and disabling conditions
  • Diagnoses involving medically fragile children

• Definition of Conditions: The bill provides a framework for defining what constitutes a "rare disease" and other specified conditions, ensuring clarity in the types of illnesses that will be covered.

• Access to Treatment: By requiring insurers to cover these conditions, the bill aims to improve access to necessary treatments, therapies, and medications that are often prohibitively expensive or not covered under standard insurance plans.

Who Would Be Affected

• Patients with Rare Diseases: Individuals diagnosed with rare diseases who currently face challenges in obtaining insurance coverage for their treatments.
• Families of Medically Fragile Children: Families caring for children with serious health conditions that require ongoing medical attention and support.
• Healthcare Providers: Medical professionals and institutions that treat patients with these conditions may see an increase in patients seeking care due to improved insurance coverage.

Procedural Aspects

• Current Status: As of January 8, 2025, the bill has been referred to the Insurance Committee for further consideration.
• Related Legislation:
  • A 2384: A companion bill that may address similar issues in the Assembly.
  • S 8957: A prior-session bill that may provide context or background on the legislative intent and discussions surrounding insurance coverage for these conditions.

Conclusion

Bill S 965 represents a significant step towards improving healthcare access for individuals with rare and life-threatening conditions. By mandating insurance coverage for these critical areas, the bill aims to alleviate the financial burden on affected families and ensure that necessary medical treatments are accessible to those in need. The bill is currently under review by the Insurance Committee, and its progress will be closely monitored by stakeholders in the healthcare community.