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Bill

S 4148

Establishes "New Jersey Menopause Coverage Act"; requires health insurance coverage of medically necessary perimenopause and menopause treatments.

2024-2025 Regular Session Introduced by Renee Burgess and 3 co-sponsors

New Jersey bill requires health insurers to cover medically necessary menopause and perimenopause treatments, expanding access to hormone replacement therapy and related therapies.

Substituted by A5278 (2R)
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Bill Summary · S 4148

Legislative bill overview

S 4148 mandates that health insurance plans in New Jersey cover medically necessary treatments for perimenopause and menopause symptoms. The bill aims to ensure that hormone replacement therapy, non-hormonal medications, and other evidence-based treatments for menopause are accessible to insured individuals without prohibitive cost barriers.

Why is this important

Menopause affects millions of women and can cause debilitating symptoms including hot flashes, night sweats, mood changes, and sleep disruption that impact work performance and quality of life. Without insurance coverage mandates, these treatments can be expensive and inaccessible, disproportionately affecting lower-income individuals who need them most.

Potential points of contention

  • Insurance cost implications: Insurers may argue that mandatory coverage increases premiums for all policyholders, though supporters contend costs are manageable given the prevalence of menopause
  • Definition of "medically necessary": Disagreement over which treatments qualify (HRT, SSRIs, supplements, etc.) and whether coverage includes experimental or off-label uses
  • Employer burden: Small businesses and self-insured employers may face compliance costs, raising questions about implementation timelines and penalties for non-compliance

Compiled from official sources — confirm details with the bill’s official record.

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