Bill
A 4027
Mandates insurers and state plans cover preimplantation genetic testing with IVF for qualifying noninfertile carriers, parity with infertility benefits, plus religious exemptions.
Note: the bill title you supplied ("Establishes the reckless driving prevention grant program") does not match the bill documents you provided. The documents for A‑4027 apply to health insurance coverage of preimplantation genetic testing (PGT) with in vitro fertilization (IVF). This summary reflects the text, committee amendment, and fiscal note in the provided documents.
Purpose
- Require health insurance carriers to cover preimplantation genetic testing (PGT) performed in conjunction with in vitro fertilization (IVF) for certain non‑infertile covered persons in order to prevent serious genetic conditions from being passed to offspring.
Key provisions
- Coverage requirement: Hospital service corporations, medical service corporations, health maintenance organizations, group health insurance policies, and entities administering State and school employee benefit programs must provide coverage for PGT with IVF even if the covered person is not infertile, when the following criteria apply:
1. Both partners are known carriers of an autosomal recessive disorder; or
2. One partner is a carrier of a single‑gene autosomal recessive disorder and the couple has an existing child diagnosed with that disorder; or
3. One partner is a known carrier of a single‑gene autosomal disorder; or
4. One partner is a known carrier of a single X‑linked disorder; and
5. The genetic condition, if transmitted, would cause significant health problems or severe disability in offspring.
- Definition: “Preimplantation genetic testing” = technique used to identify genetic defects in embryos created through IVF before pregnancy.
- Parity: Benefits for infertility/PGT shall be provided to the same extent as other pregnancy‑related procedures under the contract (same copayments, deductibles and benefit limits), and services must be provided at facilities meeting American Society for Reproductive Medicine (ASRM) or American College of Obstetricians and Gynecologists (ACOG) standards.
- Infertility coverage details (retained/updated language): lists covered infertility services, allows up to four completed egg retrievals per lifetime, and permits carriers to limit IVF to those who have tried less‑invasive options, are ≤45 years old, and have not reached the egg‑retrieval limit.
- Religious employer exemption: a religious employer may request exclusion for IVF and related procedures if coverage conflicts with bona fide religious tenets; required notice to subscribers.
Scope and applicability
- Applies to private carriers and to coverage administered in connection with the State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP).
- Exempts programs providing NJ Medicaid/NJ FamilyCare benefits (per existing law).
Fiscal impact (Office of Legislative Services)
- Estimated annual increase in State expenditures (SHBP): $248,000 to $1.3 million.
- Estimated annual increase in local expenditures (SEHBP/SHBP local share): $310,000 to $1.7 million.
- Total estimated annual increase: $558,000 to $3.0 million.
- Cost drivers and assumptions: ~5% of births in NJ use IVF; ~44% of IVF conceptions nationally use PGT; average per‑cycle test cost differs by type — PGT‑M $7,000–$12,000; PGT‑A $2,250–$4,000; PGT‑SR $5,000–$7,000. Actual costs will vary depending on program design (e.g., number of tests covered per cycle, monetary limits).
- OLS prepared the estimate after no fiscal note was provided by the Executive Branch.
Legislative status & timeline
- Introduced in Assembly: March 7, 2024 (sponsored by Assemblyman Anil Beephan Jr.).
- Reported from Assembly Financial Institutions and Insurance Committee with amendments: October 24, 2024 (amendments updated statute references and clarified definitions/coverage).
- Referred to Assembly Appropriations Committee (after committee report).
- Later entries show referral to Transportation on January 30, 2025 (this appears to be a procedural referral record — the bill’s subject is insurance/health benefits).
Related/companion legislation
- Companion/related Senate bills: S‑1032, S‑1413; prior‑session S‑9932.
Who is affected
- Insured individuals seeking to use IVF/PGT to avoid passing on serious genetic conditions (including non‑infertile people meeting the listed carrier/condition criteria).
- Health insurers, HMOs, medical/service corporations doing business in NJ.
- The State Health Benefits Program, School Employees’ Health Benefits Program, and participating local governments (due to projected cost increases).
- Employers (notably religious employers may claim the exemption provided).
Notes and considerations
- The bill includes limits carriers may impose consistent with current infertility coverage (age and prior treatment requirements).
- Exact fiscal effects depend on benefit design choices made by the SHBP and SEHBP and by private carriers (e.g., whether multiple tests per IVF cycle are covered).
Compiled from official sources — confirm details with the bill’s official record.
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