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A 4357

Extends certain pay parity regarding telemedicine and telehealth.*

2026-2027 Regular Session Introduced by Rosy Bagolie and 4 co-sponsors

Extends permanent parity: health plans must reimburse telemedicine the same as in-person care, with defined exceptions for audio-only and some behavioral health cases.

Substituted by S3947 (1R)
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Bill Summary · A 4357

Bill Summary: A 4357 (Session 222) – New Jersey

Title

Extends permanently certain pay parity regarding telemedicine and telehealth

Purpose and Intent

  • To permanently require health benefits carriers in New Jersey to cover and pay for telemedicine and telehealth services at the same provider reimbursement rate as in-person services, under the same coverage conditions that apply to in-person care.
  • Builds on and makes permanent a provision previously set to expire (P.L.2021, c.310, sec. 11).

Key Provisions

Section 8 (amendment of P.L.2017, c.117)

  • Carriers offering health benefits plans in New Jersey must provide coverage and payment for telemedicine/telehealth services on the same basis as in-person services, as long as the services are otherwise covered when delivered in person in New Jersey.
  • Reimbursement may be paid to the individual practitioner or to the practitioner’s employer/agency/organization, as appropriate.
  • Carriers may limit coverage to in-network providers, but:
    • They may not charge higher deductibles, copayments, or coinsurance for telemedicine/telehealth that would exceed those for in-person care.
    • They may not impose several restrictions on the location settings of distant or originating sites, so long as the telemedicine/telehealth services meet the same standard of care as in-person care.
    • They may not restrict the platform used for telemedicine to a limited set of providers or technologies, so long as the platform meets the standard of care and complies with federal privacy rules (45 CFR Parts 160 and 164).
    • They must cover routine patient monitoring (e.g., remote vital signs checks) if such services would be covered in-person.
    • They cannot limit coverage only to select third-party telemedicine/telehealth organizations.
  • Provisions do not:
    • Prohibit coverage for medically necessary services (subject to plan terms).
    • Require use of telemedicine in lieu of an in-person visit with an in-network provider.

New Section (Section 2)

  • A carrier must provide telemedicine/telehealth coverage at a reimbursement rate equal to the in-person reimbursement rate for the same service, provided the service is otherwise covered for in-person care in New Jersey.
  • Exceptions where the parity requirement does not apply:
    1. Telemedicine/telehealth services provided by a telemedicine/telehealth organization that does not offer the service in-person in New Jersey.
    2. Physical health care services delivered via real-time, two-way audio without a video component (including audio-only telephone), with reimbursement determined by the contract with the provider. Specifically, for audio-only:
      • Reimbursement for such services must be at least 50% of the in-person rate.
    3. Behavioral health services delivered via real-time, two-way audio without video (even if combined with store-and-forward). For these, reimbursement must equal the in-person rate.
  • Definitions: The section reaffirms and aligns definitions for terms like carrier, covered person, health benefits plan, telemedicine, telehealth, synchronous/asynchronous modalities, distant/originating sites, and telemedicine/telehealth organizations, using existing statutory definitions.

Effective Date

  • The act takes effect immediately upon enactment.

Affected Parties

  • Health benefits carriers (insurers, health service corporations, hospital service and medical service corporations, and health maintenance organizations) operating in New Jersey.
  • Covered persons (enrollees) who receive telemedicine/telehealth services.
  • Healthcare providers delivering telemedicine/telehealth (including individual practitioners, agencies, facilities, or organizations employing the practitioners).
  • Telemedicine/telehealth organizations, including those offering asynchronous or audio-only services in certain cases.

Procedural and Timeline Notes

  • Introduced: February 19, 2026
  • Committee: Assembly Financial Institutions and Insurance
  • This is a permanent extension of a previously temporary payment parity requirement established in P.L.2021, c.310.

Practical Impact and Implications

  • Improves certainty and consistency in telemedicine reimbursement by ensuring parity with in-person services for most covered cases.
  • Aims to reduce out-of-pocket costs for patients seeking telehealth to match in-person deductibles/copays/coinsurance.
  • Encourages flexibility in telemedicine modalities (including audio-only in certain situations) while maintaining care standards and privacy compliance.
  • Provides broad protections against unreasonable restrictions on telemedicine delivery platforms and patient/provider location settings.
  • Retains certain exceptions, notably around audio-only and behavioral health nuances, with specific reimbursement rules.

If you’d like, I can provide a side-by-side comparison with the current law (P.L.2017, c.117 and P.L.2021, c.310) to highlight changes and the scope of impact in a quick reference format.

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

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