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Bill

Bill

A 1462

"Michelle's Law"; requires health benefit plans to cover mammogram for an individual if recommended by health care provider.

2026-2027 Regular Session Introduced by Brian Bergen and 5 co-sponsors

Requires New Jersey health insurers to cover provider-recommended mammograms regardless of age or standard screening criteria, expanding breast imaging access.

Introduced, Referred to Assembly Financial Institutions and Insurance Committee
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WeVote Research Nonpartisan
Bill Summary · A 1462

Legislative bill overview

Michelle's Law mandates that all health benefit plans in New Jersey cover mammograms when a healthcare provider recommends them, rather than relying on standard screening guidelines. The bill removes barriers to provider-recommended breast imaging by requiring insurance coverage regardless of age, risk factors, or other clinical criteria that might otherwise limit coverage.

Why is this important

Mammogram access directly affects early breast cancer detection and survival rates. By ensuring coverage for provider-recommended scans, the bill addresses situations where patients may need screening outside typical guidelines—such as those with family history, dense breast tissue, or symptoms—but face insurance denials that delay diagnosis or create financial burden.

Potential points of contention

  • Cost implications: Expanded coverage requirements increase insurance premiums, which may be passed to employers and employees; insurers may argue unnecessary screening increases healthcare costs without proportional benefit
  • Medical necessity standards: Creates tension between provider judgment and evidence-based screening guidelines; some argue this could lead to overutilization and unnecessary procedures, while others view it as appropriate individualization of care
  • Implementation burden: Health plans must process coverage decisions quickly for provider recommendations, requiring administrative changes and creating potential disputes over what constitutes a legitimate medical recommendation

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

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