WeVote
Log In

Bill

Bill

S 4187

Permits payment of only one co-payment or deductible for follow-up care or treatment after surgery or illness under certain health benefits plans.

2024-2025 Regular Session Introduced by Benjie Wimberly

New Jersey bill limits patients to one co-pay/deductible per follow-up episode after surgery or illness across participating health plans.

Introduced in the Senate, Referred to Senate Commerce Committee
#healthinsur
0
WeVote Research Nonpartisan
Bill Summary · S 4187

Legislative bill overview

S 4187 would require health insurance plans to allow patients to pay only a single co-payment or deductible for follow-up care related to a specific surgery or illness, rather than charging separately for each follow-up visit or treatment. The bill applies to certain health benefits plans in New Jersey and aims to reduce out-of-pocket costs for post-operative and post-treatment care.

Why is this important

Follow-up care is often medically necessary but can become financially burdensome when patients face multiple co-payments or deductibles for related treatments. This could improve healthcare affordability and encourage patients to complete recommended follow-up care, potentially improving health outcomes and reducing complications from incomplete treatment.

Potential points of contention

  • Insurance industry concerns: Insurers may argue this reduces their ability to manage costs and could lead to higher premiums for all members
  • Definition ambiguity: The bill's language around "certain health benefits plans" and what qualifies as "follow-up care" for the same condition may be too vague and create disputes between insurers and patients
  • Scope limitations: It's unclear whether this applies to all health plans (HMOs, PPOs, self-insured employer plans) or only specific types, potentially creating unequal coverage protections

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

Sign in to ask a question.