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Bill

HS

Bill

A 5785

Requires certain preventive services to be provided on calendar year basis.

2024-2025 Regular Session Introduced by Heather Simmons

New Jersey bill requiring health insurers to provide preventive services on a calendar year basis, standardizing annual benefit resets to January 1st.

Introduced in the Assembly, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 5785

Legislative bill overview

Bill A 5785 requires health insurance plans to cover certain preventive services on a calendar year basis rather than other measurement periods. This means coverage resets and benefits become available annually on January 1st, creating a standardized timeline across plans for preventive care access.

Why is this important

Preventive services—like screenings, vaccinations, and wellness visits—are critical for early disease detection and public health. Standardizing coverage to a calendar year basis simplifies understanding for consumers and providers, reduces administrative confusion about when benefits reset, and may increase preventive care utilization by making eligibility more predictable.

Potential points of contention

  • Insurance industry costs: Insurers may argue that calendar-year requirements increase administrative burden and costs compared to benefit-year or plan-year structures, which they claim allow better risk management
  • Plan flexibility: Some employers and insurers prefer plan years aligned with business calendars rather than calendar years, potentially creating compliance complexity for multi-state insurers
  • Definition ambiguity: The bill's reference to "certain preventive services" may lack clarity about which services qualify, creating disputes over coverage requirements and potential loopholes

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

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