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Bill

A 3979

Requires health benefits coverage for treatment of lipedema.

2026-2027 Regular Session Introduced by Kevin Egan and 1 co-sponsor

Requires health insurance plans in New Jersey to cover lipedema treatment, including surgeries when medically necessary, with standard documentation and cost-sharing.

Introduced, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 3979

Summary of Bill A-3979 (Session 222, New Jersey)

Purpose and main intent

This bill requires health insurance contracts and programs operating in New Jersey to provide coverage for the treatment of lipedema. Lipedema is a chronic condition involving abnormal fat accumulation and pain in affected limbs. The measure aims to ensure access to comprehensive treatment, including both non-surgical and surgical options, and aligns coverage with current medical standards of care.

Key provisions and changes

  • Coverage Mandate

    • Applies to:
    • Hospital Service Corporation contracts
    • Medical Service Corporation contracts
    • Health Service Corporation contracts
    • Individual, Group, Small Employer, Health Maintenance Organization (HMO) plans
    • State Health Benefits Program contracts
    • School Employees’ Health Benefits Program
    • For all these plans, the bill requires coverage of lipedema treatment expenses, including:
    • Compression garments for all affected extremities
    • Manual lymphatic drainage
    • Medical nutrition therapy
    • Mental health care
    • Lipectomy (surgical fat removal) when deemed medically necessary by the subscriber’s/insured’s surgeon
    • Pre- and post-lipectomy visits with physicians/surgeons

  • Documentation and Denials

    • Members must provide:
    • Physician diagnosis of lipedema
    • If applicable, surgeon’s documentation with photographs supporting the diagnosis
    • Information on the number of lipectomies deemed medically necessary
    • Denials must include a detailed written explanation
    • Coverage cannot be denied solely on the basis of photos

  • Surgical Coverage and Limits

    • Coverage must equal the total number of lipectomies deemed medically necessary by the surgeon
    • Plans cannot require removing less fat than medically necessary to obtain coverage

  • Prior Authorization

    • Lipectomy prior authorization must follow the standards of the Ensuring Transparency in Prior Authorization Act (P.L.2023, c.296)

  • Cost Sharing and Standards

    • Benefits must be provided to the same extent as for similar services
    • Deductibles, coinsurance, and other cost-sharing rules must be consistent with current lipedema care standards
    • Applies to contracts where the carrier has reserved the right to change premiums

  • Effective Date

    • Effective on the first day of the sixth month after enactment
    • Applies to contracts entered into or renewed after that date

Who would be affected

  • Individuals with lipedema purchasing or enrolled in:
    • Individual and group health plans
    • Small employer plans
    • HMO plans
    • State and school employee health programs
    • Hospital, medical, and health service corporation products
  • Health insurers, HMOs, and state programs would implement coverage consistent with the bill
  • Healthcare providers (physicians/surgeons) determining medical necessity and performing lipectomies

Timeline and procedural notes

  • Introduced: January 13, 2026
  • Referred to Assembly Financial Institutions and Insurance Committee
  • Effective date set for six months after enactment; applies to new/renewed contracts after that date

Practical impact

  • Expands and standardizes lipedema treatment coverage across most health insurance formats in New Jersey
  • Emphasizes medical necessity and patient-centered documentation
  • Aims to reduce out-of-pocket barriers for diagnostic, therapeutic, and surgical interventions related to lipedema

If you’d like, I can provide a side-by-side comparison with current law or a glossary of lipedema-related terms included in the bill.

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

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