WeVote
Log In

Bill

Bill

S 374

Requires health benefits coverage for treatment of lipedema.

2026-2027 Regular Session Introduced by Teresa Ruiz and 1 co-sponsor

The bill requires broad insurance coverage for lipedema treatment, including diagnostic, non-surgical, and surgical care (lipectomy) when medically necessary, with standardized doc

Referred to Senate Budget and Appropriations Committee
0
WeVote Research Nonpartisan
Bill Summary · S 374

Summary of Bill S 374 (NJ, Session 222)

Purpose and intent

S 374 requires that a broad range of health insurance products offered in New Jersey provide coverage for the treatment of lipedema. The bill aims to ensure access to comprehensive lipedema care, including diagnostic documentation, non-surgical therapies, and surgical treatment when medically necessary, with standardized prior-authorization rules.

Key provisions and changes

  • Coverages mandated for lipedema treatment across major policy types:

    • Hospital service contracts
    • Medical service contracts
    • Health service contracts
    • Individual health insurance policies
    • Group health insurance policies
    • Small-employer plans
    • Health maintenance organization (HMO) contracts
    • State Health Benefits Commission contracts
    • School Employees’ Health Benefits Commission contracts
    • Health benefits plans under the State and School Employees programs
    • The act also covers plans offered by the State’s SHBC and SEHBC

  • Covered expenses (consistent across plans):

    • Compression garments for all affected extremities
    • Manual lymphatic drainage
    • Medical nutrition therapy
    • Mental health care
    • Lipectomy determined medically necessary by the patient’s surgeon
    • Pre- and post-lipectomy appointments with the patient’s physician and surgeon

  • Documentation required for coverage:

    • Documentation from the patient’s physician diagnosing lipedema
    • If applicable, documentation from the patient’s surgeon with photographs supporting the diagnosis
    • Information on the number of lipectomies deemed medically necessary

  • Coverage and surgical care:

    • Insurers must cover the total number of lipectomies deemed medically necessary by the surgeon
    • Insurers cannot require less fat removal than medically necessary to receive coverage

  • Prior authorization:

    • A lipectomy prior authorization remains valid for one year from the date the surgeon receives it
    • Privileges are maintained if the patient remains eligible, no misrepresentation occurred, and no material change in condition
    • Carriers must honor prior authorization from the patient’s previous carrier for the remainder of the authorization period

  • Parity with other benefits:

    • Lipedema benefits must be provided to the same extent, cost-sharing, deductibles, and coinsurance as for similar services
    • Applies to contracts where the carrier reserves the right to change premiums

  • Effective date:

    • The act takes effect on the first day of the sixth month after enactment and applies to contracts entered into or renewed after that date

Who is affected

  • Individuals and groups purchasing health coverage in New Jersey, including:
    • Small and large employers
    • Individuals and families
    • State and school employee benefit programs
    • State Health Benefits Commission and School Employees’ Health Benefits Commission plans
    • Health maintenance organizations

Procedural and timeline notes

  • Introduced: January 13, 2026
  • Reported from Senate Commerce Committee with amendments: May 18, 2026
  • Referred to Senate Budget and Appropriations Committee: May 18, 2026
  • Effective date: six months after enactment

Practical impact

  • The bill codifies lipedema coverage across a wide array of policies, standardizes required documentation, ensures full surgical coverage when medically necessary, and establishes one-year prior-authorization stability. This aims to reduce barriers to treatment and align lipedema care with current medical standards.

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

Sign in to ask a question.