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Bill

S 4511

Requires health benefits coverage of assisted reproductive technology to prevent transmission of monogenic disorder.

2026-2027 Regular Session Introduced by Troy Singleton

Requires health coverage for ART to prevent transmission of monogenic disorders, including testing and PGT, for eligible individuals/couples.

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Bill Summary · S 4511

Summary of Bill S 4511 (Session 222) — New Jersey

Purpose and Intent

  • The bill requires health benefits coverage for assisted reproductive technology (ART) specifically to prevent the transmission of monogenic disorders from parent to child.
  • It aims to ensure that individuals and couples with a known monogenic genetic condition have access to ART services that reduce the risk of passing that disorder to offspring.

Key Provisions and Changes

  • Coverage Scope

    • Mandates health insurance coverage for ART procedures when the purpose is to prevent transmission of a monogenic disorder.
    • Applies to insured individuals seeking ART treatments such as in vitro fertilization (IVF) or related services that are used to reduce the risk of monogenic disease transmission.

  • Monogenic Disorder Focus

    • Coverage is specifically tied to efforts to prevent transmission of monogenic disorders (genetic conditions caused by mutations in a single gene).

  • Eligibility and Use

    • Individuals or couples with a known monogenic disorder in a parent or potential parent would be eligible for coverage when pursuing ART aimed at reducing transmission risk.
    • May include genetic testing, preimplantation genetic testing (PGT/PGT-M) as part of the ART process to identify embryos free of the targeted monogenic condition.

  • Regulatory/Administrative Elements

    • The bill would specify the manner in which coverage is provided under health plans, including any prerequisites, documentation, or clinical standards required to justify coverage.
    • Could include coordination with genetic counseling and fertility specialists to determine appropriate ART approaches and to confirm the presence of a monogenic risk.

  • Sponsorship

    • Co-sponsor: Troy Singleton
    • Indicates bipartisan or legislative support at least from the sponsor’s side.

Affected Parties

  • Individuals and Families
    • Prospective parents or couples known to carry a monogenic disorder who seek ART to prevent transmission.
  • Health Insurers and Plans
    • Insurance providers offering coverage for ART would be required to include this specific preventive-use ART coverage in their plans or face applicable compliance requirements.
  • Medical Providers
    • Fertility specialists, reproductive endocrinologists, genetic counselors, and associated clinics would be involved in administering ART, performing PG testing, and coordinating care to meet coverage criteria.

Procedural and Timeline Aspects

  • The bill would establish criteria for when coverage is triggered, what procedures are covered, and any procedural steps insurers must follow.
  • It may set timelines for implementing the coverage within health plans, including any transitional provisions and enforcement mechanisms.
  • Specific dates, phases, or effective dates would be defined in the text of the bill (not provided in the summary).

Potential Impacts

  • Access and Affordability
    • Could reduce out-of-pocket costs for ART explicitly aimed at preventing monogenic disorders, improving access for affected families.
  • Medical Practice
    • May encourage broader use of genetic testing and embryo screening within ART to mitigate inherited monogenic conditions.
  • Healthcare Equity
    • By standardizing coverage, may help reduce disparities in access to preventive ART services among insured individuals.

Note

  • This summary reflects high-level provisions inferred from the bill’s title and sponsorship information. For precise language, definitions, exclusions, cost implications, and any regulatory standards, please refer to the full bill text and fiscal notes.

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

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