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JB

Bill

S 4122

Requires health insurance coverage for coronary artery calcium screening under certain circumstances.

2026-2027 Regular Session Introduced by Jon Bramnick

Requires health plans in New Jersey to cover coronary artery calcium screening for defined individuals, with no copays/deductibles when criteria are met.

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Bill Summary · S 4122

Summary: New Jersey S 4122 (Session 222)

Title

Requires health insurance coverage for coronary artery calcium screening under certain circumstances.

Purpose and intent

The bill seeks to ensure that health insurance coverage includes coronary artery calcium (CAC) screening for specified individuals or scenarios. The underlying aim is to promote early detection of coronary artery disease risk, potentially guiding preventive interventions and reducing downstream health costs and events.

Key provisions and changes

  • Mandatory coverage in defined circumstances: The bill requires health insurance plans to cover coronary artery calcium screening when specific conditions or criteria are met. The exact eligibility criteria (e.g., age, risk factors, clinical guidelines) are defined within the bill and govern when CAC screening must be reimbursed without patient out-of-pocket burden.

  • Scope of plans affected: Coverage requirements would apply to health insurance policies and health maintenance organization (HMO) plans offered in New Jersey, subject to standard exceptions and plan design constraints existing in state law.

  • Clinical appropriateness: The measure ties coverage to medical necessity or established clinical guidelines, ensuring CAC screening is used in appropriate preventive or diagnostic contexts rather than as a routine, non-indicated service.

  • Cost-sharing provisions: The bill typically would specify that covered CAC screening is not subject to copayment, coinsurance, or deductible requirements when performed in compliance with the statute’s criteria. (Exact cost-sharing language would be detailed in the bill text.)

  • Provider and facility requirements: Health plans may be required to reimburse CAC screening services furnished by qualified providers or facilities, consistent with existing credentialing and reimbursement standards.

  • Coordination with federal guidelines: The measure may reference alignment with or recognition of CAC screening as recommended by relevant cardiovascular risk guidelines, enhancing consistency with national clinical practice standards.

Who would be affected

  • Individuals eligible under the defined criteria for CAC screening would benefit from insurance coverage that reduces out-of-pocket costs.
  • Health insurers and health plans in New Jersey would be required to cover CAC screening under specified circumstances, potentially affecting plan design, utilization management, and reimbursement processes.
  • Healthcare providers who order CAC screening would operate within a framework that supports coverage and reimbursement for approved indications.

Procedural and timeline aspects

  • Status and version: Bill S 4122, introduced in Session 222, with Jon Bramnick listed as a co-sponsor.
  • Enrollment and enactment process: As a state bill, it would follow New Jersey legislative procedures, including committee reviews (likely Health/Appropriations or similar), floor votes in both chambers, and potential signature by the Governor to become law. Specific committee assignments, hearing dates, and fiscal impact analyses would be published during the legislative process.
  • Effective date: If enacted, the bill would specify an effective date (e.g., immediate upon enactment or a scheduled future date) and any phase-in periods for plans to come into compliance.

Notes

  • The summary reflects the general structure of coverage bills that mandate preventive service reimbursement. For precise eligibility criteria, cost-sharing language, and any exemptions or sunset provisions, refer to the bill’s text and any fiscal notes or committee analyses.
  • This overview does not imply legislative passage or status beyond the stated introduction.

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

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