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A 4693

Requires health insurance coverage for substance use disorder treatment services

2025 Regular Session Introduced by Joe Sempolinski

Requires health plans to cover substance use disorder treatment, expanding insured access; insurers must adjust benefits and claims, with details and cost-sharing to be defined.

REFERRED TO INSURANCE
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WeVote Research Nonpartisan
Bill Summary · A 4693

Summary of Assembly Bill A 4693 (2025)

Bill at a glance

  • Bill number and title: A 4693 — Requires health insurance coverage for substance use disorder treatment services
  • Status: REFERRED TO INSURANCE
  • Introduced: February 4, 2025
  • Sponsor: Joseph Sempolinski (primary)
  • Related bills (prior sessions): A 9604, A 4721, A 5834, A 8387, A 2401

What the bill would do

  • The bill would require health insurance plans to provide coverage for substance use disorder (SUD) treatment services.
  • Specific details about scope and implementation (e.g., which plans are covered, whether coverage applies to inpatient vs. outpatient services, duration, provider types, parity with other medical/surgical benefits, cost-sharing limits, prior authorization, and network adequacy) are not provided in the available information. The summary information indicates a mandate for coverage, but the exact terms would be defined in the enacted text.

Key provisions and potential impact (as of available information)

  • Mandated coverage for SUD treatment: Insurers would be obligated to cover services related to substance use disorder treatment.
  • Scope and details TBD: Without the bill text, it is unclear how comprehensive the coverage would be (e.g., services included, treatment modalities, settings, frequency, limits, and any exemptions).
  • Impact on stakeholders:
    • Policyholders/Patients: Potentially improved access to SUD treatment services through insurance coverage.
    • Insurers: Would need to adjust plan designs, benefit structures, and claims processing to meet the new requirement. Note: Additional details (cost-sharing, out-of-pocket limits, and any carve-outs) will determine the practical effect on premiums and access.

Affected parties

  • Individuals with health insurance who require substance use disorder treatment.
  • Health insurance plans and issuers operating within the jurisdiction.
  • Health care providers delivering SUD treatment services.
  • State insurance regulators responsible for enforcing coverage requirements.

Procedural and timeline aspects

  • Current stage: Referred to the Assembly Committee on Insurance on February 4, 2025.
  • Next steps (typical path): The bill could receive hearings, undergo amendments, and move to a floor vote in the Assembly. If approved, it would advance to the Senate or corresponding steps, depending on the legislative process for this body and session rules.
  • Notes on actions: The Legislative Actions show the same action listed twice on the same date, indicating a clerical duplication rather than two separate steps.

Context and related activity

  • The bill aligns with prior-session efforts reflected by related bills A 9604, A 4721, A 5834, A 8387, and A 2401, suggesting continued interest in mandating coverage for substance use disorder treatment across multiple sessions.

If you’d like, I can tailor this summary to a specific audience (e.g., policymakers, health insurers, patient advocates) or compare A 4693 to the related bills listed to highlight common provisions or differing approaches.

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

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