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Bill

S 4309

Requires health insurance coverage of diagnostic and supplemental breast examinations without cost-sharing.

2024-2025 Regular Session Introduced by Renee Burgess and 3 co-sponsors

New Jersey requires health insurers to cover breast imaging exams without patient cost-sharing, removing financial barriers to diagnostic and supplemental screening procedures.

Introduced in the Senate, Referred to Senate Commerce Committee
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Bill Summary · S 4309

Legislative bill overview

S 4309 mandates that health insurance plans in New Jersey cover diagnostic and supplemental breast examinations (such as ultrasounds and MRIs) with zero cost-sharing to patients—meaning no copays, coinsurance, or deductibles. This expands upon existing preventive care requirements by eliminating out-of-pocket expenses for these specific imaging services when medically necessary or recommended.

Why is this important

Breast cancer remains a leading cause of cancer deaths among women, and advanced imaging can detect cancers earlier, particularly in dense breast tissue where mammograms are less effective. By removing financial barriers to supplemental screening, the bill aims to increase access to potentially life-saving diagnostic tools, though it also increases costs for insurance plans and employers.

Potential points of contention

  • Cost impact: Insurers and self-insured employers will absorb increased costs for these examinations, which may be passed to consumers through higher premiums
  • Medical necessity definitions: Questions about which supplemental exams qualify and who determines "medically necessary" could lead to coverage disputes and administrative complexity
  • Preventive vs. diagnostic distinction: Regulatory clarity is needed on whether this applies only to symptomatic patients or also covers screening for asymptomatic high-risk individuals

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

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