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

2026-2027 Regular Session Introduced by Rosy Bagolie and 3 co-sponsors

New Jersey health plans must cover diagnostic and supplemental breast imaging without any cost-sharing, expanding access and potentially earlier breast cancer detection.

Introduced, Referred to Assembly Financial Institutions and Insurance Committee

Overview

A 3128 (NJ, Session 222) would require health insurance contracts and plans sold in New Jersey to cover diagnostic and supplemental breast examinations without any cost-sharing. The bill applies across a wide range of health coverage formats, including group, medical service, individual, HMO, state and school employee plans, and small employer plans. It takes effect four months after enactment and applies to contracts delivered, issued, renewed, or approved on or after that date.

Purpose and intent

Ensure coverage for breast cancer-related imaging and examinations without patient out-of-pocket costs.

Align coverage with National Comprehensive Cancer Network Guidelines for medically necessary diagnostic and supplemental breast examinations.

Remove financial barriers to obtaining diagnostic workups and risk-based screening imaging.

Key provisions and changes

Diagnostic breast examination: Coverage for medically necessary breast evaluations (e.g., contrast-enhanced mammography, diagnostic mammography, breast MRI, breast ultrasound, molecular breast imaging) when evaluating an abnormality seen or suspected from a screening, or detected by another method.

Supplemental breast examination: Coverage for medically necessary imaging used to screen for breast cancer when no abnormality is seen or suspected, particularly for individuals with higher risk due to personal/family history or dense breast tissue.

Cost-sharing: In all affected policies, plans, and contracts, these breast examinations must be covered without any cost-sharing (deductibles, coinsurance, copayments, or similar out-of-pocket costs).

Applicability: The requirements apply to:

Hospital service corporations, medical service corporations, health service corporations, health insurers, and health maintenance organizations (HMOs).
Various state programs and plans, including the State Health Benefits Program, School Employees’ Health Benefits Program, and small employer health plans.
Plans where the insurer reserved the right to change premiums.
High-deductible health plans to the maximum extent permitted by federal law, with sensitivity to tax-advantaged accounts (e.g., HSAs and MSAs) and catastrophic plans.

Definitions: The bill provides clear definitions for cost-sharing, diagnostic breast examination, and supplemental breast examination, anchored in NCCN guidelines.

Who is affected

Individuals covered by:

Group or individual health insurance contracts (hospital/medical expense benefits).
Medical service contracts.
Health service contracts.
HMOs and catastrophic plans, where applicable.
State and School Employees’ Health Benefits Programs.
Small employer health plans.

All plans that reserve the right to change premiums are subject to the new coverage requirements.

Practical impact

Reduced out-of-pocket costs for patients undergoing breast diagnostic workups and risk-based supplemental imaging.

Potentially earlier detection and monitoring for breast cancer through accessible imaging without financial barriers.

Administrative changes for insurers to implement uniform no-cost-sharing coverage for specified breast examinations.

Bill