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Bill

S 4486

Requires health insurers, SHBP, and SEHBP to cover mammograms for women over 35 and women under 35 under certain circumstances.

2024-2025 Regular Session Introduced by Britnee Timberlake

New Jersey requires insurers to cover mammograms for women 35+ and high-risk women under 35, eliminating cost-sharing across all state insurance plans.

Introduced in the Senate, Referred to Senate Commerce Committee
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Bill Summary · S 4486

Legislative bill overview

S 4486 expands mammogram coverage requirements in New Jersey by mandating that health insurers, the State Health Benefits Program (SHBP), and School Employees' Health Benefits Program (SEHBP) cover mammograms for all women over 35, and for women under 35 who meet certain risk criteria. The bill specifies coverage without cost-sharing requirements, positioning mammography as a preventive service.

Why is this important

Breast cancer screening guidelines vary by age and risk profile, and insurance coverage gaps can create barriers to early detection. This bill addresses potential disparities in access to mammograms across different insurance types and demographic groups in New Jersey. The requirement affects both private insurers and public employee health plans, representing substantial coverage changes across the state's insurance landscape.

Potential points of contention

  • Cost implications: Expanded coverage without cost-sharing increases premiums or state spending for SHBP/SEHBP, raising questions about fiscal sustainability
  • Medical guideline alignment: Current recommendations (USPSTF, ACS) generally recommend routine screening starting at age 40-50 for average-risk women; mandating coverage at 35 may diverge from evidence-based standards
  • Criteria for under-35 coverage: The bill references "certain circumstances" for younger women but doesn't specify what qualifies, creating implementation uncertainty and potential disputes over coverage decisions

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

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