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Bill

Bill

A 4916

Requires health insurers to cover colorectal cancer screenings for covered persons aged 33 or over and covered persons under the age of 33 if deemed medically necessary.

2026-2027 Regular Session Introduced by Shanique Speight

Requires health insurers to cover colorectal cancer screening for all insured persons 33+, and for under 33 if medically necessary, per current guidelines.

Introduced, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 4916

Summary of Bill A 4916 (New Jersey, 222nd Legislature)

Overview

  • Jurisdiction: New Jersey
  • Session: 222

  • Purpose: To require health insurers to cover colorectal cancer (CRC) screening for certain covered persons, with emphasis on expanding access to screening based on age, medical necessity, and clinical guidelines.

  • Sponsor: Co-sponsor Shanique Speight

What the bill does (Key Provisions)

  1. Mandated coverage for CRC screenings

    • Health insurers would be required to cover colorectal cancer screenings for:
      • All covered persons aged 33 years or older.
      • Covered persons under 33 years old if the screenings are deemed medically necessary by a health care professional.

  2. Medical necessity criterion

    • For individuals under 33, coverage applies when a clinician determines that CRC screening is medically necessary for the patient’s health status, risk factors, or clinical indications.

  3. Scope of screenings included

    • The bill specifies coverage for colorectal cancer screening tests and services consistent with current clinical guidelines. While the exact list of tests is not detailed in the summary, typical screenings may include stool-based tests, colonoscopy, sigmoidoscopy, and other guideline-concordant procedures.

  4. Compliance and administration

    • Insurers would be required to apply underwriting and cost-sharing rules in line with the mandated coverage for CRC screenings, ensuring parity with other preventive services where applicable.
    • The bill seeks to ensure that such screenings are covered without imposing higher out-of-pocket costs than those for other similar preventive services.

Who is affected

  • Covered persons under health insurance plans in New Jersey, including:

    • Adults 33 years and older (automatic coverage for CRC screening as a preventive measure).
    • Individuals under 33 if a clinician determines screening is medically necessary.

  • Health insurers operating in New Jersey, who would need to implement coverage for CRC screening as specified and align policies with the new requirement.

Procedural and timeline considerations

  • The bill, once enacted, would add a new statutory obligation for insurers regarding coverage of CRC screening.
  • The language indicates a focus on preventive care access and clinical necessity, aligning with broader public health goals to increase early detection of colorectal cancer.
  • Specific effective dates, transition timelines, or phased implementation details are not provided in the summary provided here; the bill text would contain any such provisions, including effective date and any applicable exemptions.

Potential Impact

  • Public Health: Potential increase in CRC screening rates among adults starting at age 33, and among younger individuals when medically indicated, leading to earlier detection and improved outcomes.
  • Cost Implications: May affect insurer plan costs and premium considerations, offset by long-term savings from early cancer detection and reduced treatment costs.
  • Access and Equity: Removes barriers related to screening coverage for a broader age range and for medically indicated younger patients.

If you’d like, I can tailor this summary to a specific audience (e.g., policymakers, health care providers, or patient advocates) or compare it to current NJ CRC screening coverage standards.

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

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