LEGISLATIVE FISCAL ESTIMATE
ASSEMBLY, No. 4093
STATE OF NEW JERSEY
220th LEGISLATURE
DATED: JUNE 27, 2023
SUMMARY
Synopsis: Requires health insurers, SHBP, and SEHBP to cover mammograms
for women over 35 and women under 35 under certain circumstances.
Type of Impact: Potential expenditure increase to the State General Fund; potential
expenditure increase to local governments.
Agencies Affected: Division of Pensions and Benefits, Department of the Treasury; certain
local governments.
Office of Legislative Services Estimate
Fiscal Impact FY 2024 FY 2025 FY 2026
SHBP-State Cost $952,578 $1 million $1.1 million
SHBP-Local Cost $538,085 $570,370 $604,592
SEHBP Cost $691,634 $733,132 $777,120
Total Cost $2.2 million $2.3 million $2.5 million
 The Office of Legislative Services (OLS) estimates that this bill will increase costs to the State
Health Benefits Program by $1.5 million and costs to the School Employees’ Health Benefits
Program by $691,634 in the first year that the bill takes effect.
 Data from the Civil Service Commission’s State Government 2022 Workforce Profile suggests
that 11.9 percent of the State workforce is age 35 to age 39 and 55.5 percent of the population
is female. These demographic assumptions are used in combination with the enrollment data
from the relevant mid-year rate renewal report to estimate the number of women who would
become eligible for annual breast cancer screening.
 Current law requires the State Health Benefits Commission and the School Employees’ Health
Benefits Commission to base reimbursement and payments on reasonable and customary
charges, based upon the 90th percentile of the usual, customary, and reasonable fee schedule
determined by the Health Insurance Association of America. For 2023, in-network
mammograms cost $170 at the 90th percentile of the Fair Health Index.
 If the assumptions underlying the estimate change, the conclusions may change.
Office of Legislative Services Legislative Budget and Finance Office
State House Annex Phone (609) 847-3105
P.O. Box 068 Fax (609) 777-2442
Trenton, New Jersey 08625 www.njleg.state.nj.us
 FE to A4093
2
BILL DESCRIPTION
This bill requires health insurers, including the State Health Benefits Program and the School
Employees’ Health Benefits Program, to provide health benefits coverage for expenses incurred
in conducting an annual mammogram for women 35 years of age and older as well as women
under 35 years of age with a family history of breast cancer or other breast cancer risk factors.
Current law requires health insurers, including the State Health Benefits Program, to provide
coverage for annual mammograms to women 40 years of age and older and women under 40 years
of age with a family history of breast cancer or other breast cancer risk factors. The School
Employees’ Health Benefits Program provides coverage for annual mammograms that complies
with current law.
FISCAL ANALYSIS
EXECUTIVE BRANCH
None received.
OFFICE OF LEGISLATIVE SERVICES
The OLS estimates that this bill will increase costs to the State Health Benefits Program for
State and local employees by $1.5 million and costs to the School Employees’ Health Benefits
Program by $691,634 in the first year that the bill takes effect.
Data from the Civil Service Commission’s State Government 2022 Workforce Profile reports
that 11.9 percent of the State workforce is age 35 to age 39 and 55.5 percent of the population is
female. If these demographic assumptions are combined with information from the Mid-Year
Experience Analysis reports for Plan Year 2022, the OLS concludes that 5,603 additional women
covered by the State portion of the State Health Benefits Program and 7,233 additional women
covered by the local portion of the State Health Benefits Program and the School Employees’
Health Benefits Program will become eligible for annual mammogram screenings.
Current law requires the State Health Benefits Commission and the School Employees’ Health
Benefits Commission to base reimbursement and payments on reasonable and customary charges,
based upon the 90th percentile of the usual, customary, and reasonable fee schedule determined
by the Health Insurance Association of America. For 2023, in-network mammograms cost $170
at the 90th percentile of the Fair Health Index. The analysis assumes a medical inflation rate of 6
percent. If the assumptions underlying the estimate change, the conclusions may change.
Section: State Government
Analyst: Anna Harris
Assistant Fiscal Analyst
Approved: Thomas Koenig
Legislative Budget and Finance Officer
This legislative fiscal estimate has been produced by the Office of Legislative Services due to the
failure of the Executive Branch to respond to our request for a fiscal note.
This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).


Statutes affected:
Introduced: 17:48-6, 17:48A-7, 17:48E-35.4, 17B:26-2.1, 17B:27-46.1, 26:2J-4.4, 17B:27A-7.10, 17B:27A-19.13, 52:14-17.29