This bill mandates that health insurers, including the State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP), provide coverage for mammograms for women aged 35 and older, as well as for women under 35 who have specific risk factors for breast cancer. The legislation amends existing laws to specify that insurers must cover one baseline mammogram for women who are 35 years of age, annual mammograms for women aged 35 and over, and additional mammograms for women under 35 with a family history of breast cancer or other risk factors, as determined necessary by their healthcare provider. The previous age threshold of 40 has been replaced with 35, ensuring broader access to essential breast cancer screening for women at risk.

Additionally, the bill includes provisions for further diagnostic testing, such as ultrasounds or MRIs, if the initial mammogram indicates dense breast tissue or other abnormalities. Coverage for these services will be subject to utilization review by insurers to assess medical necessity. The bill extends these coverage requirements to health benefits plans under the School Employees Health Benefits Program, ensuring that all relevant health plans provide the same level of mammogram coverage. This legislation aims to enhance early detection and treatment of breast cancer by making necessary screenings more accessible to women in New Jersey.

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