This bill requires various health insurance plans in New Jersey, including hospital service corporations and health maintenance organizations, to provide coverage for the treatment of lipedema. The mandated coverage includes expenses for compression garments, manual lymphatic drainage, medical nutrition therapy, mental health care, medically necessary lipectomy, and pre-and post-operative appointments. To qualify for this coverage, individuals must submit documentation from their physician diagnosing them with lipedema, along with any additional documentation from their surgeon, such as photographs and the number of lipectomies deemed necessary. The bill prohibits insurers from denying coverage based solely on submitted photographs and mandates that they provide a detailed explanation for any claim denials.

Additionally, the bill ensures that prior authorizations for lipectomy remain valid for one year and must be honored by subsequent insurers if a covered person changes plans. It also stipulates that insurers must cover the total number of lipectomies deemed medically necessary by the surgeon without requiring them to remove less fat than they consider necessary. The benefits provided must align with the current standard of care for lipedema, ensuring that individuals receive appropriate treatment for this chronic condition. The act will take effect six months after enactment and will apply to contracts entered into or renewed thereafter.