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, and medically necessary lipectomy, along with pre-and post-operative appointments. To qualify for this coverage, individuals must submit documentation from their physician diagnosing them with lipedema, and if applicable, additional documentation from their surgeon, including photographs and the number of lipectomies deemed necessary. The bill also prohibits insurers from denying coverage based solely on submitted photographs and mandates that they provide a detailed explanation for any claim denials.

Furthermore, the bill ensures that prior authorizations for lipectomy remain valid for one year, as long as the covered person remains eligible and there are no significant changes in their clinical condition. Insurers are required to honor prior authorizations granted by previous carriers for the duration of the authorization. The benefits provided under this bill must align with the current standard of care for lipedema, ensuring that individuals suffering from this chronic condition receive the necessary treatment for their painful symptoms.