This bill amends New Jersey law to enhance coverage for breast cancer detection imaging services. It lowers the age requirement for baseline mammograms from 40 to 18 years, mandating that all group and individual health service contracts provide coverage for one baseline mammogram and annual mammograms for women aged 18 and older. Additionally, it allows for coverage of mammograms for women under 18 who have a family history of breast cancer or other risk factors, as determined necessary by their healthcare provider. The bill also introduces coverage for physician-directed imaging, such as ultrasounds and MRIs, particularly in cases where a baseline mammogram indicates dense breast tissue or other risk factors.

The legislation includes key insertions and deletions to clarify these provisions, specifically defining "high risk assessment" as an annual evaluation that includes both a mammogram and an MRI for women identified as high risk by their physician. Coverage for additional imaging services may be subject to utilization review by insurers to assess medical necessity. The provisions of this bill will apply to all health benefit plans that are in effect or renewed after the bill's effective date, thereby ensuring broader access to essential breast cancer screening and diagnostic services for 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, 17B:27A-7.10, 17B:27A-19.13, 26:2J-4.4, 52:14-17.29