This bill requires health insurance plans in New Jersey, including various types of health service contracts and policies, to provide comprehensive coverage for the treatment of lipedema. The mandated coverage encompasses expenses for compression garments, manual lymphatic drainage, medical nutrition therapy, mental health care, and medically necessary lipectomy procedures, along with pre-and post-operative appointments. Insurers are allowed to request documentation from the subscriber's physician for diagnosis and, if necessary, from the surgeon, which may include photographs to support the diagnosis. Importantly, insurers cannot deny coverage based solely on these photographs and must provide a detailed explanation for any denial.

Additionally, the bill ensures that insurers must cover all lipectomies deemed medically necessary by the subscriber's surgeon without imposing a requirement to remove less fat than what is considered necessary for coverage. It also mandates that prior authorization for lipectomy procedures must comply with the existing regulations under the Ensuring Transparency in Prior Authorization Act. The benefits outlined in this bill will align with the current standard of care for lipedema and will apply to contracts that are entered into or renewed after the bill's effective date, which is set for the first day of the sixth month following its enactment.