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A1142 2R
[Second Reprint]
ASSEMBLY, No. 1142
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblyman JOE DANIELSEN
District 17 (Middlesex and Somerset)
Assemblywoman VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Assemblyman� WILLIAM B. SAMPSON, IV
District 31 (Hudson)
Co-Sponsored by:
Assemblymen Simonsen, McClellan, Schaer, Assemblywoman
Speight, Assemblymen G.Rodriguez, Schnall, DeAngelo, Assemblywomen Donlon,
Peterpaul, Assemblymen Spearman, Azzariti Jr., Abdelaziz, Assemblywoman Katz,
Assemblyman Scharfenberger, Assemblywoman Carter, Assemblymen Rumpf, Venezia,
Kennedy, Stanley, Karabinchak, Assemblywomen Drulis, Swain, Assemblyman Tully,
Assemblywomen Collazos-Gill, Dunn, Assemblymen Freiman, DiMaio, Assemblywoman
Flynn, Assemblyman Hutchison, Assemblywomen Sweeney, Bagolie, Assemblymen
Barlas, DePhillips, Singh, Angelozzi, Moen and Verrelli
SYNOPSIS
���� Expands requirements for health insurance carriers
concerning prostate cancer screening.
CURRENT VERSION OF TEXT
���� As reported by the Assembly Health Committee on June
18, 2026, with amendments.
��
An Act
concerning health insurance coverage for prostate
cancer screening and amending P.L.1996, c.125 and supplementing various parts
of the statutory law.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
�����
1.�� Section
1 of P.L.1996, c.125 (C.17:48E-35.13) is amended to read as follows:
����� 1.��
a.
No health service corporation contract providing hospital or medical expense
benefits
[
for groups
with greater than 49 persons
]
shall be
delivered, issued, executed or renewed in this State, or approved for issuance
or renewal in this State by the Commissioner of Insurance on or after the
effective date of
[
this act
]
P.L.1996, c.125 (C.17:48E-35.13 et al.)
,
unless the contract provides benefits to any named subscriber or other person
covered thereunder for expenses incurred in conducting an annual
[
medically recognized diagnostic examination
including, but not limited to, a digital rectal examination and a
prostate-specific antigen test for men age 50 and over who are asymptomatic and
for men age 40 and over with a family history of prostate cancer or other
prostate cancer risk factors
]
prostate
cancer screening in accordance with the latest nationally recognized clinical
practice guidelines
.
���� The benefits shall be provided
to the same extent as for any other medical condition under the contract
2
[
except that
no deductible, coinsurance, copayment, or any other cost-sharing requirement on
the benefits shall be imposed
]
2
.
���� This section shall apply to
all health service corporation contracts in which the health service
corporation has reserved the right to change the premium.
�����
The provisions of this section shall apply
to a high-deductible health plan to the maximum extent permitted by federal
law, except if the plan is used to establish a medical savings account pursuant
to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220)
or a health savings account pursuant to section 223 of the federal Internal
Revenue Code of 1986 (26 U.S.C. s.223).� The provisions of this section shall
apply to the plan to the maximum extent that is permitted by federal law and does
not disqualify the account for the deduction allowed under section 220 or 223
of the federal Internal Revenue Code of 1986, as applicable.� The provisions of
this section shall apply to a plan that meets the requirements of a
catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent
permitted by federal law.
�����
b. As used in this section.
�����
�Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
(cf: P.L.1996, c.125, s.1)
���� 2.��� Section 2 of P.L.1996,
c.125 (C.17:48-6p) is amended to read as follows:
����� 2.�
a.
No hospital service corporation contract providing hospital or
medical expense benefits
[
for groups
with greater than 49 persons
]
shall be
delivered, issued, executed or renewed in this State, or approved for issuance
or renewal in this State by the Commissioner of Insurance on or after the
effective date of
[
this act
]
P.L.1996, c.125 (C.17:48E-35.13 et al.)
,
unless the contract provides benefits to any named subscriber or other person
covered thereunder for expenses incurred in conducting an annual
[
medically recognized diagnostic examination
including, but not limited to, a digital rectal examination and a
prostate-specific antigen test for men age 50 and over who are asymptomatic and
for men age 40 and over with a family history of prostate cancer or other
prostate cancer risk factors
]
prostate
cancer screening in accordance with the latest nationally recognized clinical
practice guidelines
.
���� The benefits shall be provided
to the same extent as for any other medical condition under the contract
2
[
except that
no deductible, coinsurance, copayment, or any other cost-sharing requirement on
the benefits shall be imposed
]
2
.
���� This section shall apply to
all hospital service corporation contracts in which the hospital service
corporation has reserved the right to change the premium.
����
The provisions of this section shall apply to a high-deductible health
plan to the maximum extent permitted by federal law, except if the plan is used
to establish a medical savings account pursuant to section 220 of the federal
Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings account
pursuant to section 223 of the federal Internal Revenue Code of 1986 (26 U.S.C.
s.223).� The provisions of this section shall apply to the plan to the maximum
extent that is permitted by federal law and does not disqualify the account for
the deduction allowed under section 220 or 223 of the federal Internal Revenue
Code of 1986, as applicable.� The provisions of this section shall apply to a
plan that meets the requirements of a catastrophic plan, as defined in 45
C.F.R. s.156.155, to the maximum extent permitted by federal law.
����
b.� As used in this section:
����
�Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
(cf: P.L.1996, c.125, s.2)
���� 3.��� Section 3 of P.L.1996,
c.125 (C.17:48A-7n) is amended to read as follows:
���� 3.�
a.
No medical
service corporation contract providing hospital or medical expense benefits
[
for groups
with greater than 49 persons
]
shall be delivered, issued, executed or renewed in this State, or approved for
issuance or renewal in this State by the Commissioner of Insurance on or after
the effective date of
[
this
act
]
P.L.1996,
c.125 (C.17:48E-35.13 et al.)
, unless the contract provides benefits to any
named subscriber or other person covered thereunder for expenses incurred in
conducting an annual
[
medically
recognized diagnostic examination including, but not limited to, a digital
rectal examination and a prostate-specific antigen test for men age 50 and over
who are asymptomatic and for men age 40 and over with a family history of
prostate cancer or other prostate cancer risk factors
]
prostate cancer screening in
accordance with the latest nationally recognized clinical practice guidelines
.
���� The benefits shall be provided
to the same extent as for any other medical condition under the contract
2
[
except that
no deductible, coinsurance, copayment, or any other cost-sharing requirement on
the benefits shall be imposed
]
2
.
���� This section shall apply to
all medical service corporation contracts in which the medical service
corporation has reserved the right to change the premium.
����
The provisions of this section shall apply to a
high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223).� The provisions of this section shall apply to
the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223 of
the federal Internal Revenue Code of 1986, as applicable.� The provisions of
this section shall apply to a plan that meets the requirements of a
catastrophic plan, as defined in 45 C.F.R. s.156.155, to the maximum extent
permitted by federal law.
����
b.� As used
in this section:
����
�Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
(cf: P.L.1996, c.125, s.3)
���� 4.��� Section 4 of P.L.1996,
c.125 (C.17B:27-46.1o) is amended to read as follows:
���� 4.�
a.
No group health
insurance policy providing hospital or medical expense benefits
[
for groups
with greater than 49 persons
]
shall be delivered, issued, executed or renewed in this State, or approved for
issuance or renewal in this State by the Commissioner of Insurance on or after
the effective date of
[
this
act
]
P.L.1996, c.125 (C.17:48E-35.13
et al.)
, unless the policy provides benefits to any named insured or other
person covered thereunder for expenses incurred in conducting an annual
[
medically
recognized diagnostic examination including, but not limited to, a digital
rectal examination and a prostate-specific antigen test for men age 50 and over
who are asymptomatic and for men age 40 and over with a family history of�
prostate cancer or other prostate cancer risk factors
]
prostate cancer screening in
accordance with the latest nationally recognized clinical practice guidelines
.
���� The benefits shall be provided
to the same extent as for any other medical condition under the policy
2
[
except that
no deductible, coinsurance, copayment, or any other cost-sharing requirement on
the benefits shall be imposed
]
2
.
���� This section shall apply to
all group health insurance policies in which the health insurer has reserved
the right to change the premium.
�����
The provisions of this section shall apply to a high-deductible
health plan to the maximum extent permitted by federal law, except if the plan
is used to establish a medical savings account pursuant to section 220 of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings
account pursuant to section 223 of the federal Internal Revenue Code of 1986
(26 U.S.C. s.223).� The provisions of this section shall apply to the plan to
the maximum extent that is permitted by federal law and does not disqualify the
account for the deduction allowed under section 220 or 223 of the federal
Internal Revenue Code of 1986, as applicable.� The provisions of this section
shall apply to a plan that meets the requirements of a catastrophic plan, as
defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
�������
b.� As used in this section:
����
�Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
(cf: P.L.1996, c.125, s.4)
�����
5.�� Section
5 of P.L.1996, c.125 (C.26:2J-4.13) is amended to read as follows:
���� 5.�
a.
A certificate of
authority to establish and operate a health maintenance organization in this
State shall not be issued or continued by the Commissioner of Health on or
after the effective date of
[
this
act
]
P.L.1996,
c.125 (C.17:48E-35.13 et al.)
unless the health maintenance organization
provides health care services to any enrollee which include an annual
[
medically
recognized diagnostic examination including, but not limited to, a digital
rectal examination and a prostate-specific antigen test for men age 50 and over
who are asymptomatic and for men age 40 and over with a family history of�
prostate cancer or other prostate cancer risk factors
]
prostate cancer screening in
accordance with the latest nationally recognized clinical practice guidelines
.
���� The health care services shall
be provided to the same extent as for any other medical condition under the
contract
2
[
except that
no deductible, coinsurance, copayment, or any other cost-sharing requirement on
the services shall be imposed
]
2
.
���� The provisions of this section
shall apply to all contracts for health care services by health maintenance
organizations under which the right to change the schedule of charges for
enrollee coverage is reserved.
�����
The provisions of this section shall apply to a high-deductible
health plan to the maximum extent permitted by federal law, except if the plan
is used to establish a medical savings account pursuant to section 220 of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings
account pursuant to section 223 of the federal Internal Revenue Code of 1986
(26 U.S.C. s.223).� The provisions of this section shall apply to the plan to
the maximum extent that is permitted by federal law and does not disqualify the
account for the deduction allowed under section 220 or 223 of the federal
Internal Revenue Code of 1986, as applicable.� The provisions of this section
shall apply to a plan that meets the requirements of a catastrophic plan, as
defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
����
b.� As used
in this section:
����
�Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
(cf: P.L.1996, c.125, s.5)
���� 6.��� (New section)� a. Every
individual health insurance policy that provides hospital or medical expense
benefits and is delivered, issued, executed or renewed in this State pursuant
to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance
or renewal in this State by the Commissioner of Banking and Insurance, on or
after the effective date of this act shall provide coverage for an annual
prostate cancer screening in accordance with the latest nationally recognized
clinical practice guidelines.
���� The benefits shall be provided
to the same extent as for any other medical condition under the contract
2
[
except that no
deductible, coinsurance, copayment, or any other cost-sharing requirement on
the services shall be imposed
]
2
.
���� The provisions of this section
shall apply to all policies in which the insurer has reserved the right to
change the premium.
���� The provisions of this section shall apply to a high-deductible
health plan to the maximum extent permitted by federal law, except if the plan
is used to establish a medical savings account pursuant to section 220 of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings
account pursuant to section 223 of the federal Internal Revenue Code of 1986
(26 U.S.C. s.223).� The provisions of this section shall apply to the plan to
the maximum extent that is permitted by federal law and does not disqualify the
account for the deduction allowed under section 220 or 223 of the federal
Internal Revenue Code of 1986, as applicable.� The provisions of this section
shall apply to a plan that meets the requirements of a catastrophic plan, as
defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
���� b.� As used in
this section:
���� �Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
���� 7.��� (New section) a. Every
individual health benefits plan that provides hospital or medical expense
benefits and is delivered, issued, executed or renewed in this State pursuant
to P.L.1992, c.161 (C.17B:27A-2 et seq.) or approved for issuance or renewal in
this State on or after the effective date of this act shall provide benefits
for an annual prostate cancer screening in accordance with the latest
nationally recognized clinical practice guidelines.
���� The benefits shall be provided
to the same extent as for any other medical condition under the contract
2
[
except that no
deductible, coinsurance, copayment, or any other cost-sharing requirement on
the services shall be imposed
]
2
.
���� The provisions of this section
shall apply to all health benefits plans in which the carrier has reserved the
right to change the premium.
���� The provisions of this section shall apply to a high-deductible
health plan to the maximum extent permitted by federal law, except if the plan
is used to establish a medical savings account pursuant to section 220 of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a health savings
account pursuant to section 223 of the federal Internal Revenue Code of 1986
(26 U.S.C. s.223).� The provisions of this section shall apply to the plan to
the maximum extent that is permitted by federal law and does not disqualify the
account for the deduction allowed under section 220 or 223 of the federal
Internal Revenue Code of 1986, as applicable.� The provisions of this section
shall apply to a plan that meets the requirements of a catastrophic plan, as
defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.
���� b.� As used in
this section:
���� �Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
���� 8.��� (New section) a. Every
small employer health benefits plan that provides hospital or medical expense
benefits and is delivered, issued, executed or renewed in this State pursuant
to P.L.1992, c.162 (C.17B:27A-17 et seq.) or approved for issuance or renewal
in this State on or after the effective date of this act shall provide benefits
for an annual prostate cancer screening in accordance with the latest
nationally recognized clinical practice guidelines.
���� The benefits shall be provided
to the same extent as for any other medical condition under the contract
2
[
except that no
deductible, coinsurance, copayment, or any other cost-sharing requirement on
the services shall be imposed
]
2
.
���� The provisions of this section
shall apply to all health benefits plans in which the carrier has reserved the
right to change the premium.
���� The provisions
of this section shall apply to a high-deductible health plan to the maximum
extent permitted by federal law, except if the plan is used to establish a
medical savings account pursuant to section 220 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.220) or a health savings account pursuant to section
223 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.223).� The
provisions of this section shall apply to the plan to the maximum extent that
is permitted by federal law and does not disqualify the account for the
deduction allowed under section 220 or 223 of the federal Internal Revenue Code
of 1986, as applicable.� The provisions of this section shall apply to a plan
that meets the requirements of a catastrophic plan, as defined in 45 C.F.R.
s.156.155, to the maximum extent permitted by federal law.
���� b.� As used in this section:
���� �Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
���� 9.��� (New section) a. The
State Health Benefits Commission shall ensure that every contract purchased by
the commission on or after the effective date of this act that provides
hospital or medical expense benefits shall provide coverage for an annual
prostate cancer screening in accordance with the latest nationally recognized
clinical practice guidelines.
���� The benefits shall be provided
to the same extent as for any other medical condition under the contract
2
[
except that no
deductible, coinsurance, copayment, or any other cost-sharing requirement on
the services shall be imposed
]
2
.
���� b.� As used in this section:
���� �Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
���� 10.� (New section)� a. The
School Employees� Health Benefits Commission shall ensure that every contract
purchased by the commission on or after the effective date of this act that
provides hospital or medical expense benefits shall provide coverage for an annual
prostate cancer screening in accordance with the latest nationally recognized
clinical practice guidelines.
���� The benefits shall be provided
to the same extent as for any other medical condition under the contract
2
[
except that no
deductible, coinsurance, copayment, or any other cost-sharing requirement on
the services shall be imposed
]
2
.
���� b.� As used in
this section:
���� �Nationally
recognized clinical practice guidelines� means evidence-based clinical practice
guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with
a conflict-of-interest policy.� The guidelines establish standards of care
informed by a systematic review of evidence and an assessment of the benefits
and risks of alternative care options and include recommendations intended to
optimize patient care.
���� 11.� This act shall take
effect on the 90th day next following the date of enactment and shall apply to
all contracts and policies delivered, issued, executed, or renewed on or after
that date
1
,
except that section 7 of this act shall take effect and apply to policies and
contracts that are delivered, issued, executed, or renewed pursuant to
P.L.1992, c.161 (C.17B:27A-2 et seq.) on January 1, 2027
1
. �