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A2152
ASSEMBLY, No. 2152
STATE OF NEW JERSEY
222nd LEGISLATURE
�
PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION
Sponsored by:
Assemblywoman ELIANA PINTOR MARIN
District 29 (Essex and Hudson)
Assemblywoman VICTORIA A. FLYNN
District 13 (Monmouth)
Assemblywoman ANNETTE QUIJANO
District 20 (Union)
Co-Sponsored by:
Assemblyman Karabinchak, Assemblywoman Morales and
Assemblyman Kearney
SYNOPSIS
���� Requires health insurers to provide coverage for
certain imaging related to breast cancer detection.
CURRENT VERSION OF TEXT
���� Introduced Pending Technical Review by Legislative
Counsel.
��
An Act
concerning mammograms and amending P.L.1991, c.279 and
P.L.2004, c.86.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� Section 1 of P.L. 1991,
c.279 (C.17:48-6g) is amended to read as follows:
���� 1.��� a.� No group or
individual hospital service corporation contract providing hospital or medical
expense benefits shall be delivered, issued, executed, or renewed in this State
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, unless the contract
provides benefits to any subscriber or other person covered thereunder for
expenses incurred in conducting:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
physician-directed
imaging, including, but not limited to,
an ultrasound evaluation, a
magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination
or high risk assessment
, if the mammogram
or high risk assessment
demonstrates extremely dense breast tissue, if the mammogram
or high risk assessment
is abnormal within any degree of breast density including not dense, moderately
dense, heterogeneously dense, or extremely dense breast tissue, or if the
patient has additional risk factors for breast cancer including but not limited
to family history of breast cancer, prior personal history of breast cancer,
positive genetic testing, extremely dense breast tissue based on the Breast
Imaging Reporting and Data System established by the American College of
Radiology, or other indications as determined by the patient's health care
provider.� The coverage required under this paragraph may be subject to
utilization review, including periodic review, by the hospital service
corporation of the medical necessity of the additional screening and diagnostic
testing.
���� b.��� These benefits shall be
provided to the same extent as for any other sickness under the contract.
���� c.���� The provisions of this
section shall apply to all contracts in which the hospital service corporation
has reserved the right to change the premium.
����
d.��� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf: P.L.2013, c.196, s.1)
���� 2.��� Section 2 of P.L.1991,
c.279 (C.17:48A-7f) is amended to read as follows:
���� 2.� a.� No group or individual
medical service corporation contract providing hospital or medical expense
benefits shall be delivered, issued, executed, or renewed in this State 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, unless the contract
provides benefits to any subscriber or other person covered thereunder for
expenses incurred in conducting:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
physician-directed
imaging, including, but not limited to,
an ultrasound evaluation, a
magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination
or high risk assessment
, if the mammogram
or high risk
assessment
demonstrates extremely dense breast tissue, if the mammogram
or
high risk assessment
is abnormal within any degree of breast density
including not dense, moderately dense, heterogeneously dense, or extremely
dense breast tissue, or if the patient has additional risk factors for breast
cancer including but not limited to family history of breast cancer, prior
personal history of breast cancer, positive genetic testing, extremely dense
breast tissue based on the Breast Imaging Reporting and Data System established
by the American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the medical
service corporation of the medical necessity of the additional screening and
diagnostic testing.
���� b.��� These benefits shall be
provided to the same extent as for any other sickness under the contract.
���� c.���� The provisions of this
section shall apply to all contracts in which the medical service corporation
has reserved the right to change the premium.
����
d.��� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf: P.L.2013, c.196, s.2)
���� 3.��� Section 3 of P.L.1991,
c.279 (C.17:48E-35.4) is amended to read as follows:
���� 3.� a.� No group or individual
health service corporation contract providing hospital or medical expense
benefits shall be delivered, issued, executed, or renewed in this State 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, unless the contract
provides benefits to any subscriber or other person covered thereunder for
expenses incurred in conducting:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
physician-directed
imaging, including, but not limited to,
an ultrasound evaluation, a
magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination
or high risk assessment
, if the mammogram
or high risk
assessment
demonstrates extremely dense breast tissue, if the mammogram
or
high risk assessment
is abnormal within any degree of breast density
including not dense, moderately dense, heterogeneously dense, or extremely
dense breast tissue, or if the patient has additional risk factors for breast
cancer including but not limited to family history of breast cancer, prior
personal history of breast cancer, positive genetic testing, extremely dense
breast tissue based on the Breast Imaging Reporting and Data System established
by the American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the health
service corporation of the medical necessity of the additional screening and
diagnostic testing.
���� b.��� These benefits shall be
provided to the same extent as for any other sickness under the contract.
���� c.���� The provisions of this
section shall apply to all contracts in which the health service corporation
has reserved the right to change the premium.�
����
d.��� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf: P.L.2013, c.196, s.3)
���� 4.��� Section 4 of P.L.1991,
c.279 (C.17B:26-2.1e) is amended to read as follows:
���� 4.� a.� No individual health
insurance policy providing hospital or medical expense benefits shall be
delivered, issued, executed, or renewed in this State 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, unless the policy provides benefits to
any named insured or other person covered thereunder for expenses incurred in
conducting:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
physician-directed
imaging, including, but not limited to,
an ultrasound evaluation, a
magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination
or high risk assessment
, if the mammogram
or high risk
assessment
demonstrates extremely dense breast tissue, if the mammogram
or
high risk assessment
is abnormal within any degree of breast density
including not dense, moderately dense, heterogeneously dense, or extremely
dense breast tissue, or if the patient has additional risk factors for breast
cancer including but not limited to family history of breast cancer, prior
personal history of breast cancer, positive genetic testing, extremely dense
breast tissue based on the Breast Imaging Reporting and Data System established
by the American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the insurer of
the medical necessity of the additional screening and diagnostic testing.
���� b.��� These benefits shall be
provided to the same extent as for any other sickness under the policy.�
���� c.���� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
����
d.��� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf: P.L.2013, c.196, s.4)
���� 5.��� Section 5 of P.L.1991,
c.279 (C.17B:27-46.1f) is amended to read as follows:
���� 5.� a.� No group health
insurance policy providing hospital or medical expense benefits shall be
delivered, issued, executed, or renewed in this State 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, unless the policy provides benefits to any
named insured or other person covered thereunder for expenses incurred in
conducting:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
physician-directed
imaging, including, but not limited to,
an ultrasound evaluation, a
magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination
or high risk assessment
, if the mammogram
or high risk
assessment
demonstrates extremely dense breast tissue, if the mammogram
or
high risk assessment
is abnormal within any degree of breast density
including not dense, moderately dense, heterogeneously dense, or extremely
dense breast tissue, or if the patient has additional risk factors for breast
cancer including but not limited to family history of breast cancer, prior
personal history of breast cancer, positive genetic testing, extremely dense
breast tissue based on the Breast Imaging Reporting and Data System established
by the American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the insurer of
the medical necessity of the additional screening and diagnostic testing.
���� b.��� These benefits shall be
provided to the same extent as for any other sickness under the policy.
���� c.���� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
����
d.��� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf: P.L.2013, c.196, s.5)
���� 6.��� Section 7 of P.L.2004,
c.86 (C.17B:27A-7.10) is amended to read as follows:
���� 7.� a.� Every individual
health benefits plan that 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 to any person covered thereunder for expenses incurred
in conducting:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
physician-directed
imaging, including, but not limited to,
an ultrasound evaluation, a
magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination
or high risk assessment
, if the mammogram
or high risk
assessment
demonstrates extremely dense breast tissue, if the mammogram
or
high risk assessment
is abnormal within any degree of breast density
including not dense, moderately dense, heterogeneously dense, or extremely
dense breast tissue, or if the patient has additional risk factors for breast
cancer including but not limited to family history of breast cancer, prior
personal history of breast cancer, positive genetic testing, extremely dense
breast tissue based on the Breast Imaging Reporting and Data System established
by the American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the carrier of
the medical necessity of the additional screening and diagnostic testing.
���� b.��� The benefits shall be
provided to the same extent as for any other medical condition under the health
benefits plan.
���� c.���� The provisions of this
section shall apply to all health benefit plans in which the carrier has
reserved the right to change the premium.
����
d.��� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf: P.L.2013, c.196, s.6)
���� 7.��� Section
8 of P.L.2004, c.86 (C.17B:27A-19.13) is amended to read as follows:
���� 8.� a.� Every small employer
health benefits plan that 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 to any person covered thereunder for expenses incurred
in conducting:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
any
physician-directed imaging, including, but not limited to,
an ultrasound
evaluation, a magnetic resonance imaging scan, a three-dimensional mammography,
or other additional testing of an entire breast or breasts, after a baseline
mammogram examination
or high risk assessment
, if the mammogram
or
high risk assessment
demonstrates extremely dense breast tissue, if the
mammogram
or high risk assessment
is abnormal within any degree of
breast density including not dense, moderately dense, heterogeneously dense, or
extremely dense breast tissue, or if the patient has additional risk factors
for breast cancer including but not limited to family history of breast cancer,
prior personal history of breast cancer, positive genetic testing, extremely
dense breast tissue based on the Breast Imaging Reporting and Data System
established by the American College of Radiology, or other indications as
determined by the patient's health care provider.� The coverage required under
this paragraph may be subject to utilization review, including periodic review,
by the carrier of the medical necessity of the additional screening and
diagnostic testing.
���� b.��� The benefits shall be
provided to the same extent as for any other medical condition under the health
benefits plan.
���� c.���� The provisions of this
section shall apply to all health benefit plans in which the carrier has
reserved the right to change the premium.
����
d.��� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf: P.L.2013, c.196, s.7)
���� 8.��� Section 6 of P.L.1991,
c.279 (C.26:2J-4.4) is amended to read as follows:
���� 6.� a.� Notwithstanding any
provision of law to the contrary, 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 Banking and Insurance on or after the
effective date of this act unless the health maintenance organization provides
health care services to any enrollee for the conduct of:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
physician-directed
imaging, including, but not limited to,
an ultrasound evaluation, a
magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination
or high risk assessment
, if the mammogram
or high risk
assessment
demonstrates extremely dense breast tissue, if the mammogram
or
high risk assessment
is abnormal within any degree of breast density
including not dense, moderately dense, heterogeneously dense, or extremely
dense breast tissue, or if the patient has additional risk factors for breast
cancer including but not limited to family history of breast cancer, prior
personal history of breast cancer, positive genetic testing, extremely dense
breast tissue based on the Breast Imaging Reporting and Data System established
by the American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the health
maintenance organization of the medical necessity of the additional screening
and diagnostic testing.
���� b.��� These health care
services shall be provided to the same extent as for any other sickness under
the enrollee agreement.
���� c.���� The provisions of this
section shall apply to all enrollee agreements in which the health maintenance
organization has reserved the right to change the schedule of charges.
����
d.��� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf:� P.L.2013, c.196, s.8)
���� 9.��� Section 9 of P.L.2004,
c.86 (C.52:14-17.29i) is amended to read as follows:
���� 9.� a.� The State Health
Benefits Commission shall provide benefits to each person covered under the
State Health Benefits Program for expenses incurred in conducting:
���� (1)�� one baseline mammogram
examination for women who are
[
40
]
18
years of age; a mammogram examination every year for women age
[
40
]
18
and
over; and, in the case of a woman who is under
[
40
]
18
years of age and has a
family history of breast cancer or other breast cancer risk factors, a
mammogram examination at such age and intervals as deemed medically necessary
by the woman's health care provider; and
���� (2)��
physician-directed
imaging, including, but not limited to,
an ultrasound evaluation, a
magnetic resonance imaging scan, a three-dimensional mammography, or other
additional testing of an entire breast or breasts, after a baseline mammogram
examination
or high risk assessment
, if the mammogram
or high risk
assessment
demonstrates extremely dense breast tissue, if the mammogram
or
high risk assessment
is abnormal within any degree of breast density
including not dense, moderately dense, heterogeneously dense, or extremely
dense breast tissue, or if the patient has additional risk factors for breast
cancer including but not limited to family history of breast cancer, prior
personal history of breast cancer, positive genetic testing, extremely dense
breast tissue based on the Breast Imaging Reporting and Data System established
by the American College of Radiology, or other indications as determined by the
patient's health care provider.� The coverage required under this paragraph may
be subject to utilization review, including periodic review, by the carrier of
the medical necessity of the additional screening and diagnostic testing.
���� b.��� The benefits shall be
provided to the same extent as for any other medical condition under the
contract.
����
c.���� As used in this
section, �high risk assessment� means an annual assessment consisting of both a
mammogram examination and a magnetic resonance imaging scan provided to a woman
that is determined by the woman�s physician to be at high risk of breast
cancer.
(cf: P.L.2013, c.196, s.9)
���� 10.� This act shall take
effect immediately and shall apply to all health benefits plans currently in
effect in the State, or that are delivered, issued, executed or renewed in this
State, 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.
STATEMENT
���� This bill requires health
insurers (health, hospital and medical service corporations, commercial
individual and group health insurers, health maintenance organizations, health
benefits plans issued pursuant to the New Jersey Individual Health Coverage and
Small Employer Health Benefits Programs, and the State Health Benefits Program)
to provide coverage for mammograms for women age 18 or older, rather than age
40 and older as is required under current law.� In addition, the bill also requires
health insurers to provide coverage for physician-directed imaging under
certain circumstances.