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A4349
ASSEMBLY, No. 4349
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED FEBRUARY 19, 2026
Sponsored by:
Assemblywoman� SHANIQUE SPEIGHT
District 29 (Essex and Hudson)
Assemblywoman� SHAMA A. HAIDER
District 37 (Bergen)
SYNOPSIS
���� Requires health insurance and Medicaid coverage for
reproductive health care services; prohibits adverse actions by medical
malpractice insurers in relation to performance of health care services.�
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning insurance coverage for reproductive
health care and revising and supplementing various parts of the statutory law.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� (New section) The
Legislature finds and declares that:
���� a.��� Given the historic and
continued attacks on abortion access and reproductive health care at the
federal level and in other states, it is critical that New Jersey take
legislative action to ensure that all individuals in the State are able to
exercise their fundamental rights to choose to use or refuse contraception or
sterilization, to carry a pregnancy, to give birth, or to have an abortion,
regardless of where the they are domiciled.
���� b.��� New Jersey
has historically provided stronger protections for
reproductive rights and autonomy than are provided by other states and the
federal government.� The New Jersey Supreme Court has made clear through
several holdings, including
Right to Choose v. Byrne
, 91 N.J. 287
(1982), and
Planned Parenthood of Cent. N.J. v. Farmer
, 165 N.J. 609
(2000), that Article I, paragraph 1 of the New Jersey Constitution protects the
right to abortion and reproductive autonomy to an extent that exceeds the
protections established under the United States Constitution.� In 2022, New
Jersey codified the fundamental constitutional right to reproductive autonomy,
including the right to abortion,
and has restored and
allocated State funding to support reproductive health care services
.
���� c.��� The
Legislature is committed to ensuring that all individuals
in the State can fully exercise their right to reproductive autonomy and can
access affordable and timely reproductive health care services.� It is
imperative to ensure that every person present in the State has the freedom to
choose whether, when, and how to bear children on their own terms.
���� d.���
Access to reproductive health
care is critical for the health and economic security of all people in New
Jersey, providing all individuals in the State with the opportunity
to
lead healthier and more productive lives.
To
effectively vindicate the right to abortion and reproductive autonomy enshrined
in State law, New Jersey must address barriers to access.
����
e.���
Financial
barriers and costs associated with reproductive health care services can
prevent people from accessing appropriate and necessary care. These costs
can threaten individuals� financial security and negatively impact their
long-term economic prospects. Cost barriers associated with reproductive health
care often have a disparate impact on people who already experience barriers to
health care access, including young people, people of color, people with
disabilities, people with a low income, people living in rural areas,
immigrants, and transgender or non-binary individuals.
����
f.���� A
person's income level or their type of insurance
should never prevent them from having access to a full range of reproductive
health care.� The absence of funding should never be a reason that someone
present in New Jersey does not exercise their fundamental right to reproductive
autonomy, including abortion.
���� g.��� Health
care practitioners should not be constrained from providing necessary or
appropriate reproductive health care. Medically unnecessary regulations
discourage practitioners from offering reproductive health care, including
abortions, which effectively reduces the number of licensed providers,
diminishes the availability of legal abortion providers, and creates harmful
barriers and delays to care without providing any benefit to patients.
Extensive scientific study has shown that abortion care is a safe medical
intervention, safer than childbirth as well as many common medical procedures.
���� h.��� Given
New Jersey�s high priority to the preservation of health, the State has a
significant interest in ensuring that every person in New Jersey can access
reproductive health care, including abortion services.� The Legislature is
committed to addressing barriers to receiving and providing reproductive health
care in the State.� It shall therefore be the policy of this State to enable
all qualified health care practitioners to provide abortion services in the
State, and to advance insurance coverage and other methods through which to
ensure that reproductive health care is accessible and affordable to all people
present in New Jersey.
���� 2.��� (New section) As used in
this act:
���� �Abortion� means any medical
treatment intended to induce the termination of a pregnancy and services
rendered to facilitate the termination which may include follow-up care, except
for the purpose of producing a live birth.� �Abortion� includes, but is not
limited to, �aspiration abortion� and �medication abortion,� as defined in this
section.
���� �Aspiration abortion� means a
procedure that terminates a pregnancy utilizing manual or electric suction to
empty the uterus.
���� �Carrier� means an insurance
company, health service corporation, hospital service corporation, medical
service corporation, or health maintenance organization authorized to issue
health benefits plans in this State.
���� �Covered person� means a
person, or dependents of a person, on whose behalf a carrier offering the plan
is obligated to pay benefits or provide services pursuant to the health
benefits plan.
���� �Medication abortion� means
the use, prescription, order, dispensing,
administration, or any combination thereof as applicable, of a medication or a
combination of medications to induce termination of pregnancy.
����
�Pregnancy� means the period of the human
reproductive process beginning with the implantation of a fertilized egg.
���� �Religious employer� means an
organization that is referred to in section 6033(a)(3)(A)(i) or (iii) of the federal
Internal Revenue Code of 1986 (26 U.S.C. s.6033), as amended, and organized and
operates as a nonprofit entity.
���� 3.��� (New section)� a.� A
contract that provides hospital or medical expense benefits and is delivered,
issued, executed, or renewed in this State by a carrier or is approved for
issuance or renewal in this State by the Commissioner of Banking and Insurance,
on or after the effective date of P.L. , c.� ��(C.������� ) �(pending
before the Legislature as this bill), shall provide coverage for abortion.
���� b.��� (1)� A contract subject
to this section shall not impose a deductible, coinsurance, copayment, or any
other cost-sharing requirement on the coverage required under this section.�
���� (2)� A contract that meets the
requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, shall
be exempt from paragraph (1) of this subsection.�
���� (3)�
For
benefits offered in conjunction with a high-deductible health plan, the
contract shall not provide benefits until the expenditures applicable to the
deductible under the plan have met the amount of the minimum annual deductibles
in effect for self-only and family coverage under section 223(c)(2)(A)(i) of
the federal Internal Revenue Code (26 U.S.C. s.223(c)(2)(A)(i)) for self-only
and family coverage, respectively.� Once the foregoing expenditure amount has
been met under the plan, coverage for benefits shall begin and the provisions
in paragraph (1) of this subsection shall be in effect.
���� c.��� A contract shall not
impose any restrictions or delays on, and shall not require prior authorization
for, the coverage required under this section.
���� d.��� Notwithstanding the
provisions of subsections a. through c. of this section to the contrary, if the
Commissioner of Banking and Insurance concludes that enforcement of this
section may adversely affect the allocation of federal funds to this State, the
commissioner may grant an exemption to the requirements of this section, but
only to the minimum extent necessary to ensure the continued receipt of federal
funds.
���� e.��� A religious employer may
request, and a carrier shall grant, an exclusion under the contract for the
coverage required by this section if the required coverage conflicts with the
religious employer�s bona fide religious beliefs and practices. A
religious employer that obtains an exclusion shall provide written notice
thereof to covered persons and prospective covered persons, and a carrier shall
provide notice to the Commissioner of Banking and Insurance, in the form and
manner determined by the commissioner. The provisions of this subsection
shall not authorize a carrier to exclude coverage for care that is necessary to
preserve the life or health of a covered person.
���� 4.��� (New section)� a. �The
State Health Benefits Commission shall ensure that every contract providing
hospital or medical expense benefits, which is purchased by the commission on
or after the effective date of P.L.��� , c.��� (C.������� ) (pending before the
Legislature as this bill), provides coverage for abortions, as defined by
section 1 of P.L.��� , c.��� (C.������� ) (pending before the Legislature as
this bill).
����
b.
A contract subject to this section shall not impose a deductible, coinsurance,
copayment, or any other cost-sharing requirement on the coverage required under
this section. For a qualifying high-deductible health plan for a health
savings account, the commission shall establish the plan�s cost-sharing for the
coverage provided pursuant to this section at the minimum level necessary to
preserve the covered person�s ability to claim tax-exempt contributions and
withdrawals from the covered person�s health savings account under 26 U.S.C.
s.223.
���� �c.
A contract shall not impose any restrictions or delays on, and shall not
require prior authorization for, the coverage required under this section.
����
5.��� (New
section)� a.
� The School Employees� Health Benefits
Commission shall ensure that every contract providing hospital or medical
expense benefits, which is purchased by the commission on or after the
effective date of P.L. , c. (C.������� ) (pending
before the Legislature as this bill), provides coverage for abortions, as
defined by section 1 of P.L. , c.
(C. ) (pending before the Legislature
as this bill).
���� b.��� A
contract subject to this section shall not impose a deductible, coinsurance,
copayment, or any other cost-sharing requirement on the coverage required under
this section. For a qualifying high-deductible health plan for a health
savings account, the commission shall establish the plan�s cost-sharing for the
coverage provided pursuant to this section at the minimum level necessary to
preserve the covered person�s ability to claim tax-exempt contributions and
withdrawals from the covered person�s health savings account under 26 U.S.C.
s.223.
���� �c.
A contract shall not impose any restrictions or delays on, and shall not
require prior authorization for, the coverage required under this section.
���� 6.��� (New section) a.� Notwithstanding
any State law or regulation to the contrary, the Department of Human Services
shall ensure that expenses incurred for abortion services shall be provided
with no cost-sharing to persons served under the Medicaid program, established
pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
���� b.��� Any copayment,
coinsurance, or deductible that may be required pursuant to the contract for
services covered pursuant to subsection a. of this section shall not apply.
���� c.��� The department may take
any administrative action necessary to effectuate the provisions of this
section, including modifying or amending any applicable contract or
promulgating, amending, or repealing any guidance, guidelines, or rules, which
rules or amendments thereto shall be effective immediately upon filing with the
Office of Administrative Law for a period not to exceed 12 months, and may,
thereafter, be amended, adopted or readopted in accordance with the provisions
of the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et
seq.).
���� 7.��� Section 2 of P.L.2021,
c.375 (C.10:7-2) is amended to read as follows:
���� 2.��� a. �Every individual
present in the State, including, but not limited to, an individual who is under
State control or supervision, shall have the fundamental right to: choose or
refuse contraception or sterilization; and choose whether to carry a pregnancy,
to give birth, or to terminate a pregnancy.� The New Jersey Constitution
recognizes the fundamental nature of the right to reproductive choice,
including the right to access contraception, to terminate a pregnancy, and to
carry a pregnancy to term, shall not be abridged by any law, rule, regulation,
ordinance, or order issued by any State, county, or local governmental
authority.� Any law, rule, regulation, ordinance, or order, in effect on or
adopted after the effective date of this act,
or any part thereof,
that
is determined to have the effect of limiting the constitutional right to
freedom of reproductive choice and that does not conform with the provisions
and the express or implied purposes of this act, shall be deemed invalid and
shall have no force or effect.
���� b.���
If the State
provides, directly or by contract, hospital or medical benefits for
pregnancy-related care through any program administered or funded in whole or
in part by the State, the State shall also provide a pregnant individual
otherwise eligible for the program with substantially equivalent benefits to
permit the individual to voluntarily terminate the individual�s pregnancy.
����
c.��� A physician or other
health care professional, acting within the professional�s lawful scope of
practice and in compliance with all generally applicable regulations, shall be
authorized to provide and assist in the provision of reproductive health care
services in this State.
����
d.��� Nothing in P.L.2021,
c.375 (C.10:7-1 et seq.) shall effect or limit in anyway an advanced practice
clinician who is licensed, certified, or otherwise authorized by law to
practice in this State from performing aspiration abortion, providing
medication abortion, or managing the spontaneous termination of a pregnancy.
����
e.��� A public entity shall
not, in regulating or providing benefits, facilities, services, or information,
deny or interfere with an individual�s fundamental reproductive rights pursuant
to subsection a. of this section or discriminate against an individual on the
basis of the individual�s exercise of fundamental reproductive rights pursuant
to subsection a. of this section.
����
f.���� (1)������ All rules
and regulations promulgated by the Department of Human Services as of the
effective date of P.L.���� , c.��� (C.������� )
�(pending before the
Legislature as this bill), or parts thereof, which limit coverage for abortion
services based on the type of facility or health care professional that
provides the services, or which are otherwise inconsistent or in conflict with
the provisions or express or implied purposes of P.L.2021, c.375 (C.10:7-1 et
seq.) including, but not limited to, relevant parts or subparts of
N.J.A.C.10:54-5.43 and N.J.A.C.10:66-2.16 shall be void and have no force or
effect following the effective date of P.L. , c.���
(C.������� ) (pending before the Legislature as this bill), provided that nothing
in this subsection shall be construed to limit a professional licensing board or
regulatory agency from establishing through regulation the qualifications or
standards of care for its licensees with respect to the performance of
reproductive health care services
.
����
(2)� The rules and
regulations adopted by the Commissioner of Human Services, pursuant to this
section, shall include, but need not be limited to, rules and regulations
permitting electronic billing for abortion services, which rules and
regulations shall be promulgated by January 1, 2025.
����
g.
��� The provisions of
this section shall be enforceable under the "New Jersey Civil Rights
Act," P.L.2004, c.143 (C.10:6-1 et seq.) or in any other manner provided
by law.
����
h.��� As used in this
section:
����
�Abortion� means any
medical treatment intended to induce the termination of a pregnancy and
services rendered to facilitate the termination which may include follow-up
care, except for the purpose of producing a live birth.� �Abortion� includes,
but is not limited to, �aspiration abortion� and �medication abortion,� as
defined in this section.
����
�Advanced practice
clinician� means an advanced practice nurse licensed pursuant to P.L.1991,
c.377 (C.45:11-45 et seq.); a physician assistant licensed pursuant to
P.L.1991, c.378 (C.45:9-27.10 et seq.); a certified nurse midwife; and a
certified midwife licensed pursuant to R.S.45:10-1 et seq.
����
�Aspiration abortion� means
a procedure that terminates a pregnancy utilizing manual or electric suction to
empty the uterus.
����
�Health care professional�
means a physician and other health care professionals licensed pursuant to Title
45 of the Revised Statutes, and a hospital and other health care facilities
licensed pursuant to Title 26 of the Revised Statutes.
����
�Medication abortion� means
the use, prescription, order,
dispensing, administration, or any combination thereof as applicable, of a
medication or a combination of medications to induce termination of pregnancy.
����
�Pregnancy� means the period of the human
reproductive process beginning with the implantation of a fertilized egg.
����
�Public entity� means the
State and any county, municipality, district, public authority, public agency,
or other political subdivision or public body in the State.
����
�Reproductive health care
services� includes all medical, pharmaceutical, surgical, counseling or
referral services performed by a licensed health care professional relating to
the human reproductive system, including, but not limited to, services relating
to pregnancy, contraception,
managing infertility, or the termination of a
pregnancy.
(cf: P.L.2021, c.375, s.2)
���� 8.��� Section 17 of P.L.2004,
c.17 (C.17:30D-22) is amended to read as follows:
���� 17.�
a.
�
Notwithstanding any other law or regulation to the contrary, an insurer
authorized to transact medical malpractice liability insurance in this State
shall not increase the premium of any medical malpractice liability insurance
policy based on a claim of medical negligence or malpractice against the
insured if the insured is dismissed from an action alleging medical malpractice
within 180 days of the filing of the last responsive pleading.
����
b.��� An insurer authorized
to transact medical malpractice liability insurance in this State shall not
take any adverse action, including but not limited to, loss or denial of
coverage, or imposition of sanctions, fines, penalties, or rate increases,
against an insured licensed, certified, or registered in this State for providing
or facilitating a legally protected health care activity based on the fact that
the patient receiving the service is a resident of a state where those services
are illegal, or based on a revocation of an insured�s license from another
state or other disciplinary action by another state that resulted from an
insured�s providing, authorizing, participating in, referring, or assisting in
a legally protected health care activity, if the revocation or disciplinary
action was based on a violation of the other state�s law prohibiting the legally
protected health care activity.
����
c.��� As used in this
section:
����
�Gender-affirming health
care services� means all supplies, care, and services of a medical, behavioral
health, mental health, surgical, psychiatric, therapeutic, diagnostic,
preventative, rehabilitative, or supportive nature, including medication, relating
to the treatment of gender dysphoria and gender incongruence.
�Gender-affirming health care services� does not include sexual orientation
change efforts as defined by section 2 of P.L.2013, c.150 (C.45:1-55).
����
�Legally protected health
care activity� means providing, seeking, receiving, assisting with, or
inquiring about reproductive health care services or gender-affirming health
care services that are lawful in this State, regardless of the patient�s
location.
����
�Reproductive health care
services� includes all medical, pharmaceutical, surgical, counseling or
referral services provided by a licensed health care professional relating to
the human reproductive system, including, but not limited to, services relating
to pregnancy, contraception,
or the termination of a pregnancy.
(cf: P.L.2004, c.17, s.17)
����
���� 9.��� The following sections
are repealed:
���� Section 3 of P.L.2021, c.375
(C.26:2S-39);
���� Section 4 of P.L.2021, c.375
(C.52:14-17.29hh); and
���� Section 5 of P.L.2021, c.375
(C.52:14-17.46.6q).
���� 10.� a.� Sections 1 through 3
shall take effect on the first day of the third month next following the date
of enactment and shall apply to all policies, plans, and contracts delivered,
issued, executed, or renewed on or after the effective date, except the
Department of Banking and Insurance may take anticipatory administrative action
as may be necessary to implement the provisions.
���� b.��� Sections 4 through 9
shall take effect immediately, except that the amendment made in section 7 to subsection
b. of section 2 of P.L.2021, c.375 (C.10:7-2) shall take effect on the sixth
month next following the date of enactment.
STATEMENT
���� This bill requires health
insurance carriers (including health service corporations, hospital service
corporations, medical service corporations, commercial individual and group
health insurers, and health maintenance organizations), entities contracted to
administer health benefits in connection with the State Health Benefits Program
and School Employees� Health Benefits Program, and the NJ FamilyCares/Medicaid
program to provide coverage for the termination of pregnancies.�
���� Under the bill, �pregnancy� is
defined as the period of the human reproductive process beginning with the
implantation of a fertilized egg.� The bill provides that, upon request of a
religious employer, health insurers are required to grant an exclusion if the
coverage conflicts with the religious employer�s bona fide religious beliefs
and practices.� �Religious employer� is defined in the bill to mean an
organization that is referred to in section 6033(a)(3)(A)(i) or (iii) of the
federal Internal Revenue Code of 1986 (26 U.S.C. s.6033), and that is organized
and operates as a nonprofit entity.�
���� Additionally, the bill
provides that any State program that provides benefits for pregnancy-related
care will also provide benefits for the termination of a pregnancy.� Lastly,
under the bill,
medical malpractice insurers are
barred from taking any adverse action, including loss of coverage, sanctions,
fines, penalties, or rate increases, against an insured for providing or
facilitating reproductive health care services or gender-affirming health care
services based solely on the fact that the patient receiving the service is a
resident of a state where providing or facilitating the activity is illegal.