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A5195
ASSEMBLY, No. 5195
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED JUNE 4, 2026
Sponsored by:
Assemblyman� VINCENT M. "VINNIE" KEARNEY
District 21 (Middlesex, Morris, Somerset and Union)
SYNOPSIS
���� Requires health insurance coverage for coronary
artery calcium screening under certain circumstances.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning health insurance coverage for certain
coronary calcium
tests and supplementing various
parts of the statutory law.
����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� a.�� Every hospital
service corporation contract providing hospital or medical expense benefits and
is delivered, issued, executed or renewed in this State pursuant to P.L.1938,
c.366 (C.17:48-1 et seq.), 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 benefits to any named subscriber or other person
covered thereunder for expenses incurred in
conducting a
coronary artery calcium screening to a subscriber or other person covered under
the contract who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract.
���� d.��� The provisions of this
section shall apply to all contracts in which the hospital service corporation
has reserved the right to change the premium.
���� 2.��� a.�� Every medical
service corporation contract that provides hospital or medical expense benefits
and is delivered, issued, executed or renewed in this State pursuant to
P.L.1940, c.74 (C.17:48A-1 et seq.), 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 benefits to any named subscriber or
other person covered thereunder for expenses incurred in conducting a coronary
artery calcium screening to a subscriber or other person covered under the
contract who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� These benefits shall be
provided to the same extent as for any other medical condition under the
contract.
���� d.��� The provisions of this
section shall apply to all contracts in which the medical services corporation
has reserved the right to change the premium.
���� 3.��� a.� Every health service
corporation contract that provides hospital or medical expense benefits and is
delivered, issued, executed or renewed in this State pursuant to P.L.1985,
c.236 (C.17:48E-1 et seq.), 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 benefits to any named subscriber or other person
covered thereunder for expenses incurred in conducting a coronary artery
calcium screening to a subscriber or other person covered under the contract
who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� These benefits shall be
provided to the same extent as for any other medical condition under the
contract.
���� d.��� The provisions of this
section shall apply to all contracts in which the health services corporation
has reserved the right to change the premium.
���� 4.��� a.� Every individual
policy that provides hospital or medical expense benefits and is delivered,
issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq.,
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
benefits to any named insured or other person covered thereunder for expenses
incurred in conducting a coronary artery calcium screening to a person covered
under the policy who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� These benefits shall be
provided to the same extent as for any other medical condition under the
policy.
���� d.��� The provision of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
���� 5.��� a.� Every group policy
that provides hospital or medical expense benefits and is delivered, issued,
executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., 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
benefits to any named insured or other person covered thereunder for expenses
incurred in conducting a coronary artery calcium screening to a subscriber or
other person covered under the policy who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� These benefits shall be
provided to the same extent as for any other medical condition under the
policy.
���� d.��� The provisions of this
section shall apply to all policies in which the insurer has reserved the right
to change the premium.
���� 6.��� a.� Every enrollee
agreement that provides hospital or medical expense benefits and is delivered,
issued, executed, or renewed in this State pursuant to P.L.1973, c.337
(C.26:2J-1 et seq.), 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 health care services to any enrollee or other person covered
thereunder for expenses incurred in conducting a coronary artery calcium screening
to an enrollee or other person covered under the agreement who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on the more frequent basis.
���� c.���� These health care
services shall be provided to the same extent as for any other medical
condition under the enrollee agreement.
���� d.��� 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.
���� 7.��� 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 expenses
incurred in conducting a coronary artery calcium screening to a person covered
under the plan who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the health
benefits plan.
���� d.��� The provisions of this
section shall apply to all health benefit plans in which the carrier has
reserved the right to change the premium.
���� 8.��� 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 Stat,
on or after the effective date of this act, shall provide benefits for expenses
incurred in conducting a coronary artery calcium screening to a person covered
under the plan who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the health
benefits plan.
���� d.��� The provisions of this
section shall apply to all health benefit plans in which the carrier has
reserved the right to change the premium.
���� 9.��� 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 and medical expense benefits, shall provide
coverage
for expenses incurred in conducting a coronary artery calcium screening
to a person covered under the contract who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract.
���� 10.� 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 expenses incurred in conducting a coronary artery calcium screening
to a person covered under the contract who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� b.��� The benefits shall be
provided every five years, unless a health care provider determines that the
person would benefit from more frequent screening based on
an underlying condition, in which case the benefits shall
be provided on a more frequent basis.
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract.
���� 11.� This act shall take
effect immediately and shall apply to policies and contracts that are
delivered, issued, executed, or renewed on or after that date.
STATEMENT
���� This bill requires health
insurance carriers, including insurance companies, health service corporations,
hospital service corporations, medical service corporations, health maintenance
organizations authorized to issue health benefits plans in New Jersey, and any
entity contracted to administer health benefits in connection with the State
Health Benefits Program or School Employees� Health Benefits Program, to cover
expenses incurred in conducting a coronary artery calcium screening to a person
who:
���� (1)�� is 45 years of age or
older; or
���� (2)�� has an intermediate risk
of developing coronary heart disease as determined by a health care provider
based upon a score calculated from an evidence-based algorithm widely used in
the medical community to assess a person's ten-year cardiovascular disease
risk, including a score calculated using a pooled cohort equation.
���� The bill requires the benefits
to be provided every five years, unless a health care provider determines that
the person would benefit from more frequent screening based on
an underlying condition, in which case the benefits are to
be provided on a more frequent basis.