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A5301
ASSEMBLY, No. 5301
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED JUNE 23, 2026
Sponsored by:
Assemblywoman� VERLINA REYNOLDS-JACKSON
District 15 (Hunterdon and Mercer)
Assemblywoman� LINDA S. CARTER
District 22 (Somerset and Union)
SYNOPSIS
���� Requires insurance coverage of diapers when medically
necessary.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning insurance coverage of diapers 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.�� A hospital service corporation contract that provides hospital or
medical expense benefits and is 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, shall
provide benefits to any covered person for medical expenses incurred in the
purchase of diapers, as determined medically necessary by the covered person�s
pediatrician or other medical doctor.� The benefits shall be provided without
the imposition of any prior authorization or other utilization management
requirements.
���� b.��� The provisions of this
section shall apply to all hospital service corporation contracts in which the
hospital service corporation has reserved the right to change the premium.
���� 2.��� a.� A 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 covered person for medical expenses incurred
in the purchase of diapers, as determined medically necessary by the covered
person�s pediatrician or other medical doctor.� The benefits shall be provided
without the imposition of any prior authorization or other utilization
management requirements.
���� b.��� The provisions of this
section shall apply to all medical service corporation contracts in which the medical
service corporation has reserved the right to change the premium.
���� 3.��� a.� A 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 al.), 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 covered person for medical expenses
incurred in the purchase of diapers, as determined medically necessary by the
covered person�s pediatrician or other medical doctor.� The benefits shall be
provided without the imposition of any prior authorization or other utilization
management requirements.
���� b.��� The provisions of this
section shall apply to all health service corporation contracts in which the health
service corporation has reserved the right to change the premium.
���� 4.��� a.� An individual health
insurance policy that provides hospital and 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 benefits to any covered person for medical
expenses incurred in the purchase of diapers, as determined medically necessary
by the covered person�s pediatrician or other medical doctor.� The benefits
shall be provided without the imposition of any prior authorization or other
utilization management requirements.
���� b.��� This section shall apply
to those policies in which the insurer has reserved the right to change the
premium.
���� 5.��� a.� A group health
insurance policy that provides hospital and medical expense benefits and is
delivered, issued, executed, or renewed in this State pursuant to chapter 27 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 benefits to any covered person for
medical expenses incurred in the purchase of diapers, as determined medically
necessary by the covered person�s pediatrician or other medical doctor.� The
benefits shall be provided without the imposition of any prior authorization or
other utilization management requirements.
���� b.��� This section shall apply
to those policies in which the insurer has reserved the right to change the
premium.
���� 6.��� a.� An individual health
benefits plan that provides hospital and 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
by the Commissioner of Banking and Insurance, on or after the effective date of
this act, shall provide benefits to any covered person for medical expenses
incurred in the purchase of diapers, as determined medically necessary by the
covered person�s pediatrician or other medical doctor.� The benefits shall be
provided without the imposition of any prior authorization or other utilization
management requirements.
���� b.��� This section shall apply
to those health benefits plans in which the carrier has reserved the right to
change the premium.
���� 7.��� a.� A small employer
health benefits plan that provides hospital and 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
by the Commissioner of Banking and Insurance, on or after the effective date of
this act, shall provide benefits to any covered person for medical expenses
incurred in the purchase of diapers, as determined medically necessary by the
covered person�s pediatrician or other medical doctor.� The benefits shall be
provided without the imposition of any prior authorization or other utilization
management requirements.
���� b.��� This section shall apply
to those health benefits plans in which the carrier has reserved the right to
change the premium.
���� 8.��� a.� A health maintenance
organization contract for health care services that 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 benefits to any covered person for medical expenses incurred in the
purchase of diapers, as determined medically necessary by the covered person�s
pediatrician or other medical doctor.� The benefits shall be provided without
the imposition of any prior authorization or other utilization management
requirements.
���� b.��� This section shall apply
to those contracts for health care services under which the health maintenance
organization has reserved the right to change the schedule of charges for
enrollee coverage.
���� 9.��� 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 benefits to any covered person for
medical expenses incurred in the purchase of diapers, as determined medically
necessary by the covered person�s pediatrician or other medical doctor. �The
benefits shall be provided without the imposition of any prior authorization or
other utilization management requirements.
���� 10.� 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
and medical expense benefits shall provide benefits to any covered person for
medical expenses incurred in the purchase of diapers, as determined medically
necessary by the covered person�s pediatrician or other medical doctor.� The
benefits shall be provided without the imposition of any prior authorization or
other utilization management requirements.
���� 11.���� This act shall take
effect on the 90th day next following enactment.
STATEMENT
���� This bill requires health
benefits coverage for medical expenses incurred in the purchase of diapers that
are deemed medically necessary.� Whether diapers are a medical necessity shall
be determined by the covered person�s pediatrician or other medical doctor.
���� Some persons suffer from
genetic or other conditions that require the use of diapers beyond early
childhood.� Under this bill, insurers will be required to provide coverage for
diapers for persons for whom the use of diapers is a medical necessity.