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S3262
SENATE, No. 3262
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED FEBRUARY 2, 2026
Sponsored by:
Senator� KRISTIN M. CORRADO
District 40 (Bergen, Essex and Passaic)
SYNOPSIS
���� Requires health insurers to cover Lyme disease.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
concerning health insurance benefits for the treatment of Lyme disease 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 coverage for expenses
incurred in the treatment of Lyme disease determined to be medically necessary
by the covered person's physician after making a written evaluation of that
person's symptoms, condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section shall not be denied solely
because such treatment may be characterized as experimental or investigational
in nature.
���� c.���� This section shall
apply to all 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, 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 expenses incurred in
the treatment of Lyme disease as determined to be medically necessary by the
covered person's physician after making a written evaluation of that person's
symptoms, condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section shall not be denied solely
because such treatment may be characterized as experimental or investigational
in nature.
���� c.���� This section shall
apply to all 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, 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 expenses
incurred in the treatment of Lyme disease determined to be medically necessary
by the covered person's physician after making a written evaluation of that
person's symptoms, condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section shall not be denied solely
because such treatment may be characterized as experimental or investigational
in nature.
���� c.���� This section shall
apply to all 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 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 coverage for expenses incurred in
the treatment of Lyme disease determined to be medically necessary by the
covered person's physician after making a written� evaluation of that person's
symptoms, condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section shall not be denied solely
because such treatment may be characterized as experimental or investigational
in nature.
���� c.���� This section shall
apply to all policies in which the insurer has reserved the right to change the
premium.
���� 5.��� a.� A group health
insurance policy 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 coverage for expenses
incurred in the treatment of Lyme disease determined to be medically necessary
by the covered person's physician after making a written evaluation of that
person's symptoms, condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section shall not be denied solely
because such treatment may be characterized as experimental or investigational
in nature.
���� c.���� This section shall
apply to all policies in which the insurer has reserved the right to change the
premium.
���� 6.��� a.� A individual health
benefits plan that provides hospital and 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 for expenses
incurred in the treatment of Lyme Disease determined to be medically necessary
by the covered person's physician after making a written evaluation of that
person's symptoms, condition and response to treatment.
���� b.��� Health care services
otherwise eligible for coverage pursuant to this section shall not be denied
solely because such services may be characterized as experimental or
investigational in nature.
���� c.���� This section shall
apply to those individual 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, 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 for expenses incurred in
the treatment of Lyme Disease determined to be medically necessary by the
covered person�s physician after making a written evaluation of that person�s
symptoms, condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section shall not be denied solely
because such services may be characterized as experimental or investigational
in nature.
���� c.���� This section shall
apply to those small employer 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, 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 expenses incurred in the treatment
of Lyme Disease determined to be medically necessary by the covered person�s
physician after making a written evaluation of that person�s symptoms,
condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section shall not be denied solely
because the treatment may be characterized as experimental or investigational
in nature.
���� c.���� 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.��� 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 shall provide coverage for expenses incurred in the treatment
of Lyme Disease determined to be medically necessary by the covered person�s
physician after making a written evaluation of that person�s symptoms,
condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section may not be denied solely because
the treatment may be characterized as experimental or investigational in nature.
���� 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
and medical expense benefits shall provide coverage for expenses incurred in the
treatment of Lyme Disease determined to be medically necessary by the covered
person�s physician after making a written evaluation of that person�s symptoms,
condition and response to treatment.
���� b.��� Treatment otherwise
eligible for benefits pursuant to this section may not be denied solely because
the treatment may be characterized as experimental or investigational in
nature.
���� 11.� This act shall take
effect on the 90th day after enactment.
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; the State Health Benefits Program; and
the School Employees� Health Benefits Program) to provide coverage for expenses
incurred in the treatment of Lyme Disease. Treatment otherwise eligible for
benefits pursuant to this bill may not be denied solely because such treatment
may be characterized as experimental or investigational in nature.