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S4243
SENATE, No. 4243
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MAY 14, 2026
Sponsored by:
Senator� BENJIE E. WIMBERLY
District 35 (Bergen and Passaic)
Senator� ANGELA V. MCKNIGHT
District 31 (Hudson)
SYNOPSIS
���� Requires health insurance coverage for early-stage
kidney disease screening without cost sharing.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
requiring health insurance coverage for
early-stage kidney disease screening and supplementing various parts of
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 and 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 for expenses incurred by a covered person for
early-stage kidney disease screening that is determined to be medically
necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for the early-stage kidney disease screening conducted when a covered person�s
physician determines it is medically necessary.� The provisions of this
subsection shall apply to a high-deductible health plan to the maximum extent
permitted by federal law, except if the plan is used to establish a medical
savings account pursuant to section 220 of the federal Internal Revenue Code of
1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of
the federal Internal Revenue Code of 1986 (26 U.S.C. s.223).� The provisions of
this subsection shall apply to the plan to the maximum extent that is permitted
by federal law and does not disqualify the account for the deduction allowed
under section 220 or 223, as applicable.� The provisions of this subsection
shall apply to a plan that meets the requirements of a catastrophic plan, as
defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal
law.�
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract.���������
���� d.��� This section shall apply
to those hospital service corporation contracts in which the hospital service
corporation has reserved the right to change the premium.�
���� e.���� As used in this
section, �early-stage kidney disease screening� means a physician�s election of
either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.
���� f.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for early-stage kidney disease screening for
early-stage kidney disease established by the National Kidney Foundation, its
successor organization, or a comparable organization.�
���� 2.��� a.� A medical service
corporation contract that provides hospital and 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 for expenses incurred by a covered person for
early-stage kidney disease screening that is determined to be medically
necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for early-stage kidney disease screening conducted when a physician determines
it is medically necessary.� The provisions of this subsection shall apply to a
high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223).� The provisions of this subsection shall apply
to the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223, as
applicable.� The provisions of this subsection shall apply to a plan that meets
the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to
the maximum extent permitted by federal law.�
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract.
���� d.��� This section shall apply
to those medical service corporation contracts in which the medical service
corporation has reserved the right to change the premium.�
���� e.���� As used in this
section, �early-stage kidney disease screening� means a physician�s election of
either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.�
���� f.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for early-stage kidney disease screening established
by the National Kidney Foundation, its successor organization, or a comparable
organization.�
���� 3.��� a.� A health service
corporation contract that provides hospital and 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 for expenses incurred by a covered person
early-stage kidney disease screening that is determined to be medically
necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for early-stage kidney disease screening when a physician determines it is
medically necessary.� The provisions of this subsection shall apply to a
high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223).� The provisions of this subsection shall apply
to the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223, as
applicable.� The provisions of this subsection shall apply to a plan that meets
the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to
the maximum extent permitted by federal law.�
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract. ��������
���� d.��� This section shall apply
to those health service corporation contracts in which the health service
corporation has reserved the right to change the premium.�
���� e.���� As used in this
section, �early-stage kidney disease screening� means a physician�s election of
either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.�
���� f.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for early-stage kidney disease screening established
by the National Kidney Organization, its successor organization, or a
comparable organization.�
���� 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 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 for expenses incurred by an insured for early-stage kidney
disease screening in the blood that is determined to be medically necessary by
a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for early-stage kidney disease screening conducted when a physician determines
it to be medically necessary.� The provisions of this subsection shall apply to
a high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223).� The provisions of this subsection shall apply
to the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223, as
applicable.� The provisions of this subsection shall apply to a plan that meets
the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to
the maximum extent permitted by federal law.�
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract. ��������
���� d.��� This section shall apply
to those individual health insurance policies in which the insurer has reserved
the right to change the premium.�
���� e.���� As used in this
section, �early-stage kidney disease screening� means a physician�s election of
either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.�
���� f.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for early-stage kidney disease screening established
by the National Kidney Foundation, its successor organization, or a comparable
organization.�
���� 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
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 for expenses incurred by an insured for
early-stage kidney disease screening that is determined to be medically
necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for early-stage kidney disease screening.� The provisions of this subsection
shall apply to a high-deductible health plan to the maximum extent permitted by
federal law, except if the plan is used to establish a medical savings account
pursuant to section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C.
s.220) or a health savings account pursuant to section 223 of the federal
Internal Revenue Code of 1986 (26 U.S.C. s.223).� The provisions of this
subsection shall apply to the plan to the maximum extent that is permitted by
federal law and does not disqualify the account for the deduction allowed under
section 220 or 223, as applicable.� The provisions of this subsection shall
apply to a plan that meets the requirements of a catastrophic plan, as defined
in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.�
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
policy. ����
���� d.��� This section shall apply
to those group health insurance policies in which the insurer has reserved the
right to change the premium.
���� e.���� As used in this
section, �early-stage kidney disease screening� means a physician�s election of
either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.�
���� f.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for early-stage kidney disease screening established
by the National Kidney Foundation, its successor organization, or a comparable
organization.�
���� 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 for expenses incurred by a covered person for
early-stage kidney disease screening that is determined to be medically
necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for early-stage kidney disease screening conducted when a physician determines
it to be medically necessary.� The provisions of this subsection shall apply to
a high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223).� The provisions of this subsection shall apply
to the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223, as
applicable.� The provisions of this subsection shall apply to a plan that meets
the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to
the maximum extent permitted by federal law.�
���� c.���� The benefits shall be
provided to eh same extent as for any other medical condition under the policy.
����
���� d.��� This section shall apply
to those health benefits plans in which the carrier has reserved the right to
change the premium.
���� e.���� As used in this
section, �early-stage kidney disease screening� means a physician�s election of
either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.�
���� f.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for testing blood for levels of PFAS established
by the National Kidney Foundation, its successor organization, or a comparable
organization.�
���� 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 coverage for expenses incurred by a covered person for
early-stage kidney disease screening that is determined to be medically
necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for the early-stage kidney disease screening conducted when a covered person�s
physician determines it to be medically necessary.� The provisions of this
subsection shall apply to a high-deductible health plan to the maximum extent
permitted by federal law, except if the plan is used to establish a medical
savings account pursuant to section 220 of the federal Internal Revenue Code of
1986 (26 U.S.C. s.220) or a health savings account pursuant to section 223 of
the federal Internal Revenue Code of 1986 (26 U.S.C. s.223).� The provisions of
this subsection shall apply to the plan to the maximum extent that is permitted
by federal law and does not disqualify the account for the deduction allowed
under section 220 or 223, as applicable.� The provisions of this subsection
shall apply to a plan that meets the requirements of a catastrophic plan, as
defined in 45 C.F.R. s.156.155, to the maximum extent permitted by federal
law.�
���� c.���� This section shall
apply to those health benefits plans in which the carrier has reserved the
right to change the premium.
���� d.��� As used in this section,
�early-stage kidney disease screening� means a physician�s election of either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.�
���� e.���� For the purposes of
this section early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for early-stage kidney disease screening
established by the National Kidney Foundation, its successor organization, or a
comparable organization.�
���� 8.��� 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 for expenses incurred by an enrollee
for early-stage kidney disease screening that is determined to be medically
necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for early-stage kidney disease screening conducted when a physician determines
it to be medically necessary.� The provisions of this subsection shall apply to
a high-deductible health plan to the maximum extent permitted by federal law,
except if the plan is used to establish a medical savings account pursuant to
section 220 of the federal Internal Revenue Code of 1986 (26 U.S.C. s.220) or a
health savings account pursuant to section 223 of the federal Internal Revenue
Code of 1986 (26 U.S.C. s.223).� The provisions of this subsection shall apply
to the plan to the maximum extent that is permitted by federal law and does not
disqualify the account for the deduction allowed under section 220 or 223, as
applicable.� The provisions of this subsection shall apply to a plan that meets
the requirements of a catastrophic plan, as defined in 45 C.F.R. s.156.155, to
the maximum extent permitted by federal law.�
���� c.���� The health care
services shall be provided to the same extent as for any other medical
condition under the enrollee agreement.
���� d.��� 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.�
���� e.���� As used in this
section, �early-stage kidney disease screening� means a physician�s election of
either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.�
���� f.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for early-stage kidney disease screening established
by the National Kidney Foundation, its successor organization, or a comparable
organization.�
���� 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 benefits for expenses incurred by a
covered person for early-stage kidney disease screening that is determined to
be medically necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for early-stage kidney disease screening conducted when a covered person�s
physician determines it to be medically necessary.� A contract provided by the
State Health Benefits Commission that qualifies as a high-deductible health
plan shall provide coverage for early-stage kidney disease screening at the
lowest deductible and other cost-sharing requirement permitted for a
high-deductible health plan under section 223(c)(2)(A) of the federal Internal
Revenue Code (26 U.S.C. s.223 (c)(2)(A)). The provisions of this section shall
apply to a plan that meets the requirements of a catastrophic plan, as defined
in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.�
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract. ��������
���� d.��� As used in this section,
�early-stage kidney disease screening� means a physician�s election of either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.�
���� e.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if the covered person�s physician
determines the covered person meets clinical guidelines for early-stage kidney disease
screening by the National Kidney Foundation, its successor organization, or a
comparable organization.�
���� 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 benefits for expenses incurred by a
covered person for early-stage kidney disease screening that is determined to
be medically necessary by a physician.�
���� b.��� No deductible,
coinsurance, copayment, or any other cost-sharing requirement shall be imposed
for early-stage kidney disease screening when a covered person�s physician
determines it to be medically necessary.� A contract provided by the School
Employees� Health Benefits Commission that qualifies as a high-deductible
health plan shall provide coverage for testing blood for levels of PFAS at the
lowest deductible and other cost-sharing requirement permitted for a
high-deductible health plan under section 223(c)(2)(A) of the federal Internal
Revenue Code (26 U.S.C. s.223 (c)(2)(A)). The provisions of this section shall
apply to a plan that meets the requirements of a catastrophic plan, as defined
in 45 C.F.R. s.156.155, to the maximum extent permitted by federal law.�
���� c.���� The benefits shall be
provided to the same extent as for any other medical condition under the
contract.
���� d.��� As used in this section,
�early-stage kidney disease screening� means a physician�s election of either:
���� (1) a blood test to determine
an individual�s estimated glomerular filtration rate; or
���� (2) a urine albumin-creatinine
ratio test.
���� e.���� For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if the covered person�s physician
determines the covered person meets clinical guidelines for early-stage kidney disease
screening established by the National Kidney Foundation, and Medicine, its
successor organization, or a comparable organization.�
���� 11.� This act shall take
effect on the first day of the fourth month next following enactment and shall
apply to policies and contracts that are delivered, issued, executed, or
renewed on or after that date.�
STATEMENT
���� This bill requires health
insurers and health maintenance organizations, as well as health benefits plans
or contracts which are issued or purchased pursuant to the New Jersey
Individual Health Coverage Program, New Jersey Small Employer Health Benefits Program,
State Health Benefits Program, and School Employees� Health Benefits Program,
to provide coverage for expenses incurred by individuals for early-stage kidney
disease screening that is determined to be medically necessary by the treating
physician.
���� The incidence of chronic
kidney disease is rising in this State with in-hospital admissions increasing
60 percent since 2016.�� Chronic kidney disease is the gradual decline of
kidney function after the organs sustain long-term damage.� Two tests are
commonly used to track kidney health: a blood test to determine an individual�s
estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine
ratio test (uACR).� An eGFR test estimates how well an individual�s kidneys are
filtering blood by measuring creatine levels.� A uACR test shows how well the
kidneys filter blood by determining albumin protein levels in urine.� This bill
requires one of these tests, at the covered person�s physician�s election, to
be covered with no cost sharing, as part of screening for early-stage kidney
disease.� The bill also contains a presumption of medical necessity when a
physician determines the patient meets the criteria set forth by the National
Kidney Foundation, its successor organization, or a comparable organization.�