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S4329
SENATE, No. 4329
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MAY 21, 2026
Sponsored by:
Senator� RAJ MUKHERJI
District 32 (Hudson)
SYNOPSIS
���� Requires health insurance coverage for sepsis-related
claims.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act
requiring health insurance coverage for sepsis-related
claims 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 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 coverage for sepsis-related services and treatment
claims, as determined to be medically necessary by the covered person�s
physician. �
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract.
���� c.���� This section shall
apply to those 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 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 coverage for sepsis-related services and treatment claims, as
determined to be medically necessary by the covered person�s physician.
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract.
���� c.���� This section shall
apply to those 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 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 coverage for sepsis-related services and treatment
claims, as determined to be medically necessary by the covered person�s
physician.
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract.
���� c.���� This section shall
apply to those 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 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 coverage for sepsis-related services and treatment claims, as
determined to be medically necessary by the covered person�s physician.
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the policy.
���� c.���� This section shall
apply to those individual health insurance 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
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 coverage for sepsis-related services and treatment
claims, as determined to be medically necessary by the covered person�s
physician.
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the policy.
���� c.���� This section shall
apply to those group health insurance 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 coverage for sepsis-related services and treatment
claims, as determined to be medically necessary by the covered person�s
physician.
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the plan.
���� c.���� 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 coverage for sepsis-related services and treatment
claims, as determined to be medically necessary by the covered person�s
physician.
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the plan.
���� c.���� 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 coverage for sepsis-related services and treatment claims, as
determined to be medically necessary by the covered person�s physician.
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract.
���� 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
and medical expense benefits shall provide coverage for sepsis-related services
and treatment claims, as determined to be medically necessary by the covered
person�s physician.
���� b.��� The benefits shall be
provided to the same extent as for any other 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
and medical expense benefits shall provide coverage for sepsis-related services
and treatment claims, as determined to be medically necessary by the covered
person�s physician.
���� b.��� The benefits shall be
provided to the same extent as for any other condition under the contract.
���� 11.� This act shall take
effect on the 180th day following the date of enactment, and shall apply to
contracts delivered, issued, executed, or renewed on or after that date.
STATEMENT
���� This bill requires health
insurance carriers (insurance companies, health, hospital, and medical service
corporations, health maintenance organizations, and State and School Employees'
Health
Benefits Programs) to provide
coverage for sepsis-related services and treatment claims, as determined to be
medically necessary by the covered person�s physician.