Bill Text: NJ A2332 | 2024-2025 | Regular Session | Introduced
Bill Title: Requires health insurance coverage for testing for BRCA1 and BRCA2 genes.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced) 2024-01-09 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A2332 Detail]
Download: New_Jersey-2024-A2332-Introduced.html
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Assemblywoman LISA SWAIN
District 38 (Bergen)
Co-Sponsored by:
Assemblywoman Quijano
SYNOPSIS
Requires health insurance coverage for testing for BRCA1 and BRCA2 genes.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning health insurance coverage for certain genetic testing 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 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 for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic testing" for breast cancer for purposes of additional testing authorized pursuant to paragraph (2) of subsection a. of section 1 of P.L.1991, c.279 (C.17:48-6g).
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 hospital service corporation 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 for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic testing" for breast cancer for purposes of additional testing authorized pursuant to paragraph (2) of subsection a. of section 2 of P.L.1991, c.279 (C.17:48A-7f).
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 medical service corporation contracts in which the medical service 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 for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic testing" for breast cancer for purposes of additional testing authorized pursuant to paragraph (2) of subsection a. of section 3 of P.L.1991, c.279 (C.17:48E-35.4).
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 health service corporation contracts in which the health service 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 for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic testing" for breast cancer for purposes of additional testing authorized pursuant to paragraph (2) of subsection a. of section 4 of P.L.1991, c.279 (C.17B:26-2.1e).
c. The 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 health insurance 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 for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive
result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic
testing" for breast cancer for purposes of additional testing authorized
pursuant to paragraph (2) of subsection a. of section 5 of P.L.1991, c.279
(C.17B:27-46.1f).
c. The 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 health insurance 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 for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic testing" for breast cancer for purposes of additional testing authorized pursuant to paragraph (2) of subsection a. of section 6 of P.L.1991, c.279 (C.26:2J-4.4).
c. The 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 to any person covered thereunder for expenses incurred for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive
result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic
testing" for breast cancer for purposes of additional testing authorized pursuant
to paragraph (2) of subsection a. of section 7 of P.L.2004, c.86
(C.17B:27A-7.10).
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 State on or after the effective date of this act, shall provide benefits to any person covered thereunder for expenses incurred for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive
result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic
testing" for breast cancer for purposes of additional testing authorized
pursuant to paragraph (2) of subsection a. of section 8 of P.L.2004, c.86
(C.17B:27A-19.13).
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 or medical expense benefits shall provide benefits to any person covered thereunder for expenses incurred for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. A test with a positive
result for the existence of BRCA1 or BRCA2 shall qualify as "positive genetic
testing" for breast cancer for purposes of additional testing authorized pursuant
to paragraph (2) of subsection a. of section 9 of P.L.1991, c.279
(C.52:14-17.29i).
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 benefits to any person covered thereunder for expenses incurred for testing for the breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes.
b. The benefits shall be provided to the same extent as for any other medical condition under the contract.
11. This act shall take effect on the 90th day 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 insurance coverage for testing for breast cancer 1 (BRCA1) and breast cancer 2 (BRCA2) genes. Specifically, under the bill, health insurance carriers with policies or contracts that are delivered, issued, and executed in the State will be required to cover testing for the BRCA1 and BRCA2 genes. Additionally, the bill establishes that a test result that is positive for BRCA1 or BRCA2 genes can be categorized as "positive genetic testing" for breast cancer for the purposes of current law that authorizes additional testing after a baseline mammogram.
