NJ S4495

Mandates all New Jersey health insurers, including HMOs, individual and group plans, and state/school employee benefit programs, to cover lipedema treatment expenses effective six months after enactment

Required covered treatments include compression garments for affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, medically necessary lipectomies, and pre/post-lipectomy physician appointments

Carriers may only require a physician diagnosis and surgeon documentation (including supporting photographs and recommended number of lipectomies) to approve coverage, and cannot deny claims solely based on submitted photographs

Insurers must cover all lipectomies deemed medically necessary by the surgeon and cannot require surgeons to remove less fat than medically indicated during procedures

Prior authorizations for lipectomy remain valid for one year and must be honored by new carriers when a covered person changes insurance plans, provided eligibility continues and no material clinical changes occur