NJ S1275

Health insurers in New Jersey must cover diagnostic breast examinations (used to evaluate abnormalities found during screening or other exams) and supplemental breast examinations (additional screening for high-risk individuals) without any cost-sharing requirements such as deductibles, copayments, or coinsurance.

Covered examination types include contrast-enhanced mammography, diagnostic mammography, breast MRI, breast ultrasound, and molecular breast imaging, when medically necessary and in accordance with National Comprehensive Cancer Network Guidelines.

Supplemental breast examinations apply to individuals with personal or family medical history, dense breasts, or other factors that increase breast cancer risk, even when no abnormality is suspected.

The mandate applies to all insurance types including individual and group policies, health service corporations, HMOs, and the State and School Employees' Health Benefits Programs.

The law takes effect on the first day of the fourth month following enactment and applies to high-deductible health plans and catastrophic plans to the maximum extent permitted by federal law.