[Second Reprint]

ASSEMBLY, No. 1142

STATE OF NEW JERSEY

222nd LEGISLATURE

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblyman JOE DANIELSEN

District 17 (Middlesex and Somerset)

Assemblywoman VERLINA REYNOLDS-JACKSON

District 15 (Hunterdon and Mercer)

Assemblyman  WILLIAM B. SAMPSON, IV

District 31 (Hudson)

Co-Sponsored by:

Assemblymen Simonsen, McClellan, Schaer, Assemblywoman Speight, Assemblymen G.Rodriguez, Schnall, DeAngelo, Assemblywomen Donlon, Peterpaul, Assemblymen Spearman, Azzariti Jr., Abdelaziz, Assemblywoman Katz, Assemblyman Scharfenberger, Assemblywoman Carter, Assemblymen Rumpf, Venezia, Kennedy, Stanley, Karabinchak, Assemblywomen Drulis, Swain, Assemblyman Tully, Assemblywomen Collazos-Gill, Dunn, Assemblymen Freiman, DiMaio, Assemblywoman Flynn, Assemblyman Hutchison, Assemblywomen Sweeney, Bagolie, Assemblymen Barlas, DePhillips, Singh, Angelozzi, Moen and Verrelli

SYNOPSIS

     Expands requirements for health insurance carriers concerning prostate cancer screening.

CURRENT VERSION OF TEXT

     As reported by the Assembly Health Committee on June 18, 2026, with amendments.

An Act concerning health insurance coverage for prostate cancer screening and amending P.L.1996, c.125 and supplementing various parts of the statutory law.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1.   Section 1 of P.L.1996, c.125 (C.17:48E-35.13) is amended to read as follows:

      1.   a. No health service corporation contract providing hospital or medical expense benefits [for groups with greater than 49 persons] shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.), unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting an annual [medically recognized diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific antigen test for men age 50 and over who are asymptomatic and for men age 40 and over with a family history of prostate cancer or other prostate cancer risk factors] prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the benefits shall be imposed]².

     This section shall apply to all health service corporation contracts in which the health service corporation has reserved the right to change the premium.

The provisions of this section 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 section 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 of the federal Internal Revenue Code of 1986, as applicable.  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.

b. As used in this section.

“Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

(cf: P.L.1996, c.125, s.1)

     2.    Section 2 of P.L.1996, c.125 (C.17:48-6p) is amended to read as follows:

      2.  a. No hospital service corporation contract providing hospital or medical expense benefits [for groups with greater than 49 persons] shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.), unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting an annual [medically recognized diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific antigen test for men age 50 and over who are asymptomatic and for men age 40 and over with a family history of prostate cancer or other prostate cancer risk factors] prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the benefits shall be imposed]².

     This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

The provisions of this section 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 section 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 of the federal Internal Revenue Code of 1986, as applicable.  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. b.  As used in this section:

“Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

(cf: P.L.1996, c.125, s.2)

     3.    Section 3 of P.L.1996, c.125 (C.17:48A-7n) is amended to read as follows:

     3.  a. No medical service corporation contract providing hospital or medical expense benefits [for groups with greater than 49 persons] shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.), unless the contract provides benefits to any named subscriber or other person covered thereunder for expenses incurred in conducting an annual [medically recognized diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific antigen test for men age 50 and over who are asymptomatic and for men age 40 and over with a family history of prostate cancer or other prostate cancer risk factors] prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the benefits shall be imposed]².

     This section shall apply to all medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

The provisions of this section 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 section 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 of the federal Internal Revenue Code of 1986, as applicable.  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.

b.  As used in this section:

“Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

(cf: P.L.1996, c.125, s.3)

     4.    Section 4 of P.L.1996, c.125 (C.17B:27-46.1o) is amended to read as follows:

     4.  a. No group health insurance policy providing hospital or medical expense benefits [for groups with greater than 49 persons] shall be delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Insurance on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.), unless the policy provides benefits to any named insured or other person covered thereunder for expenses incurred in conducting an annual [medically recognized diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific antigen test for men age 50 and over who are asymptomatic and for men age 40 and over with a family history of  prostate cancer or other prostate cancer risk factors] prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the policy ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the benefits shall be imposed]².

     This section shall apply to all group health insurance policies in which the health insurer has reserved the right to change the premium.

The provisions of this section 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 section 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 of the federal Internal Revenue Code of 1986, as applicable.  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. b.  As used in this section:

“Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

(cf: P.L.1996, c.125, s.4)

5.   Section 5 of P.L.1996, c.125 (C.26:2J-4.13) is amended to read as follows:

     5.  a. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued by the Commissioner of Health on or after the effective date of [this act] P.L.1996, c.125 (C.17:48E-35.13 et al.) unless the health maintenance organization provides health care services to any enrollee which include an annual [medically recognized diagnostic examination including, but not limited to, a digital rectal examination and a prostate-specific antigen test for men age 50 and over who are asymptomatic and for men age 40 and over with a family history of  prostate cancer or other prostate cancer risk factors] prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The health care services shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the services shall be imposed]².

     The provisions of this section shall apply to all contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.

The provisions of this section 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 section 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 of the federal Internal Revenue Code of 1986, as applicable.  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.

b.  As used in this section:

“Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

(cf: P.L.1996, c.125, s.5)

     6.    (New section)  a. Every individual health insurance policy that provides hospital or medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, 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 an annual prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the services shall be imposed]².

     The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.

     The provisions of this section 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 section 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 of the federal Internal Revenue Code of 1986, as applicable.  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.

     b.  As used in this section:

     “Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

     7.    (New section) 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 for an annual prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the services shall be imposed]².

     The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.

     The provisions of this section 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 section 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 of the federal Internal Revenue Code of 1986, as applicable.  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.

     b.  As used in this section:

     “Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

     8.    (New section) 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 for an annual prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the services shall be imposed]².

     The provisions of this section shall apply to all health benefits plans in which the carrier has reserved the right to change the premium.

     The provisions of this section 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 section 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 of the federal Internal Revenue Code of 1986, as applicable.  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.

     b.  As used in this section:

     “Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

     9.    (New section) 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 coverage for an annual prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the services shall be imposed]².

     b.  As used in this section:

     “Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

     10.  (New section)  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 coverage for an annual prostate cancer screening in accordance with the latest nationally recognized clinical practice guidelines.

     The benefits shall be provided to the same extent as for any other medical condition under the contract ²[except that no deductible, coinsurance, copayment, or any other cost-sharing requirement on the services shall be imposed]².

     b.  As used in this section:

     “Nationally recognized clinical practice guidelines” means evidence-based clinical practice guidelines developed by independent organizations or medical professional societies utilizing a transparent methodology and reporting structure and with a conflict-of-interest policy.  The guidelines establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care.

     11.  This act shall take effect on the 90th day next following the date of enactment and shall apply to all contracts and policies delivered, issued, executed, or renewed on or after that date¹, except that section 7 of this act shall take effect and apply to policies and contracts that are delivered, issued, executed, or renewed pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.) on January 1, 2027¹.