Bill Text: NJ A5181 | 2026-2027 | Regular Session | Introduced
Bill Title: Mandates insurance coverage for pain management services related to outpatient gynecological procedures.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced) 2026-06-01 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A5181 Detail]
Download: New_Jersey-2026-A5181-Introduced.html
Sponsored by:
Assemblywoman HEATHER SIMMONS
District 3 (Cumberland, Gloucester and Salem)
SYNOPSIS
Mandates insurance coverage for pain management services related to outpatient gynecological procedures.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning insurance coverage for pain management services related to outpatient gynecological procedures 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 coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 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 coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 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 coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 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 coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 policies in which the insurer has reserved the right to change the premium.
5. a. A group health insurance 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 coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 policies in which the insurer has reserved the right to change the premium.
6. a. An 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 by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 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 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 by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 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 pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 or medical expense benefits shall provide coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
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 or medical expense benefits shall provide coverage for pain management services related to outpatient gynecological procedures and shall not label or categorize pain management for these procedures as elective or medically unnecessary.
b. The benefits shall be
provided to the same extent as for any other condition under the contract.
11. a. Notwithstanding any State law or regulation to the contrary, the Division of Medical Assistance and Health Services in the Department of Human Services shall ensure that expenses incurred, by an eligible enrollee, for pain management services provided for outpatient gynecological procedures are covered with no cost-sharing under the Medicaid and NJ FamilyCare programs. No prior authorization or utilization management requirements shall be imposed on services provided pursuant to this section.
b. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
c. As used in this section, "Medicaid program" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
12. This act shall take effect 90 days from the effective date of this act, except that the Commissioner of Human Services may take any anticipatory administrative action in advance as necessary for the implementation of this act.
STATEMENT
This bill would require health insurers (health, hospital and medical service corporations, commercial individual and group health insurers, health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits programs, the State Health Benefits Commission, the School Employees' Health Benefits Commission, and the State Medicaid and NJ FamilyCare programs) to cover pain management services related to outpatient gynecological procedures and such insurers would not be allowed to label such services as medically unnecessary or elective.
