Bill Text: NJ S4122 | 2026-2027 | Regular Session | Introduced
Bill Title: Requires health insurance coverage for coronary artery calcium screening under certain circumstances.
Sponsorship: Partisan Bill (Republican 1)
Status: (Introduced) 2026-05-11 - Introduced in the Senate, Referred to Senate Commerce Committee [S4122 Detail]
Download: New_Jersey-2026-S4122-Introduced.html
Sponsored by:
Senator JON M. BRAMNICK
District 21 (Middlesex, Morris, Somerset and Union)
SYNOPSIS
Requires health insurance coverage for coronary artery calcium screening under certain circumstances.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health insurance coverage for certain coronary calcium tests 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. Every hospital service corporation contract providing 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 in conducting a coronary artery calcium screening to a subscriber or other person covered under the contract who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
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 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 in conducting a coronary artery calcium screening to a subscriber or other person covered under the contract who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
c. These 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 contracts in which the medical services 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 in conducting a coronary artery calcium screening to a subscriber or other person covered under the contract who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
c. These 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 contracts in which the health services 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 in conducting a coronary artery calcium screening to a person covered under the policy who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
c. These benefits shall be provided to the same extent as for any other medical condition under the policy.
d. The provision of this section shall apply to all 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 in conducting a coronary artery calcium screening to a subscriber or other person covered under the policy who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
c. These 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 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 in conducting a coronary artery calcium screening to an enrollee or other person covered under the agreement who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on the more frequent basis.
c. These 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 for expenses incurred in conducting a coronary artery calcium screening to a person covered under the plan who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
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 Stat, on or after the effective date of this act, shall provide benefits for expenses incurred in conducting a coronary artery calcium screening to a person covered under the plan who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
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 and medical expense benefits, shall provide coverage for expenses incurred in conducting a coronary artery calcium screening to a person covered under the contract who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
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 coverage for expenses incurred in conducting a coronary artery calcium screening to a person covered under the contract who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
b. The benefits shall be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits shall be provided on a more frequent basis.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
11. This act shall take effect immediately 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 carriers, including insurance companies, health service corporations, hospital service corporations, medical service corporations, health maintenance organizations authorized to issue health benefits plans in New Jersey, and any entity contracted to administer health benefits in connection with the State Health Benefits Program or School Employees' Health Benefits Program, to cover expenses incurred in conducting a coronary artery calcium screening to a person who:
(1) is 45 years of age or older; or
(2) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation.
The bill requires the benefits to be provided every five years, unless a health care provider determines that the person would benefit from more frequent screening based on an underlying condition, in which case the benefits are to be provided on a more frequent basis.
