Bill Text: NJ S4243 | 2026-2027 | Regular Session | Introduced
Bill Title: Requires health insurance coverage for early-stage kidney disease screening without cost sharing.
Sponsorship: Partisan Bill (Democrat 2)
Status: (Introduced) 2026-05-14 - Introduced in the Senate, Referred to Senate Commerce Committee [S4243 Detail]
Download: New_Jersey-2026-S4243-Introduced.html
Sponsored by:
Senator BENJIE E. WIMBERLY
District 35 (Bergen and Passaic)
SYNOPSIS
Requires health insurance coverage for early-stage kidney disease screening without cost sharing.
CURRENT VERSION OF TEXT
As introduced.
An Act requiring health insurance coverage for early-stage kidney disease screening and supplementing various parts of 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 and 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 for expenses incurred by a covered person for early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for the early-stage kidney disease screening conducted when a covered person's physician determines it is medically necessary. The provisions of this subsection 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 subsection 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, as applicable. The provisions of this subsection 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.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
d. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
e. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
f. For the purposes of this section, early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if a physician determines the covered person meets clinical guidelines for early-stage kidney disease screening for early-stage kidney disease established by the National Kidney Foundation, its successor organization, or a comparable organization.
2. a. A medical service corporation contract that provides hospital and 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 for expenses incurred by a covered person for early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for early-stage kidney disease screening conducted when a physician determines it is medically necessary. The provisions of this subsection 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 subsection 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, as applicable. The provisions of this subsection 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.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
d. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
e. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
f. For the purposes of this section, early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if a physician determines the covered person meets clinical guidelines for early-stage kidney disease screening established by the National Kidney Foundation, its successor organization, or a comparable organization.
3. a. A health service corporation contract that provides hospital and 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 for expenses incurred by a covered person early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for early-stage kidney disease screening when a physician determines it is medically necessary. The provisions of this subsection 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 subsection 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, as applicable. The provisions of this subsection 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.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
d. This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
e. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
f. For the purposes of this section, early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if a physician determines the covered person meets clinical guidelines for early-stage kidney disease screening established by the National Kidney Organization, its successor organization, or a comparable organization.
4. a. An individual health insurance policy that provides hospital and 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 for expenses incurred by an insured for early-stage kidney disease screening in the blood that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for early-stage kidney disease screening conducted when a physician determines it to be medically necessary. The provisions of this subsection 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 subsection 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, as applicable. The provisions of this subsection 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.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
d. This section shall apply to those individual health insurance policies in which the insurer has reserved the right to change the premium.
e. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
f. For the purposes of this section, early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if a physician determines the covered person meets clinical guidelines for early-stage kidney disease screening established by the National Kidney Foundation, its successor organization, or a comparable organization.
5. a. A group health insurance policy that provides hospital and 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 for expenses incurred by an insured for early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for early-stage kidney disease screening. The provisions of this subsection 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 subsection 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, as applicable. The provisions of this subsection 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.
c. The benefits shall be provided to the same extent as for any other medical condition under the policy.
d. This section shall apply to those group health insurance policies in which the insurer has reserved the right to change the premium.
e. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
f. For the purposes of this section, early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if a physician determines the covered person meets clinical guidelines for early-stage kidney disease screening established by the National Kidney Foundation, its successor organization, or a comparable organization.
6. a. An individual health benefits plan that provides hospital and 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 benefits for expenses incurred by a covered person for early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for early-stage kidney disease screening conducted when a physician determines it to be medically necessary. The provisions of this subsection 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 subsection 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, as applicable. The provisions of this subsection 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.
c. The benefits shall be provided to eh same extent as for any other medical condition under the policy.
d. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
e. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
f. For the purposes of this section, early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if a physician determines the covered person meets clinical guidelines for testing blood for levels of PFAS established by the National Kidney Foundation, its successor organization, or a comparable organization.
7. a. A small employer health benefits plan that provides hospital and 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 expenses incurred by a covered person for early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for the early-stage kidney disease screening conducted when a covered person's physician determines it to be medically necessary. The provisions of this subsection 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 subsection 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, as applicable. The provisions of this subsection 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.
c. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
d. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
e. For the purposes of this section early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if a physician determines the covered person meets clinical guidelines for early-stage kidney disease screening established by the National Kidney Foundation, its successor organization, or a comparable organization.
8. 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 for expenses incurred by an enrollee for early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for early-stage kidney disease screening conducted when a physician determines it to be medically necessary. The provisions of this subsection 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 subsection 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, as applicable. The provisions of this subsection 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.
c. The health care services shall be provided to the same extent as for any other medical condition under the enrollee agreement.
d. 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.
e. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
f. For the purposes of
this section, early-stage kidney disease screening is presumed to be medically
necessary healthcare for a covered person if a physician determines the covered
person meets clinical guidelines for early-stage kidney disease screening established
by the National Kidney Foundation, its successor organization, or a comparable
organization.
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 benefits for expenses incurred by a covered person for early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for early-stage kidney disease screening conducted when a covered person's physician determines it to be medically necessary. A contract provided by the State Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for early-stage kidney disease screening at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the federal Internal Revenue Code (26 U.S.C. s.223 (c)(2)(A)). 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.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
d. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
e. For the purposes of this section, early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if the covered person's physician determines the covered person meets clinical guidelines for early-stage kidney disease screening by the National Kidney Foundation, its successor organization, or a comparable organization.
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 and medical expense benefits shall provide benefits for expenses incurred by a covered person for early-stage kidney disease screening that is determined to be medically necessary by a physician.
b. No deductible, coinsurance, copayment, or any other cost-sharing requirement shall be imposed for early-stage kidney disease screening when a covered person's physician determines it to be medically necessary. A contract provided by the School Employees' Health Benefits Commission that qualifies as a high-deductible health plan shall provide coverage for testing blood for levels of PFAS at the lowest deductible and other cost-sharing requirement permitted for a high-deductible health plan under section 223(c)(2)(A) of the federal Internal Revenue Code (26 U.S.C. s.223 (c)(2)(A)). 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.
c. The benefits shall be provided to the same extent as for any other medical condition under the contract.
d. As used in this section, "early-stage kidney disease screening" means a physician's election of either:
(1) a blood test to determine an individual's estimated glomerular filtration rate; or
(2) a urine albumin-creatinine ratio test.
e. For the purposes of this section, early-stage kidney disease screening is presumed to be medically necessary healthcare for a covered person if the covered person's physician determines the covered person meets clinical guidelines for early-stage kidney disease screening established by the National Kidney Foundation, and Medicine, its successor organization, or a comparable organization.
11. This act shall take effect on the first day of the fourth month next following enactment and shall apply to policies and contracts that are delivered, issued, executed, or renewed on or after that date.
STATEMENT
This bill requires health insurers and health maintenance organizations, as well as health benefits plans or contracts which are issued or purchased pursuant to the New Jersey Individual Health Coverage Program, New Jersey Small Employer Health Benefits Program, State Health Benefits Program, and School Employees' Health Benefits Program, to provide coverage for expenses incurred by individuals for early-stage kidney disease screening that is determined to be medically necessary by the treating physician.
The incidence of chronic kidney disease is rising in this State with in-hospital admissions increasing 60 percent since 2016. Chronic kidney disease is the gradual decline of kidney function after the organs sustain long-term damage. Two tests are commonly used to track kidney health: a blood test to determine an individual's estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio test (uACR). An eGFR test estimates how well an individual's kidneys are filtering blood by measuring creatine levels. A uACR test shows how well the kidneys filter blood by determining albumin protein levels in urine. This bill requires one of these tests, at the covered person's physician's election, to be covered with no cost sharing, as part of screening for early-stage kidney disease. The bill also contains a presumption of medical necessity when a physician determines the patient meets the criteria set forth by the National Kidney Foundation, its successor organization, or a comparable organization.
