26:2J-4.53 Benefits provided under enrollee agreements.
306 words·~1 min read·
/nj/title-26/chapter-2j/26-2j-4-53·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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 P.L.2025, c.200 (C. 17:48-6bbb et al.), shall provide benefits to any enrollee or other person covered thereunder for expenses incurred in obtaining medically necessary treatment for women with a diagnosis of perimenopause and menopause, including, but not limited to:
(1)hormonal therapies such as hormone replacement therapy and bioidentical hormone treatments;
(2)non-hormonal treatments, including medications to manage menopausal symptoms;
(3)behavioral health care services;
(4)pelvic floor physical therapy;
(5)bone health treatments, including screenings and medications due to hormonal changes related to perimenopause and menopause;
(6)preventative services that have a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force for early detection and treatment of health conditions related to perimenopause and menopause such as osteoporosis and cancer; and
(7)counseling and education regarding menopause management.
b. A health maintenance organization shall provide clear and accessible information to enrollees regarding covered perimenopause and menopause treatments.
c. The benefits 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.
e. As used in this section:
“Menopause” means the permanent end of a female’s menstrual cycle, diagnosed by a licensed medical provider after 12 consecutive months without a menstrual period.
“Perimenopause” means the transitional period leading to menopause, marked by fluctuating hormone levels and changes in menstrual cycles.
L.2025, c.200, s.6.