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Current as of January 01, 2024 | Updated by Findlaw Staff
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 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.), 1 shall provide benefits to any person covered thereunder for expenses incurred in obtaining medically necessary treatment for women with a diagnosis of perimenopause, menopause, and symptoms associated with 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 small employer health benefits plan shall provide clear and accessible information to a covered person regarding covered perimenopause and menopause treatments.
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 enrollee agreements in which the insurer has reserved the right to change the premium.
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.
Cite this article: FindLaw.com - New Jersey Statutes Title 17B. Insurance 17B § 27A-19.40 - last updated January 01, 2024 | https://codes.findlaw.com/nj/title-17b-insurance/nj-st-sect-17b-27a-19-40/
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