New Jersey § 26:2j-4

§ 26:2j-4.

a. A certificate of authority to establish and operate a health maintenance organization

in this State shall not be issued or continued on or after the effective date of this

act 1 for a health maintenance organization, unless the health maintenance organization

provides health care services for prescription female contraceptives, and the following

services, drugs, devices, products, and procedures on an in-network basis: (1) Any contraceptive drug, device or product approved by the United States Food and

Drug Administration, which coverage shall be subject to all of the following conditions: (a) If there is a therapeutic equivalent of a contraceptive drug, device or product

approved by the United States Food and Drug Administration, coverage shall be provided

for either the requested contraceptive drug, device or product or for one or more

therapeutic equivalents of the requested drug, device or product. (b) Coverage shall be provided without a prescription for all contraceptive drugs

available for over-the-counter sale that are approved by the United States Food and

Drug Administration. (c) Coverage shall be provided without any infringement upon a subscriber's choice

of contraception and medical necessity shall be determined by the provider for covered

contraceptive drugs, devices or other products approved by the United States Food

and Drug Administration. (2) Voluntary male and female sterilization. (3) Patient education and counseling on contraception. (4) Services related to the administration and monitoring of drugs, devices, products

and services required under this section, including but not limited to: (a) Management of side effects; (b) Counseling for continued adherence to a prescribed regimen; (c) Device insertion and removal; (d) Provision of alternative contraceptive drugs, devices or products deemed medically

appropriate in the judgment of the subscriber's health care provider; and (e) Diagnosis and treatment services provided pursuant to, or as a follow-up to, a

service required under this section. b. The coverage provided shall include prescriptions for dispensing contraceptives

for: (1) (Deleted by amendment, P.L.2021, c. 376 ) (2) up to a 12-month period at one time . c. (1) Except as provided in paragraph (2) of this subsection, the health care services

shall be provided to the same extent as for any other service, drug, device, product,

or procedure under the contract, except no deductible, coinsurance, copayment, or

any other cost-sharing requirement on the coverage shall be imposed. (2) In the case of a high-deductible health plan, benefits for male sterilization

or male contraceptives shall be provided at the lowest deductible and other cost-sharing

permitted for a high-deductible health plan under section 223(c)(2)(A) of the Internal Revenue Code ( 26 U.S.C. s.223 ). d. The provisions of this section shall apply to those contracts for health care services

by health maintenance organizations under which the right to change the schedule of

charges for enrollee coverage is reserved. e. Nothing in this section shall limit coverage of any additional preventive service

for women, as identified or recommended by the United States Preventive Services Task

Force or the Health Resources and Services Administration of the United States Department

of Health and Human Services pursuant to the provisions of 42 U.S.C. 300gg-13 . 1

L.2005, c. 251, eff. July 3, 2006.