(a) Beginning on and after January 1, 2026, a health benefit plan that is offered, issued, or renewed in this state shall provide coverage for:(1) Genetic testing for an inherited gene mutation in a clinical setting for an individual with a personal or family history of cancer if the genetic testing for an inherited gene mutation:(A) Provides clinical utility; and(B) Is ordered or recommended by a healthcare provider and is supported by medical and scientific evidence, including without limitation:(i) The National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher;(ii) Centers for Medicare & Medicaid Services national coverage determinations or Medicare administrative contractor local coverage determinations; or(iii) Nationally recognized clinical practice guidelines; and(2) Evidence-based cancer imaging for an individual at an increased risk of developing cancer if the evidence-based cancer imaging:(A) Provides clinical utility; and(B) Is ordered or recommended by a healthcare provider according to:(i) The National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher; or(ii) Nationally recognized clinical practice guidelines.
(1) Genetic testing for an inherited gene mutation in a clinical setting for an individual with a personal or family history of cancer if the genetic testing for an inherited gene mutation:(A) Provides clinical utility; and(B) Is ordered or recommended by a healthcare provider and is supported by medical and scientific evidence, including without limitation:(i) The National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher;(ii) Centers for Medicare & Medicaid Services national coverage determinations or Medicare administrative contractor local coverage determinations; or(iii) Nationally recognized clinical practice guidelines; and
(A) Provides clinical utility; and
(B) Is ordered or recommended by a healthcare provider and is supported by medical and scientific evidence, including without limitation:(i) The National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher;(ii) Centers for Medicare & Medicaid Services national coverage determinations or Medicare administrative contractor local coverage determinations; or(iii) Nationally recognized clinical practice guidelines; and
(i) The National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher;
(ii) Centers for Medicare & Medicaid Services national coverage determinations or Medicare administrative contractor local coverage determinations; or
(iii) Nationally recognized clinical practice guidelines; and
(2) Evidence-based cancer imaging for an individual at an increased risk of developing cancer if the evidence-based cancer imaging:(A) Provides clinical utility; and(B) Is ordered or recommended by a healthcare provider according to:(i) The National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher; or(ii) Nationally recognized clinical practice guidelines.
(A) Provides clinical utility; and
(B) Is ordered or recommended by a healthcare provider according to:(i) The National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher; or(ii) Nationally recognized clinical practice guidelines.
(i) The National Comprehensive Cancer Network clinical practice recommendations that are level 2a or higher; or
(ii) Nationally recognized clinical practice guidelines.
(b) (1) Except as provided in subdivision (b)(2) of this section, the coverage for genetic testing for an inherited gene mutation and evidence-based cancer imaging under subsection (a) of this section:(A) Is not subject to an annual deductible, copayment, or coinsurance limit as established for other covered benefits under a health benefit plan; and(B) Does not diminish or limit benefits otherwise allowable under a health benefit plan.(2) This subsection does not apply to:(A) A plan providing health benefits to state and public school employees under § 21-5-401 et seq.; or(B) A self-funded governmental plan.
(1) Except as provided in subdivision (b)(2) of this section, the coverage for genetic testing for an inherited gene mutation and evidence-based cancer imaging under subsection (a) of this section:(A) Is not subject to an annual deductible, copayment, or coinsurance limit as established for other covered benefits under a health benefit plan; and(B) Does not diminish or limit benefits otherwise allowable under a health benefit plan.
(A) Is not subject to an annual deductible, copayment, or coinsurance limit as established for other covered benefits under a health benefit plan; and
(B) Does not diminish or limit benefits otherwise allowable under a health benefit plan.
(2) This subsection does not apply to:(A) A plan providing health benefits to state and public school employees under § 21-5-401 et seq.; or(B) A self-funded governmental plan.
(A) A plan providing health benefits to state and public school employees under § 21-5-401 et seq.; or
(B) A self-funded governmental plan.
(c) (1) If application of this section would result in health savings account ineligibility under guidance issued by the United States Department of the Treasury under 26 U.S.C. § 223, as it existed on January 1, 2025, then this section shall apply only to health savings accounts with qualified high deductible health plans with respect to the deductible of a health benefit plan after the individual has satisfied the minimum deductible.(2) This section does apply to items or services that are considered to be preventive care under 26 U.S.C. § 223(c)(2)(C), as it existed on January 1, 2025, whether or not the minimum deductible has been satisfied.
(1) If application of this section would result in health savings account ineligibility under guidance issued by the United States Department of the Treasury under 26 U.S.C. § 223, as it existed on January 1, 2025, then this section shall apply only to health savings accounts with qualified high deductible health plans with respect to the deductible of a health benefit plan after the individual has satisfied the minimum deductible.
(2) This section does apply to items or services that are considered to be preventive care under 26 U.S.C. § 223(c)(2)(C), as it existed on January 1, 2025, whether or not the minimum deductible has been satisfied.