HB420: HB420 Insurance; require certain health benefit policies to cover genetic testing for an inherited mutation and cancer imaging under certain conditions

Currently, Georgia law does not specifically require health insurance plans to cover genetic testing for inherited cancer mutations or certain cancer imaging. This bill adds a new section to Georgia's insurance code (O.C.G.A. § 33-24-59.34) requiring most health benefit policies, including individual and group plans, state employee and teacher plans, and university system employee plans, to cover this testing and imaging. Coverage applies to a covered person with a personal or family history of cancer who is recommended for genetic testing by a healthcare provider, or someone at increased risk of cancer recommended for cancer imaging, as long as the recommendation follows nationally recognized clinical practice guidelines. Insurers can still apply normal deductibles, copays, or coinsurance to this coverage. The bill includes a safeguard so people with health savings accounts paired with high-deductible health plans do not lose their tax-advantaged status, and it directs the Insurance Commissioner to write implementing rules. The requirement applies to policies issued or renewed on or after July 1, 2025.

• Adds a new Georgia insurance code section requiring covered health benefit policies to include genetic testing for inherited cancer mutations when recommended by a healthcare provider.
• Requires the same policies to cover cancer imaging for people at increased risk of cancer when recommended by a provider following recognized clinical guidelines.
• Allows insurers to still apply normal deductibles, copayments, or coinsurance (cost-sharing) to this new coverage.
• Protects people enrolled in high-deductible health plans linked to health savings accounts from losing their tax eligibility because of this mandate.
• Directs the Insurance Commissioner to create rules for implementing the requirement based on guidelines like those from the National Comprehensive Cancer Network.
• Applies the new coverage requirement to health benefit policies issued or renewed on or after July 1, 2025.

People covered by individual or group health plans in Georgia, including state employees, public school teachers, and University System of Georgia employees; health insurers, HMOs, and similar entities that issue these policies; healthcare providers who recommend genetic testing or cancer imaging; and the state Insurance Commissioner's office, which must write implementing rules.

Georgians with a personal or family history of cancer, or those at increased cancer risk, would gain a guaranteed right to insurance coverage for genetic testing and cancer imaging when a doctor recommends it, though they could still owe deductibles or copays for these services.

• Section 1 adds new Code Section 33-24-59.34 defining key terms including 'cancer imaging,' 'genetic testing for an inherited mutation,' and 'health benefit policy.'
• Subsection (b) requires covered policies renewed or issued on or after July 1, 2025 to cover genetic testing for inherited mutations and cancer imaging under specified conditions.
• Subsection (c) clarifies that this new coverage remains subject to the policy's existing cost-sharing requirements like deductibles and copays.
• Subsection (d) protects health savings account eligibility by limiting the mandate's application for high-deductible health plans until minimum deductibles are met, except for preventive care.
• Subsection (e) directs the Insurance Commissioner to issue rules implementing the section in line with guidelines from groups such as the National Comprehensive Cancer Network.
• Section 2 repeals any conflicting laws.

1. 2025-04-04House Withdrawn, Recommitted (House)
2. 2025-02-26House Committee Favorably Reported By Substitute (House)
3. 2025-02-24House Withdrawn, Recommitted (House)
4. 2025-02-20House Committee Favorably Reported By Substitute (House)
5. 2025-02-18House Second Readers (House)
6. 2025-02-13House First Readers (House)
7. 2025-02-12House Hopper (House)

• Darlene Taylor (R, HD-173)Primary sponsor
• Lee Hawkins (R, HD-027)
• Katie Dempsey (R, HD-013)
• Karen Mathiak (R, HD-082)
• Patty Stinson (D, HD-150)
• Angie O'Steen (R, HD-169)

• health insurance coverage
• cancer screening
• genetic testing
• insurance regulation
• health savings accounts