HB 420: 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 require health insurance plans to cover genetic testing for inherited cancer mutations or cancer imaging like MRIs or CT scans used to catch cancer early. 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 plans for state employees, teachers, and university system employees, to cover these services starting with policies issued or renewed on or after July 1, 2025. Coverage applies when a healthcare provider recommends the testing or imaging in line with nationally recognized clinical practice guidelines, and only for people with a personal or family history of cancer (for genetic testing) or an increased cancer risk (for imaging). Insurers can still apply normal cost-sharing like deductibles and copays. The bill also protects health savings account eligibility by limiting coverage requirements where needed to comply with federal tax rules, and it directs the state Insurance Commissioner to write implementing regulations.

• Requires health benefit policies issued or renewed on or after July 1, 2025 to cover genetic testing for inherited cancer-related gene mutations when recommended by a healthcare provider.
• Requires those same policies to cover cancer imaging for people at increased cancer risk when recommended by a healthcare provider.
• Limits the new coverage requirements to care that follows nationally recognized clinical practice guidelines developed by independent medical organizations.
• Allows insurers to still apply deductibles, copays, and coinsurance to this coverage rather than making it fully free.
• Protects health savings account eligibility by restricting how the mandate applies to high-deductible health plans under federal tax rules.
• Directs the state Insurance Commissioner to issue rules implementing the new coverage requirement.

People with a personal or family history of cancer or an increased cancer risk who need genetic testing or imaging, health insurers and self-insured plans operating in Georgia, state employees, public school teachers, university system employees, and the state Insurance Commissioner's office, which must write implementing rules.

Patients with a family history of cancer or elevated risk could get genetic testing and imaging covered by insurance rather than paying out of pocket, potentially allowing earlier detection. Insurers and employers offering these plans would face new coverage obligations, though patients would still owe any normal deductibles or copays.

• Section 1 adds new Code Section 33-24-59.34 defining 'cancer imaging,' 'genetic testing for an inherited mutation,' 'health benefit policy,' and 'nationally recognized clinical practice guidelines.'
• Subsection (b) requires covered policies renewed or issued on or after July 1, 2025 to cover genetic testing and cancer imaging when a provider recommends it and it follows recognized guidelines.
• Subsection (c) confirms the new coverage remains subject to a policy's normal cost-sharing requirements like deductibles and copays.
• Subsection (d) limits the mandate's application to protect health savings account eligibility under federal tax law, except for preventive care.
• Subsection (e) directs the Insurance Commissioner to adopt rules to implement the coverage requirement, referencing guidelines from groups like the National Comprehensive Cancer Network.
• Section 2 repeals any conflicting laws.

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

• Darlene Taylor (R, HD-173)Patrocinador principal
• 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
• cancer imaging