A bill for an act relating to insurance coverage for biomarker testing.(Formerly HF 2157; See HF 2668.)
The bill is significant in shaping the landscape of health insurance in the state by ensuring that crucial biomarker tests, which can guide treatment decisions, are recognized and covered under health insurance policies. Starting January 1, 2025, this coverage requirement targets third-party payment providers and encompasses various health-related contracts, extending protections to beneficiaries participating in medical assistance programs and the Healthy and Well Kids in Iowa program, thereby expanding access to potentially life-saving testing without prohibitive out-of-pocket costs.
House File 2492 introduces regulations regarding health insurance coverage for biomarker testing in Iowa. The legislation mandates that health carriers offering individual, group, or small group contracts must provide coverage for biomarker testing aimed at diagnosing, treating, or monitoring a disease or condition in covered individuals, provided the tests demonstrate clinical utility. The bill emphasizes the importance of ensuring continuity of care by limiting interruptions caused by previous testing procedures.
Notably, the bill does specify exclusions for certain types of insurance, meaning that coverage for biomarker testing may not be universally available to all patients, which could lead to disparities in care. Additionally, the bill provides a framework for requesting exceptions to coverage, which could be a point of contention as stakeholders assess the practicality and accessibility of these exception processes. The role of the insurance commissioner to adopt necessary rules for enforcement may also bring forth discussions regarding the regulatory oversight of insurance practices pertaining to biomarker testing.