EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0476*
SENATE BILL 476
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By: Senator Beidle
Introduced and read first time: January 22, 2025
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Genetic Testing and Cancer Imaging – Required Coverage 2
and Prohibited Cost–Sharing 3
FOR the purpose of requiring certain insurers, nonprofit health service plans, and health 4
maintenance organizations to provide coverage for genetic testing for certain 5
individuals who may have an increased risk of developing cancer and follow–up 6
evidence–based cancer imaging for individuals with an increased risk of developing 7
cancer; prohibiting certain insurers, nonprofit health service plans, and health 8
maintenance organizations from imposing a copayment, coinsurance, or deductible 9
requirement on coverage for genetic testing and follow–up evidence–based cancer 10
imaging; and generally relating to health insurance coverage for genetic testing and 11
cancer imaging. 12
BY adding to 13
Article – Insurance 14
Section 15–861 15
Annotated Code of Maryland 16
(2017 Replacement Volume and 2024 Supplement) 17
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 18
That the Laws of Maryland read as follows: 19
Article – Insurance 20
15–861. 21
(A) THIS SECTION APPLIES TO: 22
(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 23
PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 24 2 SENATE BILL 476
ON AN EXPENSE –INCURRED BASIS UNDER HEALTH I NSURANCE POLICIES OR 1
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE; AND 2
(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 3
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 4
CONTRACTS THAT ARE I SSUED OR DELIV ERED IN THE STATE. 5
(B) AN ENTITY SUBJECT TO THIS SECTION SHALL P ROVIDE COVERAGE FOR : 6
(1) GENETIC TESTING TO I DENTIFY WHETHER AN I NDIVIDUAL WITH A 7
PERSONAL OR FAMILY H ISTORY OF CANCER HAS AN INHERITED MUTATIO N 8
ASSOCIATED WITH AN I NCREASED RISK OF CAN CER IF THE GENETIC TES TING IS: 9
(I) RECOMMENDED BY A HEA LTH CARE PROFESSIONAL ; AND 10
(II) CONSISTENT WITH EVID ENCE–BASED, CLINICAL PRACTICE 11
GUIDELINES; AND 12
(2) IF AN INDIVIDUAL WHO UNDERGOES GENETI C TESTING FOR 13
WHICH COVERAGE IS PR OVIDED UNDER ITEM (1) OF THIS SUBSECTION IS 14
DETERMINED TO BE AT AN INCREASED RISK O F DEVELOPING CANCER , FOLLOW–UP 15
EVIDENCE–BASED CANCER IMAGING THAT: 16
(I) IS RECOMMENDED FOR T HE TYPE OF CANCER ID ENTIFIED 17
BY THE GENETIC TESTI NG; AND 18
(II) USES MODALITIES ESTA BLISHED IN THE MOST RECENT 19
VERSION OF THE NATIONAL COMPREHENSIVE CANCER NETWORK CLINICAL 20
PRACTICE GUIDELINES IN ONCOLOGY. 21
(C) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION , 22
AN ENTITY SUBJECT TO THIS SECTION MAY NOT IMPOSE A COPAYMENT , 23
COINSURANCE , OR DEDUCTIBLE REQUIREME NT ON COVERAGE FOR GENETIC 24
TESTING OR FOLLOW–UP EVIDENCE–BASED CANCER IMAGING AS DESCRIBED IN 25
SUBSECTION (B) OF THIS SECTION. 26
(2) (I) IF THE APPLICATION OF T HE REQUIREMENTS UNDE R 27
PARAGRAPH (1) OF THIS SUBSECTION W OULD RESULT IN HEALT H SAVINGS 28
ACCOUNT INELIGIBILIT Y UNDER 26 U.S.C. § 223, THE REQUIREMENT SHAL L APPLY 29
TO THE HEALTH SAVINGS ACCOU NT–QUALIFIED HIGH DEDUC TIBLE HEALTH PLANS 30
WITH RESPECT TO THE DEDUCTIB LE OF THE PLAN AFTER THE BENEFICIARY 31
SATISFIES THE MINIMUM DEDUCTIBLE UNDER 26 U.S.C. § 223. 32
SENATE BILL 476 3
(II) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 1
ACCORDANCE WITH 26 U.S.C. § 223(C)(2)(C), THE REQUIREMENTS OF THIS 2
SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE BENEFICIARY STATUS 3
SATISFIES THE MINIMUM DEDUCTIBLE U NDER 26 U.S.C. § 223. 4
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 5
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 6
after January 1, 2026. 7
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 8
January 1, 2026. 9