HI HB553

Requires health insurers, mutual benefit societies, and health maintenance organizations to cover biomarker testing for policyholders and their dependents starting January 1, 2026, when supported by FDA approvals, drug indications, Medicare coverage determinations, or nationally recognized clinical practice guidelines.

Biomarker testing coverage includes single-analyte tests, multi-plex panel tests, protein expression analysis, and whole exome/genome/transcriptome sequencing for diagnosis, treatment, monitoring, or guiding treatment decisions.

Insurers must provide clear and accessible exception request processes for patients and providers when coverage is restricted, with exception procedures also available on the insurer's website.

Coverage may be subject to copayments, deductibles, and coinsurance on terms no less favorable than other covered medical services, and must minimize care disruptions including multiple biopsies.

Insurers must provide written notice to policyholders about biomarker testing coverage by December 31, 2026, and applies to Medicaid managed care plans with state plan amendments required.