SB 28 — Requiring insurance coverage of certain genetic testing without cost sharing

WEST VIRGINIA LEGISLATURE REGULAR SESSION IntroducedCommittee Substitute for Senate Bill 28 By Senator Chapman [Introduced[Reported February 12,19, 2025;2025, from the Committee on Health and Human Resources] A BILL to amend the Code of West Virginia, 1931, as amended, by adding six new sections, designated §5-16-7h, §33-15-4y, §33-16-3ii, §33-24-7z, §33-25-8w, and §33-25A-8z, relating to requiring insurance coverage for clinical genetic testing for an inherited gene mutation and evidenced-based cancer imaging;

referredproviding toeffective thedate; Committee on Health and Human Resources;

and then to the Committee on Finance] Intr SB 28 2025R1507 A BILL to amend the Code of West Virginia, 1931, as amended, by adding seven new sections, designated §5-16-7h, §33-15-4y, §33-16-3ii, §33-16-3pp, §33-24-7z, §33-25-8w, and §33- 25A-8z, relating to requiring insurance coverage for clinical genetic testing for an inherited gene mutation and evidenced-based cancer imaging;

(b) This section applies to all coverage issued by this agency delivered, issued for delivery, reissued, or extended in the state on and after January 1, 2025,2026, or at any time thereafter when any term of the policy, contract, or plan is changedchanged, or any premium adjustment is made.

Intr1 SB 28 2025R1507 (d) If under federal law, application of this section would result in Health Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this requirement shall apply only, for Health Savings Account-qualified High Deductible Health Plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this section shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

(a) An insurance policy issued by an insurer pursuant to this article thatshall providesprovide reimbursementcoverage orfor indemnitythe forcost laboratoryof orhealth X-raycare services shallpursuant provideto coveragethis article for the cost of the following health care services:

One(1) mammogramClinical examinationgenetic everytesting yearfor an inherited gene mutation for womenindividuals agedwith 40a andpersonal overfamily withouthistory firstof requiringcancer anthat orderis forrecommended theby same;a healthcare professional;

and,and in(2) theEvidenced-based casecancer ofimaging afor womanindividuals whowith isan underincreased 40risk years of age and has a family history of breast cancer oras otherrecommended breastby cancerthe riskNational factors,Comprehensive aCancer mammogramNetwork examination(NCCN) atclinical suchpractice ageguidelines. and intervals as deemed medically necessary by the woman's health care provider.

(b) TheThis requirements of this section shallapplies apply to all insurancecoverage policies issued by an insurer pursuant to this articleagency delivered, issued for delivery, reissued, or extended in the state on and after January 1, 2025,2026, or at any time thereafter when any term of the policy, contract, or plan is changedchanged, or any premium adjustment is made.

(d) If under federal law, application of this section would result in Health Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this requirement shall apply Intr2 SB 28 2025R1507 only, for Health Savings Account-qualified High Deductible Health Plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this section shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

(b) This section applies to all coverage issued by this agency delivered, issued for delivery, reissued, or extended in the state on and after January 1, 2025,2026, or at any time thereafter when any term of the policy, contract, or plan is changedchanged, or any premium adjustment is made.

(d) If under federal law, application of this section would result in Health Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this requirement shall apply only, for Health Savings Account-qualified High Deductible Health Plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this section Intr3 SB 28 2025R1507 shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

§33-16-3pp.

Required coverage for clinical genetic testing for an inherited gene mutation and evidenced-based cancer imaging.

(a) An insurance policy issued by an insurer pursuant to this article shall provide coverage for the cost of health care services pursuant to this article for the cost of the following health care services:

(1) Clinical genetic testing for an inherited gene mutation for individuals with a personal family history of cancer that is recommended by a healthcare professional;

and (2) Evidenced-based cancer imaging for individuals with an increased risk of cancer as recommended by the National Comprehensive Cancer Network (NCCN) clinical practice guidelines.

(b) This section applies to all coverage issued by this agency delivered, issued for delivery, reissued, or extended in the state on and after January 1, 2025, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.

(c) Coverage required by this section may not be subject to cost-sharing requirements.

(d) If under federal law, application of this section would result in Health Savings Account ineligibility under section 223 of the federal Internal Revenue Code, this requirement shall apply only, for Health Savings Account-qualified High Deductible Health Plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under section 223, except for with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this section shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

Intr SB 28 2025R1507 §33-24-7z.

(a) NotwithstandingAn any provision of any policy, provision, contract, plan or agreement to which this article applies, an insurance policy issued by an insurer pursuant to this article shall provide coverage for the cost of health care services pursuant to this article for the cost of the following health care services:

(b) This section applies to all coverage issued by this agency delivered, issued for delivery, reissued, or extended in the state on and after January 1, 2025,2026, or at any time thereafter when any term of the policy, contract, or plan is changedchanged, or any premium adjustment is made.

4 ARTICLE 25.

(a) AAn contract,insurance planpolicy or agreement issued by an insurer pursuant to this article thatshall providesprovide Intrcoverage SBfor 28the 2025R1507cost reimbursementof orhealth indemnitycare for laboratory or X-ray services shallpursuant provideto coveragethis article for the cost of the following health care services:

One(1) mammogramClinical examinationgenetic everytesting yearfor an inherited gene mutation for womenindividuals agedwith 40a andpersonal overfamily withouthistory firstof requiringcancer anthat orderis forrecommended theby same;a healthcare professional;

and,and in(2) theEvidenced-based casecancer ofimaging afor womanindividuals whowith isan underincreased 40risk years of age and has a family history of breast cancer oras otherrecommended breastby cancerthe riskNational factors,Comprehensive aCancer mammogramNetwork examination(NCCN) atclinical suchpractice ageguidelines. and intervals as deemed medically necessary by the woman's health care provider.

(b) TheThis requirements of this section shallapplies apply to all insurancecoverage policies issued by an insurer pursuant to this articleagency delivered, issued for delivery, reissued, or extended in the state on and after January 1, 2025,2026, or at any time thereafter when any term of the policy, contract, or plan is changedchanged, or any premium adjustment is made.

5 (a) NotwithstandingAn any provision of any policy, provision, contract, plan or agreement to which this article applies, an insurance policy issued by an insurer pursuant to this article shall provide coverage for the cost of health care services pursuant to this article for the cost of the following health care services:

(1) Clinical genetic testing for an inherited gene mutation for individuals with a personal Intr SB 28 2025R1507 family history of cancer that is recommended by a healthcare professional;

(b) This section applies to all coverage issued by this agency delivered, issued for delivery, reissued, or extended in the state on and after January 1, 2025,2026, or at any time thereafter when any term of the policy, contract, or plan is changedchanged, or any premium adjustment is made.