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SB 476

Health Insurance - Genetic Testing and Cancer Imaging - Required Coverage and Prohibited Cost-Sharing

2025 Regular Session Introduced by Pam Beidle

Requires insurers to cover genetic testing for inherited cancer risk and follow-up imaging if high risk, with no cost-sharing, under evidence-based guidelines.

Hearing 2/12 at 1:00 p.m.
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Bill Summary · SB 476

SB 476 — Health Insurance: Genetic Testing and Cancer Imaging (2025)

Status: Hearing scheduled 2/12 at 1:00 p.m.
Introduced: February 19, 2025 (Sen. Beidle)
Summary prepared from fiscal and committee materials

Purpose and intent

SB 476 requires certain health carriers to cover genetic testing to identify inherited cancer‑risk mutations for people with a personal or family history of cancer, and to cover recommended follow‑up evidence‑based cancer imaging when testing indicates an increased cancer risk. The bill also generally prohibits cost‑sharing for these services.

Key provisions

  • Covered entities: Insurers, nonprofit health service plans, and health maintenance organizations that provide hospital, medical, or surgical benefits in Maryland.
  • Genetic testing coverage: Carriers must cover genetic testing to determine whether an individual with a personal or family history of cancer has an inherited mutation associated with increased cancer risk, when:
    • a health care professional recommends the test, and
    • the testing is consistent with evidence‑based clinical practice guidelines.
  • Follow‑up imaging coverage: If testing shows increased risk, carriers must cover follow‑up evidence‑based cancer imaging that:
    • is recommended for the specific type of cancer identified, and
    • uses imaging modalities established in the most recent National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology.
  • Cost‑sharing prohibition: Carriers may not impose a copayment, coinsurance, or deductible for the genetic testing and the follow‑up imaging described above, except:
    • A deductible may apply for a health savings account‑qualified high‑deductible health plan (HDHP) to the extent necessary to preserve HSA eligibility under 26 U.S.C. § 223. The bill treats preventive items under 26 U.S.C. § 223(c)(2)(C) specially (see bill text).
  • Clinical standards: Testing and imaging must align with evidence‑based clinical practice guidelines and NCCN guidance for modality selection.

Who is affected

  • Primary: Health carriers subject to Maryland insurance law (insurers, nonprofit plans, HMOs).
  • Beneficiaries: Individuals in Maryland with a personal or family history of cancer who are recommended for genetic testing and those determined to be at increased risk by such testing.
  • Public purchasers: The State Employee and Retiree Health and Welfare Benefits Program may need to expand covered imaging in self‑insured plans.
  • Local governments: Potential premium impacts for fully insured plans they purchase.

Timeline / applicability

  • Effective date: January 1, 2026.
  • Applies to policies, contracts, and health benefit plans issued, delivered, or renewed in Maryland on or after January 1, 2026.

Fiscal and administrative impact

  • Maryland Insurance Administration: Minimal one‑time special fund revenue (~$125) from a rate/form filing fee; ongoing review manageable within existing resources.
  • State Employee Program: Likely an indeterminate increase in expenditures beginning FY2026 to cover additional follow‑up imaging not currently covered.
  • Local jurisdictions: If premiums rise to reflect new benefits, fully insured plans purchased by local governments could incur higher costs.
  • Small business: Fiscal note reports no expected adverse impact on small businesses.
  • MIA note: The Insurance Administration advised the bill does not apply to the nongrandfathered individual and small employer markets (clarification could affect scope).

Context / implementation notes

  • The bill relies on “evidence‑based” clinical practice guidelines and NCCN standards to define covered services, which focuses coverage on clinically accepted indications.
  • The HDHP/HSA exception is intended to preserve federal tax treatment of HSAs while still extending coverage; operational details may require carrier guidance or regulatory interpretation.

If you want, I can:
- Draft a short one‑page explainer for consumers (what to ask your insurer/doctor), or
- Extract and summarize the precise text of the HDHP/HSA exception for plan administrators.

Compiled from official sources — confirm details with the bill’s official record.

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