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SB 1626

Insurance, Health, Accident - As introduced, requires that a health plan, or an insurer offering a health plan, include coverage for clinical genetic testing for an inherited gene mutation for an individual with a personal or family history of cancer that is recommended by a healthcare professional, and evidence-based cancer imaging for an individual with an increased risk of cancer as recommended by National Comprehensive Cancer Network clinical practice guidelines. - Amends TCA Title 4; Title 56 and Title 71.

114th Regular Session (2025-2026) Introduced by Richard Briggs

Tennessee health plans must cover clinically indicated inherited cancer gene testing and NCCN-based cancer imaging without any cost-sharing.

Placed on Senate Finance, Ways, and Means Committee calendar for 4/20/2026
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Bill Summary · SB 1626

Summary of Bill SB 1626 / HB 1775 (Tennessee) – Insurance, Health, Accident

Date: 2026

1) Purpose and Intent

  • The bill requires health plans offered by insurers in Tennessee to provide coverage for two specific health benefits without cost-sharing: 1) Clinical genetic testing for an inherited gene mutation linked to cancer, when recommended by a healthcare professional. 2) Evidenced-based cancer imaging for individuals at increased cancer risk, as recommended by the National Comprehensive Cancer Network (NCCN) clinical practice guidelines.
  • The aim is to ensure access to genetic testing and NCCN-guided cancer imaging by removing patient cost-sharing, thereby improving early detection and risk-based care for individuals with cancer family histories or elevated risk.

2) Key Provisions

  • New definitions (Section 1):

    • Cost-sharing requirement: deductible, coinsurance, copayment, or similar out-of-pocket expense.
    • Evidenced-based cancer imaging: NCCN guideline-based imaging modalities.
    • Genetic testing for an inherited mutation: germline multi-gene testing per evidence-based clinical guidelines.
    • Health plan: insurer-issued policy or contract covering healthcare services.
    • Healthcare service: services to prevent, diagnose, treat, or heal illness or disability.
    • Insurer: entity regulated under Tennessee insurance laws.

  • Mandatory coverage (Section 1, subsection b):

    • A health plan or insurer must cover: 1) Clinical genetic testing for an inherited cancer-related gene mutation when recommended by a healthcare professional. 2) Evidenced-based cancer imaging for individuals at increased cancer risk as recommended by NCCN guidelines.

  • No cost-sharing (Section 1, subsection c):

    • Coverage required under subsection (b) must not be subject to cost-sharing requirements (no deductibles, copays, or coinsurance for these services).

  • Federal tax consideration (Section 1, subsection d):

    • If applying subsection (b) would cause an individual to become ineligible for a Health Savings Account (HSA) under § 223 of the Internal Revenue Code, the coverage applies for HDHPs with respect to the deductible after the enrollee meets the minimum deductible, with an exception for preventive care as defined under § 223(c)(2)(C) where the cost-sharing prohibition applies regardless of deductible status.

  • Effective date and scope (Section 2):

    • The amended requirements take effect July 1, 2026, and apply to plans issued, amended, or renewed on or after that date.

3) Affected Parties

  • Health plans and insurers offering health plans in Tennessee are required to cover these services without cost-sharing.
  • Enrollees in state employee plans and other SGIP (State Group Insurance Program) participants are directly affected by the cost-sharing prohibition and potential premium adjustments.
  • Federal and state program considerations:
    • Potential impacts on premiums for private plans and the State Group Insurance Program.
    • Interaction with HSA eligibility where applicable.

4) Procedural and Timeline Details

  • Legislative action history indicates passage through committees and multiple readings in 2026, with sponsor information and co-sponsor noted (Sen. Briggs; House sponsor Scarbrough).
  • Amended version (SB 1626 / HB 1775, as amended) moves an effective date to January 1, 2027 for a state employee group plan provision, but the core provision in the unamended text had July 1, 2026, as the broader effective date for most plans.
  • Fiscal notes estimate both state and federal expenditure impacts, particularly related to SGIP, with detailed breakdowns of anticipated annual cost increases and how the state and federal shares would bear them.

5) Fiscal and Economic Impact (High-Level)

  • General estimate (as introduced):
    • State: tens of millions in recurring costs across SGIP (~$11.3 million statewide in FY26-27 and subsequent years).
    • Federal: hundreds of thousands to low millions in related expenditures (varies by plan and federal funding share).
    • Local governments: several million in recurring expenditures.
    • Potential premium increases for some plans, estimated to be under 1% of total premiums for those not currently offering these benefits.
  • With amended version (as amended in fiscal memo):
    • A more targeted timeline (effective 1/1/2027 for state employee plans) with phased annual expenditure increases estimated through subsequent years.
    • State general fund and federal expenditure changes outlined, along with estimated impacts to premiums.

6) Summary

  • SB 1626 / HB 1775 would require health plans in Tennessee to cover clinical genetic testing for inherited cancer mutations and NCCN-recommended, evidence-based cancer imaging without cost-sharing.
  • The bill aligns coverage with professional guidelines and NCCN standards, prioritizing preventive and risk-based cancer care.
  • Effective dates differ between versions, with broader applicability starting mid-2026 (or 1/1/2027 for certain state plans, per amended language).
  • Fiscal analyses project increased state, federal, and local government costs, and possible modest premium increases for private plans, balanced by health benefits from improved access to preventive genetic testing and imaging.

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

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