General Provisions
Cal. INS § 10123.20
California Statutes
(
a) A health insurance policy that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally medically accepted cancer screening tests, subject to all other terms and conditions that would otherwise apply. (
b) A health insurance policy that is issued, amended, delivered, or renewed on or after July 1, 2022, shall not require prior authorization for either of the following:
(1) Biomarker testing for an insured with advanced or metastatic stage or cancer.
(2) Biomarker testing of cancer progression or recurrence in the insured with advanced or metastatic stage or cancer. (
c) For purposes of this section, “biomarker test” means a diagnostic test, such as single or multigene, of the cancer patient’s biospecimen, such as tissue, blood, or other bodily fluids, for DNA or RNA alterations, including phenotypic characteristics of a malignancy, to identify an individual with a subtype of cancer, in order to guide patient treatment. (
d) This
section shall not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, or hospital indemnity insurance, coverage for benefits under this
section shall apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy or contract. This
section shall not be construed as imposing a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance. (
e) Notwithstanding subdivision (b), this
section does not prohibit a health insurer from requiring prior authorization on biomarker testing that is not for an FDA-approved therapy for advanced or metastatic stage or cancer. (
f) This
section does not limit, prohibit, or modify an insured’s rights to biomarker testing as part of an approved clinical trial under