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

Section 10145.4.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 10123.20
Date2022-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierINS10123.20.20216052

General Provisions

Cal. INS § 10123.20

California Statutes

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

Section 10145.4.

Document details

CollectionCalifornia Statutes
CitationCal. INS § 10123.20
Date2022-01-01
Typestatute
Languageen
SourceCA_STAT
IdentifierINS10123.20.20216052
General Provisions | CaseLite