Health insurance; require coverage for genetic testing for inherited mutation and evidence-based cancer imaging.

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To: Insurance
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026

By: Representatives Creekmore IV, Felsher,
Scoggin, Arnold, Blackwell, Scott

HOUSE BILL NO. 430

AN ACT TO REQUIRE ANY GROUP HEALTH PLAN, OR A HEALTH 1
INSURANCE ISSUER OFFERING GROUP OR INDIVIDUAL HEALTH INSURANCE TO 2
INCLUDE COVERAGE FOR CLINICAL GENETIC TESTING FOR AN INHERITED 3
GENE MUTATION FOR INDIVIDUALS WITH A PERSONAL OR FAMILY HISTORY OF 4
CANCER THAT IS RECOMMENDED BY A HEALTH CARE PROFESSIONAL AND 5
EVIDENCED-BASED CANCER IMAGING FOR INDIVIDUALS WITH AN INCREASED 6
RISK OF CANCER AS RECOMMENDED BY NCCN CLINICAL PRACTICE 7
GUIDELINES; TO PROHIBIT GROUP HEALTH PLANS AND HEALTH INSURANCE 8
ISSUERS THAT PROVIDE SUCH SERVICES FROM IMPOSING ANY COST-SHARING 9
REQUIREMENTS FOR THOSE SERVICES; TO BRING FORWARD SECTION 25-15-9, 10
MISSISSIPPI CODE OF 1972, WHICH PROVIDES FOR THE FORMULATION OF 11
THE STATE EMPLOYEES LIFE AND HEALTH INSURANCE PLAN; AND FOR 12
RELATED PURPOSES. 13
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 14
SECTION 1. (1) As used in this section, the following terms 15
shall be defined as provided in this subsection: 16
(a) "Cost-sharing requirements" means a deductible, 17
coinsurance, copayment or similar out-of-pocket expense. 18
(b) "Evidenced-based cancer imaging" means 19
evidence-based cancer imaging modalities in accordance with the 20
most recent version of the National Comprehensive Cancer Network 21
(NCCN) clinical practice guidelines. 22
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(c) "Genetic testing for an inherited mutation" means 23
germline multi-gene testing for an inherited mutation associated 24
with an increased risk of cancer in accordance with 25
evidence-based, clinical practice guidelines. 26
(2) Any group health plan, or a health insurance issuer 27
offering group or individual health insurance shall include 28
coverage for: 29
(a) Clinical genetic testing for an inherited gene 30
mutation for individuals with a personal or family history of 31
cancer that is recommended by a health care professional; and 32
(b) Evidenced-based cancer imaging for individuals with 33
an increased risk of cancer as recommended by NCCN clinical 34
practice guidelines. 35
(3) A group health plan, or a health insurance issuer 36
offering group or individual health insurance coverage, that 37
provides the benefits required under subsection (2) of this 38
section to an individual enrolled under such plan, shall not 39
impose any cost-sharing requirements for those services. 40
(4) If under federal law, application of subsection (3) of 41
this section would result in health savings account ineligibility 42
under Section 223 of the federal Internal Revenue Code, this 43
requirement shall apply only for health savings account-qualified 44
high deductible health plans with respect to the deductible of 45
such a plan after the enrollee has satisfied the minimum 46
deductible under Section 223, except for with respect to items or 47
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services that are preventive care pursuant to Section 223(c)(2)(C) 48
of the federal Internal Revenue Code, in which case the 49
requirements of subsection (2) shall apply regardless of whether 50
the minimum deductible under Section 223 has been satisfied. 51
SECTION 2. Section 25-15-9, Mississippi Code of 1972, is 52
brought forward as follows: 53
25-15-9. (1) (a) The board shall design a plan of health 54
insurance for state employees that provides benefits for 55
semiprivate rooms in addition to other incidental coverages that 56
the board deems necessary. The amount of the coverages shall be 57
in such reasonable amount as may be determined by the board to be 58
adequate, after due consideration of current health costs in 59
Mississippi. The plan shall also include major medical benefits 60
in such amounts as the board determines. The plan shall provide 61
for coverage for telemedicine services as provided in Section 62
83-9-351. The board is also authorized to accept bids for such 63
alternate coverage and optional benefits as the board deems 64
proper. The board is authorized to accept bids for surgical 65
services that include assistance in locating a surgeon, setting up 66
initial consultation, travel, a negotiated single case rate bundle 67
and payment for orthopedic, spine, bariatric, cardiovascular and 68
general surgeries. The surgical services may only utilize 69
surgeons and facilities located in the State of Mississippi unless 70
otherwise provided by the board. Any contract for alternative 71
coverage and optional benefits shall be awarded by the board after 72
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it has carefully studied and evaluated the bids and selected the 73
best and most cost-effective bid. The board may reject all of the 74
bids; however, the board shall notify all bidders of the rejection 75
and shall actively solicit new bids if all bids are rejected. The 76
board may employ or contract for such consulting or actuarial 77
services as may be necessary to formulate the plan, and to assist 78
the board in the preparation of specifications and in the process 79
of advertising for the bids for the plan. Those contracts shall 80
be solicited and entered into in accordance with Section 25-15-5. 81
The board shall keep a record of all persons, agents and 82
corporations who contract with or assist the board in preparing 83
and developing the plan. The board in a timely manner shall 84
provide copies of this record to the members of the advisory 85
council created in this section and those legislators, or their 86
designees, who may attend meetings of the advisory council. The 87
board shall provide copies of this record in the solicitation of 88
bids for the administration or servicing of the self-insured 89
program. Each person, agent or corporation that, during the 90
previous fiscal year, has assisted in the development of the plan 91
or employed or compensated any person who assisted in the 92
development of the plan, and that bids on the administration or 93
servicing of the plan, shall submit to the board a statement 94
accompanying the bid explaining in detail its participation with 95
the development of the plan. This statement shall include the 96
amount of compensation paid by the bidder to any such employee 97
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during the previous fiscal year. The board shall make all such 98
information available to the members of the advisory council and 99
those legislators, or their designees, who may attend meetings of 100
the advisory council before any action is taken by the board on 101
the bids submitted. The failure of any bidder to fully and 102
accurately comply with this paragraph shall result in the 103
rejection of any bid submitted by that bidder or the cancellation 104
of any contract executed when the failure is discovered after the 105
acceptance of that bid. The board is authorized to promulgate 106
rules and regulations to implement the provisions of this 107
subsection. 108
The board shall develop plans for the insurance plan 109
authorized by this section in accordance with the provisions of 110
Section 25-15-5. 111
Any corporation, association, company or individual that 112
contracts with the board for the third-party claims administration 113
of the self-insured plan shall prepare and keep on file an 114
explanation of benefits for each claim processed. The explanation 115
of benefits shall contain such information relative to each 116
processed claim that the board deems necessary, and, at a minimum, 117
each explanation shall provide the claimant's name, claim number, 118
provider number, provider name, service dates, type of services, 119
amount of charges, amount allowed to the claimant and reason 120
codes. The information contained in the explanation of benefits 121
shall be available for inspection upon request by the board. The 122
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board shall have access to all claims information utilized in the 123
issuance of payments to employees and providers. 124
(b) There is created an advisory council to advise the 125
board in the formulation of the State and School Employees Health 126
Insurance Plan. The council shall be composed of the State 127
Insurance Commissioner, or his designee, an 128
employee-representative of the institutions of higher learning 129
appointed by the board of trustees thereof, an 130
employee-representative of the Department of Transportation 131
appointed by the director thereof, an employee-representative of 132
the Department of Revenue appointed by the Commissioner of 133
Revenue, an employee-representative of the Mississippi Department 134
of Health appointed by the State Health Officer, an 135
employee-representative of the Mississippi Department of 136
Corrections appointed by the Commissioner of Corrections, and an 137
employee-representative of the Department of Human Services 138
appointed by the Executive Director of Human Services, two (2) 139
certificated public school administrators appointed by the State 140
Board of Education, two (2) certificated classroom teachers 141
appointed by the State Board of Education, a noncertificated 142
school employee appointed by the State Board of Education and a 143
community/junior college employee appointed by the Mississippi 144
Community College Board. 145
The Lieutenant Governor may designate the Secretary of the 146
Senate, the Chairman of the Senate Appropriations Committee, the 147
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Chairman of the Senate Education Committee and the Chairman of the 148
Senate Insurance Committee, and the Speaker of the House of 149
Representatives may designate the Clerk of the House, the Chairman 150
of the House Appropriations Committee, the Chairman of the House 151
Education Committee and the Chairman of the House Insurance 152
Committee, to attend any meeting of the State and School Employees 153
Insurance Advisory Council. The appointing authorities may 154
designate an alternate member from their respective houses to 155
serve when the regular designee is unable to attend the meetings 156
of the council. Those designees shall have no jurisdiction or 157
vote on any matter within the jurisdiction of the council. For 158
attending meetings of the council, the legislators shall receive 159
per diem and expenses, which shall be paid from the contingent 160
expense funds of their respective houses in the same amounts as 161
provided for committee meetings when the Legislature is not in 162
session; however, no per diem and expenses for attending meetings 163
of the council will be paid while the Legislature is in session. 164
No per diem and expenses will be paid except for attending 165
meetings of the council without prior approval of the proper 166
committee in their respective houses. 167
(c) No change in the terms of the State and School 168
Employees Health Insurance Plan may be made effective unless the 169
board, or its designee, has provided notice to the State and 170
School Employees Health Insurance Advisory Council and has called 171
a meeting of the council at least fifteen (15) days before the 172
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effective date of the change. If the State and School Employees 173
Health Insurance Advisory Council does not meet to advise the 174
board on the proposed changes, the changes to the plan shall 175
become effective at such time as the board has informed the 176
council that the changes shall become effective. 177
(d) Medical benefits for retired employees and 178
dependents under age sixty-five (65) years and not eligible for 179
Medicare benefits. For employees who retire before July 1, 2005, 180
and for employees retiring due to work-related disability under 181
the Public Employees' Retirement System, the same health insurance 182
coverage as for all other active employees and their dependents 183
shall be available to retired employees and all dependents under 184
age sixty-five (65) years who are not eligible for Medicare 185
benefits, the level of benefits to be the same level as for all 186
other active participants. For employees who retire on or after 187
July 1, 2005, and not retiring due to work-related disability 188
under the Public Employees' Retirement System, the same health 189
insurance coverage as for all other active employees and their 190
dependents shall be available to those retiring employees and all 191
dependents under age sixty-five (65) years who are not eligible 192
for Medicare benefits only if the retiring employees were 193
participants in the State and School Employees Health Insurance 194
Plan for four (4) years or more before their retirement, the level 195
of benefits to be the same level as for all other active 196
participants. This section will apply to those employees who 197
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retire due to one hundred percent (100%) medical disability as 198
well as those employees electing early retirement. 199
(e) Medical benefits for retired employees and 200
dependents over age sixty-five (65) years or otherwise eligible 201
for Medicare benefits. For employees who retire before July 1, 202
2005, and for employees retiring due to work-related disability 203
under the Public Employees' Retirement System, the health 204
insurance coverage available to retired employees over age 205
sixty-five (65) years or otherwise eligible for Medicare benefits, 206
and all dependents over age sixty-five (65) years or otherwise 207
eligible for Medicare benefits, shall be the major medical 208
coverage. For employees retiring on or after July 1, 2005, and 209
not retiring due to work-related disability under the Public 210
Employees' Retirement System, the health insurance coverage 211
described in this paragraph (e) shall be available to those 212
retiring employees only if they were participants in the State and 213
School Employees Health Insurance Plan for four (4) years or more 214
and are over age sixty-five (65) years or otherwise eligible for 215
Medicare benefits, and to all dependents over age sixty-five (65) 216
years or otherwise eligible for Medicare benefits. Benefits shall 217
be reduced by Medicare benefits as though the Medicare benefits 218
were the base plan. 219
All covered individuals shall be assumed to have full 220
Medicare coverage, Parts A and B; and any Medicare payments under 221
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both Parts A and B shall be computed to reduce benefits payable 222
under this plan. 223
(f) Lifetime maximum: The lifetime maximum amount of 224
benefits payable under the health insurance plan for each 225
participant is Two Million Dollars ($2,000,000.00). 226
(2) Nonduplication of benefits — reduction of benefits by 227
Title XIX benefits: When benefits would be payable under more 228
than one (1) group plan, benefits under those plans will be 229
coordinated to the extent that the total benefits under all plans 230
will not exceed the total expenses incurred. 231
Benefits for hospital or surgical or medical benefits shall 232
be reduced by any similar benefits payable in accordance with 233
Title XIX of the Social Security Act or under any amendments 234
thereto, or any implementing legislation. 235
Benefits for hospital or surgical or medical benefits shall 236
be reduced by any similar benefits payable by workers' 237
compensation. 238
No health care benefits under the state plan shall restrict 239
coverage for medically appropriate treatment prescribed by a 240
physician and agreed to by a fully informed insured, or if the 241
insured lacks legal capacity to consent by a person who has legal 242
authority to consent on his or her behalf, based on an insured's 243
diagnosis with a terminal condition. As used in this paragraph, 244
"terminal condition" means any aggressive malignancy, chronic 245
end-stage cardiovascular or cerebral vascular disease, or any 246
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other disease, illness or condition which physician diagnoses as 247
terminal. 248
Not later than January 1, 2016, the state health plan shall 249
not require a higher co-payment, deductible or coinsurance amount 250
for patient-administered anti-cancer medications, including, but 251
not limited to, those orally administered or self-injected, than 252
it requires for anti-cancer medications that are injected or 253
intravenously administered by a health care provider, regardless 254
of the formulation or benefit category determination by the plan. 255
For the purposes of this paragraph, the term "anti-cancer 256
medications" has the meaning as defined in Section 83-9-24. 257
(3) (a) Schedule of life insurance benefits — group term: 258
The amount of term life insurance for each active employee of a 259
department, agency or institution of the state government shall 260
not be in excess of One Hundred Thousand Dollars ($100,000.00), or 261
twice the amount of the employee's annual wage to the next highest 262
One Thousand Dollars ($1,000.00), whichever may be less, but in no 263
case less than Thirty Thousand Dollars ($30,000.00), with a like 264
amount for accidental death and dismemberment on a 265
twenty-four-hour basis. The plan will further contain a premium 266
waiver provision if a covered employee becomes totally and 267
permanently disabled before age sixty-five (65) years. Employees 268
retiring after June 30, 1999, shall be eligible to continue life 269
insurance coverage in an amount of Five Thousand Dollars 270
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($5,000.00), Ten Thousand Dollars ($10,000.00) or Twenty Thousand 271
Dollars ($20,000.00) into retirement. 272
(b) Effective October 1, 1999, schedule of life 273
insurance benefits — group term: The amount of term life 274
insurance for each active employee of any school district, 275
community/junior college, public library or university-based 276
program authorized under Section 37-23-31 for deaf, aphasic and 277
emotionally disturbed children or any regular nonstudent bus 278
driver shall not be in excess of One Hundred Thousand Dollars 279
($100,000.00), or twice the amount of the employee's annual wage 280
to the next highest One Thousand Dollars ($1,000.00), whichever 281
may be less, but in no case less than Thirty Thousand Dollars 282
($30,000.00), with a like amount for accidental death and 283
dismemberment on a twenty-four-hour basis. The plan will further 284
contain a premium waiver provision if a covered employee of any 285
school district, community/junior college, public library or 286
university-based program authorized under Section 37-23-31 for 287
deaf, aphasic and emotionally disturbed children or any regular 288
nonstudent bus driver becomes totally and permanently disabled 289
before age sixty-five (65) years. Employees of any school 290
district, community/junior college, public library or 291
university-based program authorized under Section 37-23-31 for 292
deaf, aphasic and emotionally disturbed children or any regular 293
nonstudent bus driver retiring after September 30, 1999, shall be 294
eligible to continue life insurance coverage in an amount of Five 295
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Thousand Dollars ($5,000.00), Ten Thousand Dollars ($10,000.00) or 296
Twenty Thousand Dollars ($20,000.00) into retirement. 297
(4) Any eligible employee who on March 1, 1971, was 298
participating in a group life insurance program that has 299
provisions different from those included in this article and for 300
which the State of Mississippi was paying a part of the premium 301
may, at his discretion, continue to participate in that plan. The 302
employee shall pay in full all additional costs, if any, above the 303
minimum program established by this article. Under no 304
circumstances shall any individual who begins employment with the 305
state after March 1, 1971, be eligible for the provisions of this 306
subsection. 307
(5) The board may offer medical savings accounts as defined 308
in Section 71-9-3 as a plan option. 309
(6) Any premium differentials, differences in coverages, 310
discounts determined by risk or by any other factors shall be 311
uniformly applied to all active employees participating in the 312
insurance plan. It is the intent of the Legislature that the 313
state contribution to the plan be the same for each employee 314
throughout the state. 315
(7) On October 1, 1999, any school district, 316
community/junior college district or public library may elect to 317
remain with an existing policy or policies of group life insurance 318
with an insurance company approved by the State and School 319
Employees Health Insurance Management Board, in lieu of 320
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participation in the State and School Life Insurance Plan. On or 321
after July 1, 2004, until October 1, 2004, any school district, 322
community/junior college district or public library may elect to 323
choose a policy or policies of group life insurance existing on 324
October 1, 1999, with an insurance company approved by the State 325
and School Employees Health Insurance Management Board in lieu of 326
participation in the State and School Life Insurance Plan. The 327
state's contribution of up to fifty percent (50%) of the active 328
employee's premium under the State and School Life Insurance Plan 329
may be applied toward the cost of coverage for full-time employees 330
participating in the approved life insurance company group plan. 331
For purposes of this subsection (7), "life insurance company group 332
plan" means a plan administered or sold by a private insurance 333
company. After October 1, 1999, the board may assess charges in 334
addition to the existing State and School Life Insurance Plan 335
rates to such employees as a condition of enrollment in the State 336
and School Life Insurance Plan. In order for any life insurance 337
company group plan to be approved by the State and School 338
Employees Health Insurance Management Board under this subsection 339
(7), it shall meet the following criteria: 340
(a) The insurance company offering the group life 341
insurance plan shall be rated "A-" or better by A.M. Best state 342
insurance rating service and be licensed as an admitted carrier in 343
the State of Mississippi by the Mississippi Department of 344
Insurance. 345
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ST: Health insurance; require coverage for
genetic testing for inherited mutation and
evidence-based cancer imaging.
(b) The insurance company group life insurance plan 346
shall provide the same life insurance, accidental death and 347
dismemberment insurance and waiver of premium benefits as provided 348
in the State and School Life Insurance Plan. 349
(c) The insurance company group life insurance plan 350
shall be fully insured, and no form of self-funding life insurance 351
by the company shall be approved. 352
(d) The insurance company group life insurance plan 353
shall have one (1) composite rate per One Thousand Dollars 354
($1,000.00) of coverage for active employees regardless of age and 355
one (1) composite rate per One Thousand Dollars ($1,000.00) of 356
coverage for all retirees regardless of age or type of retiree. 357
(e) The insurance company and its group life insurance 358
plan shall comply with any administrative requirements of the 359
State and School Employees Health Insurance Management Board. If 360
any insurance company providing group life insurance benefits to 361
employees under this subsection (7) fails to comply with any 362
requirements specified in this subsection or any administrative 363
requirements of the board, the state shall discontinue providing 364
funding for the cost of that insurance. 365
SECTION 3. This act shall take effect and be in force from 366
and after July 1, 2026. 367