An Act Concerning Health Benefit Review And Requiring Health Insurance Coverage For Biomarker Testing.
HB 6895 makes two main changes to Connecticut insurance law. First, it creates a new health benefit review process for mandated health benefits enacted on or after January 1, 2026. Under that process, the Insurance Commissioner must produce a review report within three years of a new mandate’s effective date, and the mandate will expire four years after it takes effect unless the General Assembly reauthorizes it by majority vote in both chambers after reviewing the report. The bill also expands the required contents of legislative fiscal and impact statements by adding an enrollee impact statement for bills that would affect premiums for health plans offered through the exchange.
Second, the bill requires individual and group health insurance policies to cover biomarker testing when the test has demonstrated clinical utility and is supported by medical and scientific evidence such as FDA approval or clearance, Medicare coverage determinations, or nationally recognized clinical practice guidelines. The coverage must be provided in a way that minimizes disruptions in care, and the testing must be performed at an in-network certified laboratory or approved CLIA-waived facility. The bill also requires insurers to maintain a clear process for exceptions and appeals related to coverage denials, and it sets deadlines for prior authorization decisions: seven days for non-urgent requests and 72 hours for urgent requests.
The bill’s impact on state law is significant because it adds a new statutory coverage mandate for biomarker testing and changes how future health insurance mandates are reviewed and retained. It also amends legislative procedures to require additional analysis of bills that could affect exchange premiums. These changes apply to policies and mandates beginning in 2026 and affect insurers, health carriers, the state employee plan, the insurance exchange, policyholders, and health care providers ordering biomarker tests.
The general sentiment around the bill appears favorable in committee, as reflected by the 12-1 joint favorable substitute vote in the Insurance and Real Estate Committee. The absence of recorded committee transcript discussion limits the ability to identify detailed arguments, but the strong vote suggests broad support for expanding access to biomarker testing and for adding more structured review of health benefit mandates.
The main point of contention likely concerns cost and administrative burden. The bill requires insurers to cover a potentially expensive and rapidly evolving category of testing, while also imposing new prior authorization, exception, and appeal requirements. The new sunset-and-renewal process for mandated benefits may also be debated by those who favor permanent coverage mandates versus those who want periodic legislative reapproval and cost review. Any opposition appears limited, given the near-unanimous committee vote.
The bill amends Connecticut’s insurance statutes by creating a new mandatory coverage requirement for biomarker testing in individual and group health plans and by establishing a new review-and-sunset framework for future mandated health benefits. It also revises legislative filing requirements to add enrollee impact statements for bills that may affect exchange premiums. Insurers, health carriers, the state employee plan, and health benefit plans offered through the exchange are directly affected, along with patients and providers seeking biomarker testing coverage.
Committee sentiment appears generally supportive. The bill received a Joint Favorable Substitute vote of 12-1, indicating strong bipartisan or near-bipartisan approval at the committee level. No transcript excerpts were provided, so there is no recorded floor or hearing debate to suggest broader controversy, but the vote suggests the bill was viewed positively overall.
The likely areas of contention are cost, utilization management, and the scope of the new mandate. Opponents may be concerned that requiring coverage for biomarker testing could increase premiums or administrative costs, especially given the bill’s prior authorization and appeal timelines. Another possible point of debate is the new rule that mandated health benefits expire after four years unless reapproved by both chambers, which could be seen either as a useful accountability measure or as an added hurdle for maintaining coverage. Supporters are likely focused on improved access to precision medicine and earlier, more targeted treatment decisions.