Require the coverage of biomarker testing in certain health insurance policies.
Summary
HB 1112 would require certain health insurance policies in South Dakota to cover biomarker testing beginning January 1, 2026. The mandate applies to individual health policies, group health policies, and small employer health benefit plans delivered, issued for delivery, or renewed in the state. Coverage would be required when biomarker testing is ordered by a qualified health care provider acting within the provider’s scope of practice and when the testing is supported by medical and scientific evidence.
The bill defines “biomarker” as an objectively measured characteristic used to indicate a normal biological process, disease process, or response to a therapeutic regimen, and defines “biomarker testing” as analysis of tissue, blood, or other biospecimens for the presence of a biomarker. The bill excludes specified disease policies and other limited-benefit coverage from the mandate.
Impact
If enacted, the bill would amend South Dakota insurance law by adding new coverage requirements in chapters 58-17, 58-18, and 58-18B. Insurers offering covered health policies and small employer plans would have to include biomarker testing as a covered benefit when medically supported and ordered by an appropriate provider, which could affect utilization review, claims processing, and benefit design. The mandate would not apply to limited-benefit or specified disease policies.
Sentiment
The available voting history suggests the bill was received favorably at least in committee, with a 13-0 vote to defer it to the 41st legislative day. No committee transcript is available, so there is no recorded debate to indicate opposition or support beyond the unanimous vote. Overall, the bill appears to have had a neutral-to-positive reception at the committee stage.
Contention
The main policy issue likely to draw attention is the cost and scope of requiring insurers to cover biomarker testing whenever it is supported by medical and scientific evidence. Potential points of contention include how that standard will be interpreted, whether coverage could increase premiums or utilization, and how insurers will determine medical necessity. Another possible issue is the breadth of the mandate across individual, group, and small employer plans, balanced against the bill’s exclusions for limited-benefit coverage.