CO| This Colorado Division of Insurance Bulletin No. B-4.155 explains the Division’s interpretation and expectations regarding coverage of biomarker testing under Senate Bill 24-124, which requires coverage of biomarker tests used for diagnosis, treatment, appropriate management, and ongoing monitoring of a covered person’s disease or condition when such testing is medically necessary and supported by medical and scientific evidence. The guidance applies to all carriers issuing health benefit plans and clarifies that large group health benefit plans must cover biomarker testing for plan years issued or renewed on or after January 1, 2025, under § 10-16-104(28)(g)(II), C.R.S. For individual and small group plans, § 10-16-104(28)(a), C.R.S. requires coverage for biomarker testing to the extent the benefit is not in addition to Colorado’s essential health benefits benchmark plan; the Division has determined that the testing mandated by SB 24-124 is not beyond benchmark benefits, and therefore must be covered in all individual and small group plans when medically necessary and evidence-based, as outlined in § 10-16-104(28)(b)(I)-(V), C.R.S. The bulletin notes that a formal determination was submitted to HHS on September 6, 2024, and states that if HHS later seeks state defrayal for any additional costs attributable to SB 24-124, the Division will notify the Joint Budget Committee and the relevant legislative health committees.
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