California (CA) Health Plans Must Cover Home Test Kits for Sexually Transmitted Diseases (STD)

California became the first state to require insurers to cover at-home tests for STDs by passing Senate Bill 306. This new requirement is one of several measures the state has taken to curb an ongoing rise in STDs.

What is it?  Group health plans subject to CA state laws must cover home test kits for STDs when ordered for an enrollee by an in-network provider.

When is this effective? It is effective for contracts issued, renewed, or delivered on or after January 1, 2022.

Who must comply? Group health plans that are subject to CA state laws which generally includes all fully-insured plans written in the state of CA.

What should an employer do next?

  • For fully insured group health plans that renewed or issued coverage on 1/1/2022, contact the insurance carrier to understand if an amendment should be issued.
  • For fully insured group health plans renewing or issued after 1/1/2022, coverage should automatically be written into the policy.

Special Note: A “home test kit” means a product used for a test recommended by the federal Centers for Disease Control and Prevention guidelines or the United States Preventive Services Task Force that has been CLIA-waived, FDA-cleared or -approved, or developed by a laboratory in accordance with established regulations and quality standards, to allow individuals to self-collect specimens for STDs, including HIV, remotely at a location outside of a clinical setting.

As of now, home test kits are waiting on FDA approval which may cause a delay in rolling out the new law effectively. Additionally, an independent analysis ordered by state legislators in 2021 predicts that most in-network providers won’t start prescribing home tests for at least a year until billing codes and administrative practices can be adjusted.

To read a detailed description of the new law, please click here.

While every effort has been taken in compiling this information to ensure that its contents are totally accurate, neither the publisher nor the author can accept  liability  for any inaccuracies or changed circumstances of any information herein or for the consequences of any reliance placed upon it. This publication is distributed on the understanding that the publisher is not engaged in rendering legal, accounting or other professional advice or services. Readers should always seek professional advice before entering into any commitments.

About Michelle Cammayo

Michelle Cammayo has more than 13 years of Employee Benefits experience specializing in all lines of health and welfare benefits. Today, Michelle works closely with clients and partners to provide guidance in areas of the law including ERISA, HIPAA, COBRA, FMLA and PPACA. She also oversees the Compliance Department at Bolton & Company to ensure we are helping our clients manage and eliminate risk with regards to employee benefit compliance.

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