Text: HF788            Text: HF790
Complete Bill History


House File 789

HOUSE FILE BY COMMITTEE ON COMMERCE (SUCCESSOR TO HSB 161) Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act requiring insurers offering certain individual or group 2 health insurance contracts, policies, or plans to provide 3 coverage for certain enteral formulas, audiological services 4 and hearing aids for children, and vaccinations for human 5 papilloma virus. 6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 7 TLSB 1631HV 82 8 av/cf/24 PAG LIN 1 1 Section 1. NEW SECTION. 514C.23 ENTERAL FORMULAS == 1 2 COVERAGE. 1 3 1. Except as provided in subsections 4 and 5, and 1 4 notwithstanding the uniformity of treatment requirements of 1 5 section 514C.6, a contract, policy, or plan providing for 1 6 third=party payment or prepayment of health or medical 1 7 expenses shall not exclude or restrict benefits for enteral 1 8 formulas for home use for which a practitioner licensed by law 1 9 to prescribe and administer prescription drugs has issued a 1 10 written order, if such contract, policy, or plan provides 1 11 benefits for other outpatient prescription drugs or devices. 1 12 Such written order must state that the enteral formula is 1 13 medically necessary for the patient. 1 14 2. For purposes of this section, "enteral formula" means 1 15 enteral formulas which have been proven effective for the 1 16 treatment of inborn errors of metabolism with a dietary 1 17 restriction, which if left untreated will cause 1 18 malnourishment, chronic physical disability, mental 1 19 retardation, or death. "Enteral formula" includes metabolic 1 20 formula prescribed for persons diagnosed with inborn errors of 1 21 metabolism with a dietary restriction. The commissioner, by 1 22 rule, shall further define enteral formula. 1 23 3. a. This section applies to the following classes of 1 24 third=party payment provider contracts, policies, or plans 1 25 delivered, issued for delivery, continued, or renewed in this 1 26 state on or after January 1, 2008: 1 27 (1) Individual or group accident and sickness insurance 1 28 providing coverage on an expense=incurred basis. 1 29 (2) Any individual or group hospital or medical service 1 30 contract issued pursuant to chapter 509, 514, or 514A. 1 31 (3) Any individual or group health maintenance 1 32 organization contract regulated under chapter 514B. 1 33 (4) A plan established pursuant to chapter 509A for public 1 34 employees. 1 35 (5) An organized delivery system licensed by the director 2 1 of public health. 2 2 b. This section shall not apply to accident=only, 2 3 specified disease, short=term hospital or medical, hospital 2 4 confinement indemnity, credit, dental, vision, Medicare 2 5 supplement, long=term care, basic hospital and medical= 2 6 surgical expense coverage as defined by the commissioner, 2 7 disability income insurance coverage, coverage issued as a 2 8 supplement to liability insurance, workers' compensation or 2 9 similar insurance, or automobile medical payment insurance. 2 10 4. An individual or group contract, policy, or plan 2 11 subject to the requirements of this section shall not impose 2 12 an annual deductible on enteral formula coverage benefits that 2 13 is greater than two thousand five hundred dollars per year for 2 14 each family covered and shall not impose an aggregate annual 2 15 limit for enteral formula coverage benefits that is less than 2 16 twelve thousand five hundred dollars per year for each family 2 17 covered. 2 18 5. An individual or group contract, policy, or plan 2 19 subject to the requirements of this section shall provide, at 2 20 a minimum, enteral formula coverage benefits to each male 2 21 insured until that individual reaches the age of twenty=one 2 22 years old or until that individual ceases to be enrolled as a 2 23 full=time student, as defined in section 261.102, whichever 2 24 occurs later, and shall provide, at a minimum, enteral formula 2 25 coverage benefits to each female insured until that individual 2 26 reaches the age of forty=five years old. 2 27 Sec. 2. NEW SECTION. 514C.24 AUDIOLOGICAL SERVICES AND 2 28 HEARING AIDS FOR CHILDREN == COVERAGE. 2 29 1. Notwithstanding the uniformity of treatment 2 30 requirements of section 514C.6, a contract, policy, or plan 2 31 providing for third=party payment or prepayment of health or 2 32 medical expenses shall provide minimum coverage benefits for 2 33 audiological services and hearing aids for children, including 2 34 but not limited to the following classes of third=party 2 35 payment provider contracts, policies, or plans delivered, 3 1 issued for delivery, continued, or renewed in this state on or 3 2 after January 1, 2008: 3 3 a. Individual or group accident and sickness insurance 3 4 providing coverage on an expense=incurred basis. 3 5 b. An individual or group hospital or medical service 3 6 contract issued pursuant to chapter 509, 514, or 514A. 3 7 c. An individual or group health maintenance organization 3 8 contract regulated under chapter 514B. 3 9 d. An individual or group Medicare supplemental policy, 3 10 unless coverage pursuant to such policy is preempted by 3 11 federal law. 3 12 e. A plan established pursuant to chapter 509A for public 3 13 employees. 3 14 2. This section shall not apply to accident=only, 3 15 specified disease, short=term hospital or medical, hospital 3 16 confinement indemnity, credit, dental, vision, long=term care, 3 17 basic hospital and medical=surgical expense coverage as 3 18 defined by the commissioner, disability income insurance 3 19 coverage, coverage issued as a supplement to liability 3 20 insurance, workers' compensation or similar insurance, or 3 21 automobile medical payment insurance. 3 22 3. As used in this section, "minimum coverage for 3 23 audiological services and hearing aids for children" means 3 24 coverage that includes at a minimum both of the following: 3 25 a. Coverage for hearing aids that are prescribed, filled 3 26 and dispensed by a licensed audiologist for children up to 3 27 eighteen years of age. 3 28 b. Coverage for an ear mold and a hearing aid for each 3 29 hearing=impaired ear payable every twenty=four months for 3 30 children up to eighteen years of age and coverage for up to 3 31 four additional ear molds per year for children up to three 3 32 years of age. 3 33 4. The commissioner of insurance shall adopt rules 3 34 pursuant to chapter 17A as necessary to administer this 3 35 section. 4 1 Sec. 3. NEW SECTION. 514C.25 HUMAN PAPILLOMA VIRUS 4 2 VACCINATIONS == COVERAGE. 4 3 1. Notwithstanding the uniformity of treatment 4 4 requirements of section 514C.6, a contract, policy, or plan 4 5 providing for third=party payment or prepayment of health or 4 6 medical expenses that provides coverage benefits for any 4 7 vaccination or immunization shall provide coverage benefits 4 8 for vaccinations for the human papilloma virus, to each female 4 9 insured who is nine years of age or older until that 4 10 individual reaches twenty=six years of age, including but not 4 11 limited to the following classes of third=party payment 4 12 provider contracts, policies, or plans delivered, issued for 4 13 delivery, continued, or renewed in this state on or after 4 14 January 1, 2008: 4 15 a. Individual or group accident and sickness insurance 4 16 providing coverage on an expense=incurred basis. 4 17 b. An individual or group hospital or medical service 4 18 contract issued pursuant to chapter 509, 514, or 514A. 4 19 c. An individual or group health maintenance organization 4 20 contract regulated under chapter 514B. 4 21 d. An individual or group Medicare supplemental policy, 4 22 unless coverage pursuant to such policy is preempted by 4 23 federal law. 4 24 e. A plan established pursuant to chapter 509A for public 4 25 employees. 4 26 2. This section shall not apply to accident only, 4 27 specified disease, short=term hospital or medical, hospital 4 28 confinement indemnity, credit, dental, vision, long=term care, 4 29 basic hospital and medical=surgical expense coverage as 4 30 defined by the commissioner, disability income insurance 4 31 coverage, coverage issued as a supplement to liability 4 32 insurance, workers' compensation or similar insurance, or 4 33 automobile medical payment insurance. 4 34 3. As used in this section, "human papilloma virus" means 4 35 the human papilloma virus as defined by the centers for 5 1 disease control and prevention of the United States department 5 2 of health and human services. 5 3 4. The commissioner of insurance shall adopt rules 5 4 pursuant to chapter 17A as necessary to administer this 5 5 section. 5 6 EXPLANATION 5 7 This bill requires insurers offering certain individual or 5 8 group health insurance contracts, policies, or plans in the 5 9 state to provide coverage for certain enteral formulas, 5 10 audiological services and hearing aids for children, and 5 11 vaccinations for human papilloma virus. 5 12 The provisions of the bill are applicable to third=party 5 13 payment provider contracts, policies, or plans delivered, 5 14 issued for delivery, continued, or renewed in this state on or 5 15 after January 1, 2008. 5 16 The commissioner of insurance is required to adopt rules 5 17 under Code chapter 17A to administer the provisions of the 5 18 bill. 5 19 ENTERAL FORMULAS. New Code section 514C.23 requires 5 20 specified individual and group health insurance contracts, 5 21 policies, or plans that provide coverage for outpatient 5 22 prescription drugs or devices to also provide coverage for 5 23 certain enteral formulas that have been prescribed by a 5 24 licensed medical practitioner for the treatment of inborn 5 25 errors of metabolism with a dietary restriction which if left 5 26 untreated will cause malnourishment, chronic physical 5 27 disability, mental retardation, or death. 5 28 The bill prohibits imposition of an annual deductible on 5 29 enteral formula coverage benefits that exceeds $2,500 per year 5 30 for each family covered or an aggregate annual limit for such 5 31 benefits that is less than $12,500 per year for each family. 5 32 The bill requires that the benefits must be provided, at a 5 33 minimum, to each male insured until that individual reaches 21 5 34 years of age or ceases to be enrolled as a full=time student, 5 35 whichever occurs later, and to each female insured until that 6 1 individual reaches the age of 45. 6 2 AUDIOLOGICAL SERVICES AND HEARING AIDS FOR CHILDREN. New 6 3 Code section 514C.24 requires specified individual and group 6 4 health insurance contracts, policies, or plans that provide 6 5 coverage for third=party payment or prepayment of health or 6 6 medical expenses to provide minimum coverage for audiological 6 7 services and hearing aids for children. 6 8 The bill provides that "minimum coverage for audiological 6 9 services and hearing aids for children" must include, at a 6 10 minimum, coverage for hearing aids that are prescribed, 6 11 filled, and dispensed by a licensed audiologist for children 6 12 up to 18 years of age, coverage for an ear mold and a hearing 6 13 aid for each hearing=impaired ear payable every 24 months for 6 14 children up to 18 years of age, and coverage for up to four 6 15 additional ear molds per year for children up to three years 6 16 of age. 6 17 HUMAN PAPILLOMA VIRUS VACCINATIONS. New Code section 6 18 514C.25 requires specified individual and group health 6 19 insurance contracts, policies, or plans that provide coverage 6 20 of any vaccinations or immunizations to provide coverage of 6 21 vaccinations for the human papilloma virus to each female 6 22 insured who is nine years of age until that individual reaches 6 23 26 years of age. 6 24 The bill defines "human papilloma virus" to mean the human 6 25 papilloma virus as defined by the centers for disease control 6 26 and prevention of the United States department of health and 6 27 human services. 6 28 LSB 1631HV 82 6 29 av:rj/cf/24
Text: HF788            Text: HF790 Complete Bill History