House File 321 - Introduced HOUSE FILE BY HEDDENS, WESSEL=KROESCHELL, GAYMAN, SHOMSHOR, FREVERT, BUKTA, ABDUL-SAMAD, H. MILLER, JOCHUM, BELL, PETERSEN, T. TAYLOR, R. OLSON, SCHUELLER, BAILEY, WENTHE, LENSING, FORD, FOEGE, SMITH, KRESSIG, REASONER, and D. TAYLOR Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act requiring health insurance coverage for certain dependent 2 children who are full=time students and require a medically 3 necessary leave of absence from school. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 1437HH 82 6 av/cf/24 PAG LIN 1 1 Section 1. NEW SECTION. 514C.23 COVERAGE OF STUDENTS. 1 2 1. Notwithstanding the uniformity of treatment 1 3 requirements of section 514C.6, a policy or contract providing 1 4 for third=party payment or prepayment of health or medical 1 5 expenses, which provides coverage for dependent children of an 1 6 insured or subscriber beyond the age of eighteen years if the 1 7 child is a full=time student, shall include coverage during a 1 8 dependent's medically necessary leave of absence from school 1 9 for a period not to exceed twelve months or until the date on 1 10 which coverage would otherwise end pursuant to the terms and 1 11 conditions of the policy or contract, whichever comes first. 1 12 Any breaks in the school semester shall not disqualify a 1 13 dependent child from coverage under this section. Entitlement 1 14 to coverage under this section shall be established by 1 15 submitting documentation and certification of medical 1 16 necessity to the insurer from the student's attending 1 17 physician, which shall be considered prima facie evidence of 1 18 entitlement to coverage under this section. The date of the 1 19 documentation and certification of medical necessity of a 1 20 leave of absence shall be the date the entitlement to 1 21 insurance coverage required by this section commences. 1 22 2. a. This section applies to the following classes of 1 23 third=party payment provider contracts or policies delivered, 1 24 issued for delivery, continued, or renewed in this state on or 1 25 after July 1, 2007: 1 26 (1) Individual or group accident and sickness insurance 1 27 providing coverage on an expense=incurred basis. 1 28 (2) Any individual or group hospital or medical service 1 29 contract issued pursuant to chapter 509, 514, or 514A. 1 30 (3) Any individual or group health maintenance 1 31 organization contract regulated under chapter 514B. 1 32 (4) Any other entity engaged in the business of insurance, 1 33 risk transfer, or risk retention, which is subject to the 1 34 jurisdiction of the commissioner. 1 35 (5) A plan established pursuant to chapter 509A for public 2 1 employees. 2 2 (6) An organized delivery system licensed by the director 2 3 of public health. 2 4 b. This section shall not apply to accident=only, 2 5 specified disease, short=term hospital or medical, hospital 2 6 confinement indemnity, credit, dental, vision, Medicare 2 7 supplement, long=term care, basic hospital and medical= 2 8 surgical expense coverage as defined by the commissioner, 2 9 disability income insurance coverage, coverage issued as a 2 10 supplement to liability insurance, workers' compensation or 2 11 similar insurance, or automobile medical payment insurance, or 2 12 individual accident and sickness policies issued to 2 13 individuals or to individual members of a member association. 2 14 EXPLANATION 2 15 This bill requires health insurance coverage for certain 2 16 dependent children who are full=time students. 2 17 The bill provides that a policy or contract providing for 2 18 third=party payment or prepayment of health or medical 2 19 expenses, which provides coverage for dependent children of an 2 20 insured or subscriber beyond the age of 18 years if the child 2 21 is a full=time student, shall include coverage during a 2 22 dependent's medically necessary leave of absence from school 2 23 for a period not to exceed 12 months or until the date on 2 24 which coverage would otherwise end pursuant to the terms and 2 25 conditions of the policy, whichever comes first. The bill 2 26 provides that entitlement to the coverage must be established 2 27 by submitting documentation and certification of medical 2 28 necessity to the insurer from the student's treating 2 29 physician, which shall be considered prima facie evidence of 2 30 entitlement to coverage under the new provision. The date of 2 31 such documentation and certification is the date the 2 32 entitlement to such insurance coverage commences. 2 33 The coverage requirement applies to third=party payment 2 34 provider contracts or policies that are individual or group 2 35 accident and sickness insurance providing coverage on an 3 1 expense=incurred basis; individual or group hospital or 3 2 medical service contracts issued pursuant to Code chapter 509, 3 3 514, or 514A; individual or group health maintenance 3 4 organization contracts regulated under Code chapter 514B; 3 5 other entities engaged in the business of insurance, risk 3 6 transfer, or risk retention, which are subject to the 3 7 jurisdiction of the commissioner; plans established pursuant 3 8 to Code chapter 509A for public employees; and organized 3 9 delivery systems licensed by the director of public health. 3 10 The bill requirements are applicable to such contracts or 3 11 policies delivered, issued for delivery, continued, or renewed 3 12 in this state on or after July 1, 2007. 3 13 The bill requirements do not apply to accident=only, 3 14 specified disease, short=term hospital or medical, hospital 3 15 confinement indemnity, credit, dental, vision, Medicare 3 16 supplement, long=term care, basic hospital and medical= 3 17 surgical expense coverage as defined by the commissioner, 3 18 disability income insurance coverage, coverage issued as a 3 19 supplement to liability insurance, workers' compensation or 3 20 similar insurance, automobile medical payment insurance, or 3 21 individual accident and sickness policies issued to 3 22 individuals or to individual members of a member association. 3 23 LSB 1437HH 82 3 24 av:nh/cf/24