SF 72 (LSB 1060XS (6) 85)

SENATE FILE 72

BY  HATCH, McCOY, JOCHUM, QUIRMBACH, HORN, TAYLOR, BRASE, DOTZLER, DVORSKY, BOLKCOM, PETERSEN, SODDERS, MATHIS, HART, and BEALL

A BILL FOR

An Act providing for the establishment of the Iowa health benefit marketplace and including effective date provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

DIVISION I

IOWA HEALTH BENEFIT MARKETPLACE ACT
    Section 1.  NEW SECTION.  514M.1  Title.
   This chapter shall be known and may be cited as the “Iowa Health Benefit Marketplace Act”.
    Sec. 2.  NEW SECTION.  514M.2  Purpose and intent.
   The purpose of this chapter is to provide for the establishment of a health benefit marketplace in this state to facilitate the sale and purchase of qualified health benefit plans by qualified individuals in the individual market in this state and by qualified small employers in the small group market in this state. The intent of authorizing the establishment of a health benefit marketplace in this state is to reduce the number of uninsured individuals in this state, provide a transparent marketplace and consumer education, and assist individuals with access to relevant federal and state programs, premium assistance tax credits, and cost-sharing reductions.
    Sec. 3.  NEW SECTION.  514M.3  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Board” means the board of directors of the Iowa health benefit marketplace as provided in section 514M.5.
   2.  “Commissioner” means the commissioner of insurance.
   3.  “Executive director” means the executive director of the Iowa health benefit marketplace.
   4.  “Federal Act” means the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, and any amendments thereto, or regulations or guidance issued under, those Acts.
   5.
  a.  “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
   b.  “Health benefit plan” does not include any of the following:
   (1)  Coverage only for accident, or disability income insurance, or any combination thereof.
   (2)  Coverage issued as a supplement to liability insurance.
   (3)  Liability insurance, including general liability insurance and automobile liability insurance.
   (4)  Workers’ compensation or similar insurance.
   (5)  Automobile medical payment insurance.
   (6)  Credit-only insurance.
   (7)  Coverage for on-site medical clinics.
   (8)  Other similar insurance coverage, specified in federal regulations issued pursuant to Tit. XXVII of the federal Public Health Service Act, as enacted by the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, and amended by the federal Act, under which benefits for health care services are secondary or incidental to other insurance benefits.
   c.  “Health benefit plan” does not include any of the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan:
   (1)  Limited scope dental or vision benefits.
   (2)  Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.
   (3)  Other similar, limited benefits specified in federal regulations issued pursuant to the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.
   d.  “Health benefit plan” does not include any of the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health benefit plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health benefit plan maintained by the same plan sponsor:
   (1)  Coverage only for a specified disease or illness.
   (2)  Hospital indemnity or other fixed indemnity insurance.
   e.  “Health benefit plan” does not include any of the following if offered as a separate policy, certificate, or contract of insurance:
   (1)  Medicare supplemental health insurance as defined under section 1882(g)(1) of the federal Social Security Act.
   (2)  Coverage supplemental to the coverage provided under 10 U.S.C. ch. 55, by the civilian health and medical program of the uniformed services.
   (3)  Supplemental coverage similar to that provided under a group health benefit plan.
   6.  “Health carrier” means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit hospital or health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.
   7.  “Insurance producer” means a person required to be licensed under chapter 522B.
   8.  “Marketplace” means the Iowa health benefit marketplace established pursuant to section 514M.4.
   9.  “Navigator” means a person selected, licensed, and regulated by the marketplace in accordance with section 1311(i) of the federal Act, standards developed by the secretary, and chapter 522D.
   10.  “Qualified dental plan” means a limited scope dental plan that has been certified in accordance with section 514M.10.

   11.  “Qualified employer” means a small employer that elects to make its full-time employees eligible for one or more qualified health benefit plans offered through the small business health options program of the marketplace, and at the option of the employer, make some or all of its part-time employees so eligible, provided that the employer does either of the following:
   a.  Has its principal place of business in this state and elects to provide coverage through the marketplace to all of its eligible employees wherever employed.
   b.  Elects to provide coverage through the marketplace to all of its eligible employees who are principally employed in this state.
   12.  “Qualified health benefit plan” means a health benefit plan that has in effect a certification as described in section 1311(c) of the federal Act and section 514M.10.
   13.  “Qualified individual” means an individual, including a minor, who is all of the following:
   a.  Is seeking to enroll in a qualified health benefit plan offered to individuals through the marketplace.
   b.  Is a resident of this state.
   c.  At the time of enrollment, is not incarcerated, other than incarceration pending the disposition of charges.
   d.  Is, and is reasonably expected to be, for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States.
   14.  “Secretary” means the secretary of the United States department of health and human services.
   15.  “Secretary of the board” means the secretary of the board of directors of the Iowa health benefit marketplace.
   16.  “Small business health options program” means the small business health options program component of the marketplace established under section 514M.8.
   17.
  a.  “Small employer” means an employer that employed an average of at least one and not more than fifty employees during the preceding calendar year.
   b.  For the purposes of this subsection:
   (1)  All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as a single employer.
   (2)  An employer and any predecessor employer shall be treated as a single employer.
   (3)  All employees shall be counted, including part-time employees and employees who are not eligible for coverage through the employer.
   (4)  If an employer was not in existence throughout the preceding calendar year, the determination of whether that employer is a small employer shall be based on the average number of employees that the employer is reasonably expected to employ on business days in the current calendar year.
   (5)  An employer that makes enrollment in qualified health benefit plans available to its employees through the small business health options program component of the marketplace, and would cease to be a small employer by reason of an increase in the number of its employees, shall continue to be treated as a small employer for purposes of this chapter as long as the employer continuously makes enrollment through the small business health options program component of the marketplace available to its employees.
    Sec. 4.  NEW SECTION.  514M.4  Establishment of Iowa health benefit marketplace.
   1.  The Iowa health benefit marketplace is established as a nonprofit corporation. The marketplace shall be established for the purpose of facilitating the sale and purchase of qualified health benefit plans by qualified individuals in the individual market in this state and by qualified small employers in the small group market in this state.
   2.  The powers and duties of the marketplace are vested in and shall be exercised by a board of directors established under section 514M.5.
   3.  The marketplace shall operate under a plan of operation established and approved by the board of directors, in consultation with the commissioner. The plan shall effectuate the purposes of this chapter and assure the fair, reasonable, and equitable administration of the marketplace. The board shall do all of the following pursuant to the plan, including but not limited to:
   a.  Plan, direct, coordinate, and execute the administrative functions of the marketplace.
   b.  Employ professional and clerical staff as necessary.
   c.  Keep an accurate account of all activities, receipts, and expenditures of the marketplace and annually submit a report to the commissioner, governor, general assembly, and the auditor of state concerning such accountings pursuant to section 514M.14.
   4.  The marketplace shall be operated on a statewide basis.
   5.  The marketplace shall include separate marketplace components which facilitate the sale and purchase of qualified health benefit plans to eligible individuals and to small employers as described in this chapter and in the federal Act.
   6.  The marketplace may establish a reimbursement system for health benefit plans issued in this state that all health carriers and health care providers may join to facilitate fair and reasonable payments for the cost of health care services provided pursuant to a health benefit plan.
   7.  The marketplace shall do all of the following:
   a.  Facilitate the purchase and sale of qualified health benefit plans to qualified individuals and qualified employers as described in this chapter and in the federal Act.
   b.  Establish rate schedules for commissions paid to insurance producers by qualified health benefit plans offered through the marketplace.
   c.  Meet the requirements of this chapter and any rules adopted pursuant to this chapter.

   8.
  a.  A person who selects, purchases, or enrolls in a qualified health benefit plan offered through the marketplace shall be enrolled in the plan by an insurance producer or may enroll in the plan directly through the marketplace internet site. The commission paid to an insurance producer who enrolls a person in a plan offered through the marketplace shall be established by the marketplace.
   b.  On the anniversary date of coverage obtained through the marketplace, an enrollee may renew or enroll in coverage offered through the marketplace through any insurance producer of the enrollee’s choice or may enroll directly through the marketplace internet site. A commission shall be paid to an insurance producer who renews or enrolls a person in coverage under this paragraph in the same manner as is provided in paragraph “a”.
   9.  The marketplace may employ staff to carry out the functions of the marketplace, but no employee of the marketplace shall sell, solicit, or negotiate enrollment in a health benefit plan or otherwise offer services for which a license as an insurance producer is required pursuant to chapter 522B.
   10.  The marketplace may contract with an eligible entity to fulfill any of its specialized duties or responsibilities as described in this chapter. An eligible entity includes but is not limited to an entity that has experience in individual and small group health benefit plans, benefit administration, or other experience relevant to the responsibilities to be assumed by the entity. However, a health carrier or an affiliate of a health carrier is not an eligible entity for the purposes of this subsection.
   11.  The marketplace may enter into information-sharing agreements with federal and state agencies to carry out its responsibilities under this chapter provided such agreements include adequate protections with respect to the confidentiality of the information to be shared and comply with all state laws and rules and federal laws and regulations.
   12.  Each qualified health benefit plan offered through the marketplace shall be assigned a rating by the marketplace in accordance with criteria developed by the secretary under section 1311(c)(3) of the federal Act, and the marketplace shall determine the level of coverage of each qualified health benefit plan in accordance with regulations issued by the secretary under section 1302(d)(2)(A) of the federal Act and applicable state law.
   13.  If a qualified health benefit plan offered through the marketplace meets or exceeds the criteria for a qualified health benefit plan set forth by the secretary, the plan shall be reviewed and assigned a rating by the marketplace.
    Sec. 5.  NEW SECTION.  514M.5  Board of directors —— executive director —— secretary.
   1.  The board of directors of the Iowa health benefit marketplace shall effectuate the powers and duties of the marketplace as set forth in this chapter.
   2.  The board shall consist of seven voting members and five ex officio, nonvoting members. The voting members shall be appointed by the governor, subject to confirmation by the senate. The voting members of the board shall annually elect one voting member as chairperson and one voting member as vice chairperson.
   a.  The voting members shall be appointed by the governor as follows:
   (1)  Two persons who represent the interests of small business from nominations made to the governor by nationally recognized groups that represent the interests of small business.
   (2)  Three persons who represent the interests of consumers from nominations made to the governor by nationally recognized groups that represent the interests of consumers.
   (3)  One person who is an insurance producer licensed under chapter 522B.

   (4)  One person who is a health care provider.
   b.  The ex officio, nonvoting members of the board are as follows:
   (1)  Four members of the general assembly, one appointed by the speaker of the house of representatives, one appointed by the minority leader of the house of representatives, one appointed by the majority leader of the senate, and one appointed by the minority leader of the senate.
   (2)  A person who shall serve as the secretary of the board, appointed by the board.
   3.  The governor shall not appoint to the board any person who is either the spouse or a relative within the first degree of consanguinity of a serving member of the board.
   4.  Each member of the board appointed by the governor shall be a resident of this state and the composition of voting members of the board shall be in compliance with sections 69.16, 69.16A, and 69.16C.
   5.  The voting members of the board shall be appointed for staggered terms of three years on or before March 1, 2014, and by December 15 of each year thereafter. The initial terms of the voting members of the board shall be staggered at the discretion of the governor. A voting member of the board is eligible for reappointment. The governor shall fill a vacancy on the board in the same manner as the original appointment for the remainder of the term. A voting member of the board may be removed by the governor for misfeasance, malfeasance, willful neglect of duty, failure to actively participate in the affairs of the board, or other cause after notice and a public hearing unless the notice and hearing are waived by the member in writing.
   6.  A voting member of the board shall not be an employee of, a consultant to, a member of the board of directors of, affiliated with, have an ownership interest in, or otherwise be a representative of any health carrier, insurance producer agency, insurance consultant organization, trade association of insurers, or association offering health benefit plans to its members, while serving on the board.
   7.  Voting members of the board shall be reimbursed from the moneys of the marketplace for all actual and necessary expenses incurred in the performance of their duties as members, and shall receive per diem at the rate of fifty dollars per day for their services.
   8.  A majority of the voting members of the board constitutes a quorum. The affirmative vote of a majority of the voting members is necessary for any action taken by the board. The majority shall not include a member who has a conflict of interest and a statement by a member of a conflict of interest is conclusive for this purpose. A vacancy in the membership of the board does not impair the right of a quorum to exercise the rights and perform the duties of the board. An action taken by the board under this chapter may be authorized by resolution at a regular or special meeting and each resolution shall take effect immediately and need not be published or posted.
   9.  The voting members of the board shall give bond as required for public officers by chapter 64.
   10.  The voting members of the board are subject to and are officials within the meaning of chapter 68B.
   11.  The board shall meet at the call of the chairperson, or in the absence of the chairperson, at the call of the vice chairperson, or when any four voting members of the board file a written request with the chairperson for a meeting. Written notice of the time and place of each meeting shall be given to each member of the board.
   12.
  a.  The voting members of the board shall appoint an executive director, subject to confirmation by the senate, to supervise the administrative affairs and general management and operations of the marketplace.
   b.  The voting members of the board may appoint other officers as the members of the board determine. The officers shall not be members of the board, with the exception of the secretary of the board, and shall serve at the pleasure of the voting members of the board, and shall receive compensation as fixed by the board.
   c.  The board may employ other staff to carry out the functions of the marketplace, but no employee of the marketplace shall sell, solicit, or negotiate enrollment in a health benefit plan or otherwise offer services for which a license as an insurance producer is required pursuant to chapter 522B. All employees of the marketplace are exempt from chapter 8A, subchapter IV, and chapter 97B.
   13.
  a.  The voting members of the board shall appoint a secretary of the board who shall be an ex officio member of the board as provided in subsection 2, shall keep a record of the proceedings of the board, and shall be the custodian of all books, documents, and papers filed with the board, including information filed in an electronic format, and the minute book or journal of the board.
   b.  The secretary of the board shall serve at the pleasure of the board, and shall receive compensation as fixed by the board.
   14.  Members of the board, or persons acting on behalf of the marketplace, while acting in the scope of their agency or employment, are not subject to personal liability resulting from carrying out the powers and duties in this chapter.
    Sec. 6.  NEW SECTION.  514M.6  General powers.
   1.  The marketplace has any and all powers necessary and convenient to carry out its purposes and duties and exercise its specific powers, including but not limited to the power to:
   a.  Sue and be sued in its own name.
   b.  Have and alter a corporate seal.
   c.  Make and alter bylaws for its management consistent with the provisions of this chapter.
   d.  Make and execute agreements, contracts, and other instruments of any and all types on such terms and conditions as the marketplace may find necessary or convenient to the purpose of the marketplace, with any public or private entity, including but not limited to contracts for goods and services. All political subdivisions, other public agencies, and state departments and agencies may enter into contracts and otherwise cooperate with the marketplace.
   e.  Adopt procedures relating to competitive bidding, including the identification of those circumstances under which competitive bidding by the marketplace, either formally or informally, shall be required. In any bidding process, the marketplace may administer its own bidding and procurement or may utilize the services of the department of administrative services or any other agency. Except when such rules apply, the marketplace and all contracts made by it in carrying out its public and essential governmental functions with respect to any of its purposes shall be exempt from the provisions and requirements of all laws or rules of the state which require competitive bids in connection with the letting of such contracts.
   f.  Acquire, hold, improve, mortgage, lease, and dispose of real and personal property, including but not limited to the power to sell at public or private sale, with or without public bidding, any such property, or other obligation held by it.
   g.  Procure insurance against any loss in connection with its operations and property interests.
   h.  Accept appropriations, gifts, grants, loans, or other aid from public or private entities. A record of all gifts or grants, stating the type, amount, and donor, shall be clearly set out in the marketplace’s annual report along with the record of other receipts.
   i.  Provide to public and private entities technical assistance and counseling related to the marketplace’s purposes.
   j.  In cooperation with other local, state, or federal governmental agencies, conduct research studies, develop estimates of unmet health insurance needs, gather and compile data useful to facilitating decision making, and enter into agreements to carry out programs within or without the state which the marketplace finds to be consistent with the goals of the marketplace.
   k.  Enter into agreements with the federal government, tribes, and other states to facilitate the sale or purchase of qualified health benefit plans by qualified individuals and qualified small employers in this state.
   l.  Own or acquire intellectual property rights including but not limited to copyrights, trademarks, service marks, and patents, and enforce the rights of the marketplace with respect to such intellectual property rights.
   m.  Form committees or panels as necessary to facilitate the marketplace’s duties. Committees or panels formed pursuant to this paragraph shall be subject to the provisions of chapters 21 and 22.
   n.  Establish one or more funds within the state treasury under the control of the marketplace. Notwithstanding section 8.33 or 12C.7, or any other provision to the contrary, moneys invested by the treasurer of state pursuant to this paragraph shall not revert to the general fund of the state and interest accrued on the moneys shall be moneys of the marketplace and shall not be credited to the general fund of the state. The nonreversion of moneys allowed under this paragraph does not apply to moneys appropriated to the marketplace by the general assembly.
   o.  Exercise generally all powers typically exercised by private enterprises engaged in business pursuits unless the exercise of such a power would violate the terms of this chapter or the Constitution of the State of Iowa.
   2.  Notwithstanding any other provision of law, any purchase or lease of real property, other than on a temporary basis, when necessary in order to implement the purposes of the marketplace or protect the investments of the marketplace, shall require written notice from the marketplace to the government oversight committees of the general assembly or their successor committees and the prior approval of the executive council.
   3.  The powers enumerated in this section are cumulative of and in addition to those powers enumerated elsewhere in this chapter and such powers do not limit or restrict any other powers of the marketplace.
    Sec. 7.  NEW SECTION.  514M.7  Specific powers.
   1.  In addition to the general powers described in section 514M.6, the marketplace shall have all powers convenient and necessary to carry out the purpose and intent of this chapter.
   2.  The marketplace established pursuant to section 514M.4 shall make qualified health benefit plans that are effective on January 1, 2015, available to qualified individuals and qualified employers in this state.
   3.  At such time as applications for waivers from the requirements of the federal Act are accepted by the secretary, the marketplace may request such waivers from the secretary.
   4.  The marketplace shall allow a health carrier to offer a plan that provides limited scope dental benefits meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986 through the marketplace, either separately or in conjunction with a qualified health benefit plan, if the plan provides pediatric dental benefits meeting the requirements of section 1302(b)(1)(J) of the federal Act.
   5.  The marketplace or a health carrier offering qualified health benefit plans through the marketplace shall not charge an individual a fee or penalty for termination of coverage if the individual enrolls in another type of minimum essential coverage because the individual has become newly eligible for that coverage or because the individual’s employer-sponsored coverage has become affordable using the standards of the federal Act, as codified at section 36B(c)(2)(C) of the Internal Revenue Code of 1986.
    Sec. 8.  NEW SECTION.  514M.8  Duties of the marketplace.
   The marketplace shall do all of the following:
   1.  Implement procedures for the certification, recertification, and decertification of health benefit plans as qualified health benefit plans, consistent with guidelines developed by the secretary under section 1311(c) of the federal Act and applicable state law.
   2.  Provide for the operation of a toll-free telephone hotline to respond to requests for assistance.
   3.  Provide for enrollment periods, as determined by the secretary under section 1311(c)(6) of the federal Act and applicable state law.
   4.  Utilize a standardized format for presenting health benefit plan options in the marketplace, including the use of the uniform outline of coverage established under section 2715 of the Public Health Service Act and applicable state law.
   5.  In accordance with section 1413 of the federal Act and applicable state law, inform individuals of eligibility requirements for the Medicaid program under Tit. XIX of the federal Social Security Act, the children’s health insurance program under Tit. XXI of the federal Social Security Act, or any applicable state or local public program and, if through screening of an application by the marketplace, the marketplace determines that any individual is eligible for any such program, enroll that individual in that program.
   6.  Establish and make available by electronic means a calculator to determine the actual cost of coverage after application of any premium tax credit for which an individual is eligible using the standards of the federal Act as codified at section 36B(c)(2)(C) of the Internal Revenue Code of 1986 and any cost-sharing reductions under section 1402 of the federal Act.
   7.  Establish a small business health options program component of the marketplace through which individuals employed by a qualified employer may enroll in any qualified health benefit plan offered through the small business health options program at the level of coverage specified by the employer. In establishing a small business health options program marketplace component, the marketplace shall do all of the following:
   a.  Provide consolidated billing and premium payment by qualified employers including detailed information to those employers about health benefit plans chosen by their employees and the cost of those plans.
   b.  Establish an electronic interface and facilitate the flow of funds between health carriers, employers, and employees, including subsidiaries.
   c.  Provide for the dissemination of health benefit plan enrollment information to employers.
   8.  Establish an individual health options marketplace component through which individuals may enroll in any qualified health benefit plan for individuals.
   9.  Select entities qualified and licensed to serve as navigators in accordance with section 1311(i) of the federal Act, standards developed by the secretary, section 514M.9, and chapter 522D, and award grants to facilitate the function of navigators as provided in section 514M.9.
   10.  Encourage and review the development of cafeteria plans pursuant to section 125 of the Internal Revenue Code of 1986, for use by employers participating in the marketplace.
   11.  Maintain an internet site through which enrollees, employers, and prospective enrollees of qualified health benefit plans, at a minimum, may obtain standardized comparative information on qualified health benefit plans and health benefit plans that are not offered through the marketplace. In developing the electronic clearinghouse, the marketplace may require health carriers participating in the marketplace to make available and regularly update an electronic directory of contracting health care providers so individuals seeking coverage through the marketplace can search by health care provider name to determine which qualified health benefit plans in the marketplace include that health care provider in their network, and whether that health care provider is accepting new patients for that particular health benefit plan.
   12.  Consult with stakeholders who are relevant to carrying out the activities required under this chapter.
   13.  Assist in the implementation of reinsurance and risk adjustment mechanisms, as required by state and federal law.
   14.  Establish guidelines for determining qualifications for marketplace employees and entities or persons who are licensed and selected as navigators.
   15.  Subject to section 1411 of the federal Act and applicable state law, grant a certification attesting that, for purposes of the individual responsibility penalty under the standards of the federal Act, as codified at section 5000A of the Internal Revenue Code of 1986, an individual is exempt from the individual responsibility requirement or from the penalty imposed by that section because of any of the following:
   a.  There is no affordable qualified health benefit plan available through the marketplace, or the individual’s employer, covering the individual.
   b.  The individual meets the requirements for any other such exemption from the individual responsibility requirement or penalty.
   16.  Transfer to the United States secretary of the treasury all of the following:
   a.  A list of the individuals who are issued a certification under subsection 15, paragraph “a”, including the name and taxpayer identification number of each individual.
   b.  The name and taxpayer identification number of each individual who was an employee of an employer but who was determined to be eligible for the premium tax credit using the standards of the federal Act as codified at section 36B(c)(2)(C) of the Internal Revenue Code of 1986, because of either of the following:

   (1)  The employer did not provide minimum essential health benefits coverage.
   (2)  The employer provided minimum essential health benefits coverage, but it was determined using the standards of the federal Act, as codified at section 36B(c)(2)(C) of the Internal Revenue Code of 1986, to either be unaffordable to the employee or not to provide the required minimum actuarial value.
   c.  The name and taxpayer identification number of all of the following:
   (1)  Each individual who notifies the marketplace under section 1411(b)(4) of the federal Act that the individual has changed employers.
   (2)  Each individual who ceases coverage under a qualified health benefit plan during a plan year and the effective date of that cessation.
   17.  Provide to each employer the name of each employee of the employer described in subsection 16, paragraph “b”, who ceases coverage under a qualified health benefit plan during a plan year and the effective date of the cessation.
   18.  Perform duties required of, or delegated to, the marketplace by the secretary, the United States secretary of the treasury, or the commissioner related to determining eligibility for premium tax credits, reduced cost-sharing, or individual responsibility requirement exemptions.
   19.  In consultation with the commissioner, review the rate of premium growth of health benefit plans within the marketplace and outside the marketplace, and consider the information obtained in developing recommendations on whether to continue limiting qualified employer status to small employers.
    Sec. 9.  NEW SECTION.  514M.9  Navigators.
   1.  The marketplace may select entities qualified and licensed to serve as navigators in accordance with section 1311(i) of the federal Act, standards developed by the secretary, and applicable state law including chapter 522D, and award grants to enable navigators to do all of the following:
   a.  Conduct public education activities to raise awareness of the availability of qualified health benefit plans through the marketplace.
   b.  Distribute fair and impartial information concerning enrollment in qualified health benefit plans, and the availability of premium tax credits for which an individual may be eligible using the standards of the federal Act, as codified at section 36B(c)(2)(C) of the Internal Revenue Code of 1986, and any cost-sharing reductions under section 1402 of the federal Act.
   c.  Facilitate enrollment in qualified health benefit plans offered through the marketplace or in health benefit plans offered outside the marketplace by referring consumers to insurance producers and to the marketplace internet site for enrollment.
   d.  Provide referrals to the office of health insurance consumer assistance established under the federal Act pursuant to section 2793 of the federal Public Health Service Act and the office of the commissioner or any other appropriate state agency, for any enrollee with a grievance, complaint, or question regarding the enrollee’s health benefit plan or coverage, or a determination under that plan or coverage.
   e.  Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the marketplace.
   2.  An entity selected and licensed as a navigator shall not engage in any activities that require licensure as an insurance producer under chapter 522B unless the entity is also licensed as an insurance producer.
    Sec. 10.  NEW SECTION.  514M.10  Health benefit plan certification.
   1.  The marketplace may certify a health benefit plan as a qualified health benefit plan if the plan meets all of the following criteria:
   a.  The plan provides the essential health benefit package described in section 1302(a) of the federal Act, except that the plan is not required to provide essential benefits that duplicate the minimum benefits of qualified dental plans as provided in subsection 6 if all of the following occur:
   (1)  The marketplace determines that at least one qualified dental plan is available to supplement the plan’s coverage.
   (2)  The health carrier makes a prominent disclosure at the time it offers the plan, in a form approved by the marketplace, that the plan does not provide the full range of essential pediatric benefits and that qualified dental plans providing those benefits and other dental benefits not covered by the plan are offered through the marketplace.
   b.  The premium rates and contract language have been approved by the commissioner.
   c.  The plan provides at least a bronze level of coverage, as that level is defined by the federal Act, unless the plan is certified as a qualified catastrophic plan, meets the requirements of the federal Act for catastrophic plans, and will only be offered to individuals eligible for catastrophic coverage.
   d.  The plan’s cost-sharing requirements do not exceed the limits established under section 1302(c)(1) of the federal Act, and if the plan is offered through the small business health options program component of the marketplace that offers plans to small employers, the plan’s deductible does not exceed the limits established under section 1302(c)(2) of the federal Act.
   e.  The plan offers wellness programs.
   f.  The health carrier offering the plan provides greater transparency and disclosure of information about the plan benefits, provider networks, claim payment practices, and solvency ratings, and establishes a process for consumers to compare features of health benefit plans offered through the marketplace.

   g.  The health carrier offering the plan meets all of the following criteria:
   (1)  Is licensed and in good standing to offer health insurance coverage in this state.
   (2)  Offers at least one qualified health benefit plan in the silver level and at least one qualified health benefit plan in the gold level, as those levels are defined in the federal Act, through each component of the marketplace in which the health carrier participates, where component refers to the components of the marketplace which offer individual coverage and coverage for small employers.
   (3)  Charges the same premium rate for each qualified health benefit plan without regard to whether the plan is offered through the marketplace.
   (4)  Does not charge any termination of coverage fees or penalties in violation of section 514M.7.
   (5)  Complies with the regulations developed by the secretary under section 1311(d) of the federal Act, applicable state laws, and such other requirements as the marketplace may establish.
   h.  The plan meets the requirements of certification as adopted by rule pursuant to this section and by the secretary under section 1311(c) of the federal Act, which include but are not limited to minimum standards in the areas of marketing practices, network adequacy, essential community providers in underserved areas, accreditation, quality improvement, uniform enrollment forms and descriptions of coverage, and information on quality measures for plan performance.
   i.  The marketplace determines that making the plan available through the marketplace is in the interest of qualified individuals and qualified employers in this state.
   2.  The marketplace shall not exclude a health benefit plan from certification for any of the following reasons:
   a.  On the basis that the plan is a fee-for-service plan.
   b.  Through the imposition of premium price controls.

   c.  On the basis that the plan provides treatments necessary to prevent patients’ deaths in circumstances the marketplace determines are inappropriate or too costly.
   3.  The marketplace shall require each health carrier seeking certification of a health benefit plan as a qualified health benefit plan to do all of the following:
   a.  Provide notice of any proposed premium increase and a justification for the increase to the marketplace and to affected policyholders before implementation of that increase. The health carrier shall prominently post the information on its internet site. The marketplace shall take this information, along with the information and the recommendations provided to the marketplace by the commissioner under the federal Act pursuant to section 2794(b) of the federal Public Health Service Act and applicable state law, into consideration when determining whether to allow the health carrier to make plans available through the marketplace.
   b.  Make available to the public, in the format described in paragraph “c”, and submit to the marketplace, the secretary, and the commissioner, accurate and timely disclosure of all of the following:
   (1)  Claims payment policies and practices.
   (2)  Periodic financial disclosures.
   (3)  Data on enrollment.
   (4)  Data on disenrollment.
   (5)  Data on the number of claims that are denied.
   (6)  Data on rating practices.
   (7)  Information on cost-sharing and payments with respect to any out-of-network coverage.
   (8)  Information on enrollee and participant rights under Tit. I of the federal Act and applicable state law.
   (9)  Other information as determined appropriate by the secretary, the marketplace, or the commissioner.
   c.  The information required in paragraph “b” shall be provided in plain language, as that term is defined in section 1311(e) of the federal Act, as amended by section 10104 of the federal Act, and applicable state law.
   4.  The marketplace shall permit individuals to learn, in a timely manner upon the request of an individual, the amount of cost-sharing, including deductibles, copayments, and coinsurance, under the individual’s health benefit plan or coverage for which the individual would be responsible for paying with respect to the furnishing of a specific item or service by a participating health care provider. At a minimum, this information shall be made available to the individual through an internet site and through other means for individuals without access to the internet.
   5.  The marketplace shall not exempt any health carrier seeking certification of a health benefit plan, regardless of the type or size of the health carrier, from applicable state licensure or solvency requirements and shall apply the criteria of this section in a manner that assures a level playing field between or among health carriers participating in the marketplace.
   6.
  a.  The provisions of this chapter that are applicable to qualified health benefit plans shall also apply to the extent relevant to qualified dental plans except as modified in accordance with the provisions of paragraphs “b”, “c”, and “d”, or by rules adopted by the marketplace.
   b.  A health carrier to offer dental coverage shall be licensed, but is not required to be licensed to offer other health benefits.
   c.  A qualified dental plan shall be limited to dental and oral health benefits, without substantially duplicating the benefits typically offered by health benefit plans without dental coverage and shall include, at a minimum, the essential pediatric dental benefits prescribed by the secretary pursuant to section 1302(b)(1)(J) of the federal Act, and such other dental benefits as the marketplace or the secretary may specify by rule or regulation.

   d.  A comprehensive plan may be offered through the marketplace in which dental benefits are included either as part of a qualified health benefit plan, or by a qualified dental plan offered in conjunction with a qualified health benefit plan, provided that the medical and dental benefits offered by the comprehensive plan are priced separately and are offered for purchase separately at the same price.
    Sec. 11.  NEW SECTION.  514M.11  Funding —— publication of costs.
   1.  The marketplace may charge assessments or user fees to health carriers that offer health benefit plans through the marketplace or may otherwise generate the funding necessary to support the operation of the marketplace, as provided pursuant to the plan of operation of the marketplace.
   2.  The marketplace shall publish the average costs of licensing, regulatory fees, and any other payments required by the marketplace, and the administrative costs of the marketplace, on an internet site for the purpose of educating consumers about the costs of operating the marketplace. The information provided shall include information on moneys lost due to waste, fraud, and abuse of the health care system.
   3.  State funding shall not be appropriated or allocated for the operation or administration of the marketplace. Any assessments or user fees charged pursuant to this section shall provide for the sharing of losses and expenses of the marketplace on an equitable and proportionate basis among health carriers in this state as provided in the plan of operation of the marketplace.
    Sec. 12.  NEW SECTION.  514M.12  Rules.
   In consultation with and subject to the approval of the board, the commissioner shall adopt rules pursuant to chapter 17A to effectuate and administer the provisions of this chapter. Rules adopted under this section shall not conflict with or prevent the application of regulations promulgated by the secretary under the federal Act.
    Sec. 13.  NEW SECTION.  514M.13  Advisory council.
   1.  The board shall establish an advisory council consisting of various stakeholders including representatives from the insurance industry, insurance producer organizations, consumer advocacy groups, labor unions, employers, health care providers, farmers, and other interested parties. The advisory council shall meet when requested by the board.
   2.  The advisory council shall offer input to the board regarding rules proposed by the commissioner, the plan of operation for the marketplace, and any other topics relevant to the marketplace.
   3.  The board may alter the composition of the advisory council at any time to reflect changes in the interests of the various stakeholders.
    Sec. 14.  NEW SECTION.  514M.14  Annual report.
   1.  The marketplace shall submit an annual report to the commissioner, governor, general assembly, and the auditor of state by January 15. The report shall include an accurate accounting of all the activities of the marketplace and of all its receipts and expenditures during the prior fiscal year.
   2.  The report shall describe how the operations and activities of the marketplace serve the interests of the state and further the purposes set forth in this chapter.
    Sec. 15.  NEW SECTION.  514M.15  Relation to other laws.
   This chapter, and action taken by the marketplace pursuant to this chapter, shall not be construed to preempt or supersede the authority of the commissioner to regulate the business of insurance in this state. Except as expressly provided to the contrary in this chapter, all health carriers offering qualified health benefit plans in this state shall comply fully with all applicable health insurance laws of this state and rules adopted and orders issued by the commissioner.
    Sec. 16.  NEW SECTION.  514M.16  Transition provisions.
   1.
  a.  Beginning on or before March 1, 2014, upon their appointment, the board of directors of the marketplace shall meet, and in consultation with the commissioner, shall begin plans to implement the transition of the functions and administration of the federally facilitated exchanges or state partnership exchanges in operation in the state as of January 1, 2014, pursuant to the federal Act, to the marketplace established pursuant to this chapter, in accordance with the federal Act and standards developed by the secretary, and applicable state law.
   b.  The marketplace established pursuant to this chapter shall be operational and shall offer enrollment in qualified health benefit plans to qualified individuals and qualified employers in this state on or before October 1, 2014. The qualified health benefit plans that are offered through the marketplace shall be effective on January 1, 2015.
   2.  The commissioner shall transfer the functions and administration of the Iowa insurance information exchange established in section 505.32 to the marketplace established pursuant to this chapter on or before January 1, 2015.

DIVISION II

CORRESPONDING PROVISION
    Sec. 17.  Section 505.32, Code 2013, is amended by adding the following new subsection:
   NEW SUBSECTION.  6.  This section is repealed on July 1, 2015.

DIVISION III

EFFECTIVE DATE
    Sec. 18.  EFFECTIVE DATE.  This Act takes effect January 1, 2014.
EXPLANATION
   This bill provides for the establishment of the Iowa health benefit marketplace.
   The bill creates new Code chapter 514M, which provides for the establishment of a health benefit marketplace to facilitate the sale and purchase of qualified health benefit plans in this state by qualified individuals in the individual market and by qualified small employers in the small group market. The intent of establishing such a marketplace is to reduce the number of uninsured individuals in this state, provide a transparent marketplace and consumer education, and assist individuals with access to relevant federal and state programs, premium assistance tax credits, and cost-sharing reductions.
   For purposes of the bill, a qualified employer that can participate in the small business health options program component of the marketplace is an employer that employs an average of at least one and not more than 50 employees during the preceding calendar year and elects to make its full-time employees, and at the employer’s option, some or all of its part-time employees, eligible for one or more qualified health benefit plans offered through the small business health options program component of the marketplace. A qualified employer must either have its principal place of business in this state and elect to provide health coverage through the marketplace to all of its eligible employees wherever employed, or elect to provide coverage through the marketplace to all of its eligible employees who are principally employed in this state.
   The Iowa health benefit marketplace is established as a nonprofit corporation. The marketplace shall be operated on a statewide basis pursuant to a plan of operation established and approved by its board of directors in consultation with the commissioner of insurance. The marketplace shall include separate components which facilitate the purchase of qualified health benefit plans by eligible individuals and small employers as described in new Code chapter 514M and the federal Patient Protection and Affordable Care Act, as amended. The marketplace may employ staff to carry out its duties but no employees of the marketplace may offer services for which a license as an insurance producer is required pursuant to Code chapter 522B. The marketplace is also authorized to contract with an eligible entity to fulfill any of its duties or responsibilities as described in new Code chapter 514M.
   The board of directors of the marketplace is comprised of seven voting members appointed by the governor for three-year staggered terms with two representing the interests of small business; three representing the interests of consumers; one who is a licensed insurance producer; and one who is a health care provider. The voting members must be appointed on or before March 1, 2014. There are also five ex officio, nonvoting members of the board including four members of the general assembly with one each appointed by the speaker and the minority leader of the house of representatives, and by the majority and minority leaders of the senate, and including the secretary of the board.
   The voting members of the board are required to appoint an executive director, subject to confirmation by the senate, to supervise the administrative affairs and general management and operations of the marketplace. The board may appoint other officers as the board deems necessary. The board is also required to appoint a secretary of the board who keeps a record of the board proceedings, is the custodian of all books, documents, and papers filed with the board, including information filed in an electronic format, and of the minute book or journal of the board.
   The marketplace has all the general powers of a nonprofit corporation that are necessary and convenient to carry out its purposes and duties and to exercise its specific powers as provided in new Code chapter 514M.
   The marketplace is required to make qualified health benefit plans that are effective on or before January 1, 2015, available to qualified individuals and qualified employers in the state. The specific duties and powers of the marketplace are set forth in new Code chapter 514M.
   The marketplace is authorized to select entities licensed and qualified to act as navigators in accordance with the requirements of state and federal law for the purpose of conducting public education activities, distributing fair and impartial information concerning enrollment in qualified health benefit plans, facilitating such enrollment, providing referrals to the appropriate federal or state entity for grievances, complaints, or questions regarding an enrollee’s health benefit plan, and providing culturally and linguistically appropriate information to persons served by the marketplace. An entity licensed as a navigator under Code chapter 522D shall not engage in any activities that require licensure as an insurance producer unless the entity is also licensed as an insurance producer under Code chapter 522B. The marketplace is authorized to certify a health benefit plan as a qualified health benefit plan if the plan meets specified criteria.
   The marketplace may charge assessments or user fees to health carriers that offer health benefit plans through the marketplace or otherwise generate the funding necessary to support the operation of the marketplace as provided in the marketplace’s plan of operation. The marketplace is required to publish the average costs of licensing, regulatory fees, and any other payments required by the marketplace, as well as the administrative costs of the marketplace on an internet site for the purpose of educating consumers about the costs of operating the marketplace. No state funding can be appropriated or allocated for the operation or administration of the marketplace. Any assessments or user fees charged must provide for sharing the losses and expenses of the marketplace on an equitable and proportionate basis among health carriers in the state.
   In consultation with and subject to the approval of the board, the commissioner of insurance is required to adopt rules pursuant to Code chapter 17A to effectuate and administer the provisions of new Code chapter 514M. The board is required to establish an advisory council consisting of various stakeholders including representatives from the insurance industry, insurance producer organizations, consumer advocacy groups, labor unions, employers, health care providers, farmers, and other interested parties. The council shall offer input to the board regarding rules proposed by the commissioner, the plan of operation for the marketplace, and any other relevant topics.
   The marketplace is required to submit an annual report to the commissioner, governor, general assembly, and the auditor of state by January 15, which includes an accurate accounting of all the activities of the marketplace and of all its receipts and expenditures during the prior fiscal year. The report shall also describe how the operations and activities of the marketplace serve the interests of the state and further the purposes of new Code chapter 514M.
   The enactment of the Code chapter and actions taken by the marketplace are not to be construed as preempting or superseding the authority of the commissioner to regulate insurance in this state.
   The new Code chapter contains transition provisions that require the new marketplace board to be appointed and meet on or before March 1, 2014, and in consultation with the commissioner of insurance, begin plans to implement the transition of the functions and administration of the federally facilitated exchanges or state partnership exchanges in operation in the state as of January 1, 2014, pursuant to the federal Act, to the marketplace established pursuant to new Code chapter 514M.
   The marketplace must be operational and offer enrollment in qualified health benefit plans to qualified individuals and qualified employers in this state on or before October 1, 2014. The qualified health benefit plans that are offered through the marketplace must be effective on January 1, 2015.
   The commissioner of insurance is also directed to transfer the functions and administration of the Iowa insurance information exchange established in Code section 505.32 to the marketplace on or before January 1, 2015, and Code section 505.32 is repealed on that date.
   The bill is effective January 1, 2014.