SF 2064 (LSB 5752XS (2) 88)

SENATE FILE 2064

BY  PETERSEN, RAGAN, MATHIS, BOULTON, CELSI, J. SMITH, JOCHUM, WAHLS, KINNEY, DOTZLER, R. TAYLOR, BISIGNANO, LYKAM, GIDDENS, BOLKCOM, QUIRMBACH, HOGG, and T. TAYLOR

A BILL FOR

An Act relating to preexisting condition protections and including applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514M.1  Short title.
   This chapter shall be known and may be cited as “The Protect Coverage for Preexisting Conditions Act”.
    Sec. 2.  NEW SECTION.  514M.2  Definitions.
   As used in this chapter, unless the context otherwise requires:
   1.  “Commissioner” means the commissioner of insurance.
   2.  “Health benefit plan” means any policy, contract, certificate, or agreement, including a short-term, limited-duration policy, offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. 
   3.  “Health care services” means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. 
   4.  “Health carrier” means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, a plan established pursuant to chapter 509A for public employees, a plan offered or maintained by a multiple employer welfare association, or any other entity providing a plan of health insurance, health benefits, or health care services. Notwithstanding section 505.20, subsection 1, “health carrier” also includes a nonprofit agricultural organization domiciled in the state that sponsors a health benefit plan pursuant to section 505.20. 
   5.  “Preexisting condition exclusion” means a limitation or exclusion of benefits, or a denial of coverage, relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage or the date of denial of coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received for the condition before the date of enrollment or the date of denial of coverage.
    Sec. 3.  NEW SECTION.  514M.3  Preexisting conditions.
   Notwithstanding any other provision of law to the contrary, a health carrier that offers an individual health benefit plan or a group health benefit plan in this state shall not do either of the following: 
   1.  Deny coverage to any employer or to any individual that is eligible to apply for the individual health benefit plan or the group health benefit plan.
   2.  Impose any preexisting condition exclusion on an employer or on an individual with respect to the individual health benefit plan or the group health benefit plan.
    Sec. 4.  NEW SECTION.  514M.4  Premium rates.
   1.  a.  Notwithstanding any other provision of law to the contrary, a health carrier that offers an individual health benefit plan or a group health benefit plan in this state shall develop premium rates for the individual health benefit plan or the group health benefit plan based only on the following factors:
   (1)  Age, except that the rate shall not vary by more than three-to-one for like individuals of different ages who are age twenty-one and older.
   (2)  Whether the health benefit plan covers an individual or family.
   (3)  Tobacco use, except that the rate shall not vary by more than one and one-half times the rate charged to a non-tobacco user.
   (4)  Geographic rating area established in compliance with federal law.
   b.  Notwithstanding any other provision of law to the contrary, with respect to premium rates for family coverage under an individual health benefit plan or a group health benefit plan offered in this state, a health carrier shall apply the factors permitted pursuant to paragraph “a” based on the premium that is attributable to each family member covered under the health benefit plan in accordance with rules adopted by the commissioner.
   2.  Notwithstanding any other provision of law to the contrary, a health carrier that offers an individual health benefit plan or a group health benefit plan in this state shall adjust the premium rates established pursuant to subsection 1 no more frequently than annually and based only on the factors in subsection 1, paragraph “a”, except that the health carrier may adjust the premium rates in the following circumstances: 
   a.  With respect to a small group health plan, if there are changes in enrollment.
   b.  There is a change to the family composition of an individual enrolled in an individual health benefit plan or of an employee enrolled in a group health benefit plan.
   c.  There is a change in the geographic rating area or in tobacco use for an individual enrolled in an individual health benefit plan.
   d.  An individual enrolled in an individual health benefit plan requests changes to the health benefit plan or a small employer requests changes to a group health benefit plan.
   e.  A change in federal law or federal regulations requiring a premium rate adjustment.
    Sec. 5.  NEW SECTION.  514M.5  Rules.
   The commissioner shall adopt rules pursuant to chapter 17A as necessary to implement and administer this chapter.
    Sec. 6.  NEW SECTION.  514M.6  Enforcement.
   The commissioner shall take any action within the commissioner’s authority to enforce compliance with this chapter.
    Sec. 7.  APPLICABILITY.  This Act applies to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to preexisting condition protections and creates “The Protect Coverage for Preexisting Conditions Act”.
   The bill prohibits a health carrier that offers an individual health benefit plan (individual plan) or a group health benefit plan (group plan) in this state from denying coverage to any employer or to any individual that is eligible to apply for the individual plan or the group plan, or from imposing any preexisting condition exclusion on an employer or on an individual with respect to the individual plan or the group plan. “Health carrier” is defined in the bill as an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, a plan established pursuant to Code chapter 509A for public employees, a plan offered or maintained by a multiple employer welfare association, or any other entity providing a plan of health insurance, health benefits, or health care services. “Health carrier” also includes a nonprofit agricultural organization domiciled in the state that sponsors a health benefit plan pursuant to Code section 505.20. 
   The bill defines “preexisting condition exclusion” as a limitation or exclusion of benefits, or a denial of coverage, relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage or the date of denial of coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received for the condition before the date of enrollment or the date of denial of coverage. 
   A health carrier that offers an individual plan or a group plan must develop premium rates for the individual or group plan based on age, whether the health benefit plan covers an individual or family, tobacco use, and the geographic rating area established in compliance with federal law. With respect to premium rates for family coverage under an individual plan or a group plan, a health carrier must apply those same factors, in accordance with rules adopted by the commissioner, based on the premium attributable to each family member covered under the plan. Premium rates can be adjusted no more frequently than annually and based only on those same factors, except that the health carrier may adjust the premium rates in specified circumstances as detailed in the bill. 
   The bill directs the commissioner to adopt rules as necessary to implement and administer the provisions of the bill and to take any action within the commissioner’s authority to enforce compliance with the provisions of the bill.
   The bill applies to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021.