SF 2409 (LSB 6182XS (3) 88)

SENATE FILE 2409

BY  QUIRMBACH

A BILL FOR

An Act relating to health insurance provided under an Iowa comprehensive health insurance association policy, and including applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 514E.1, Code 2020, is amended by adding the following new subsections:
   NEW SUBSECTION.  5A.  “Cost sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense obligation.
   NEW SUBSECTION.  9A.  “Health care professional” means the same as defined in section 514J.102.
    Sec. 2.  NEW SECTION.  514E.12  Health care services —— payments.
   A health care professional shall accept as payment in full from the association, for the provision of health care services to an insured, an amount equal to the amount that Medicare pays a health care professional for provision of the same health care services. An insured shall be responsible only for any cost sharing imposed on the insured by the insured’s association policy for the health care services.
    Sec. 3.  NEW SECTION.  514E.13  Application for coverage —— restrictions.
   Any provider of dialysis services shall be prohibited from directly or indirectly assisting an individual with enrollment in an association policy if the individual is eligible for any other health plan coverage.
    Sec. 4.  APPLICABILITY.  The section of this Act enacting section 514E.12 applies to health care services provided by a health care professional to an insured 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 health insurance provided under an Iowa comprehensive health insurance association policy. The bill requires a health care professional to accept as payment in full from the association, for the provision of health care services to an insured, an amount equal to the amount that Medicare pays a health care professional for provision of the same health care services. An insured is only responsible for any cost sharing imposed on the insured by the insured’s association policy. This applies to health care services provided by a health care professional to an insured on or after January 1, 2021.
   The bill prohibits any provider of dialysis services from directly or indirectly assisting an individual with enrollment in an association policy if the individual is eligible for any other health plan coverage.