Text: HF00203 Text: HF00205 Text: HF00200 - HF00299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 514C.8 DIAGNOSTIC OR SURGICAL 1 2 PROCEDURE INVOLVING BONE OR JOINT OF SKELETAL STRUCTURE. 1 3 1. Notwithstanding the uniformity of treatment 1 4 requirements of section 514C.6, a policy or contract providing 1 5 for third-party payment or prepayment of health or medical 1 6 expenses for any diagnostic or surgical procedure involving a 1 7 bone or joint of the skeletal structure shall not exclude or 1 8 deny coverage for the same diagnostic or surgical procedure, 1 9 excluding intraoral prosthetic devices, involving any other 1 10 bone or joint of the face, neck, or head, if under the 1 11 accepted standards of the profession of the provider rendering 1 12 the service, the procedure is medically necessary to treat a 1 13 condition caused by congenital deformity, disease, or injury. 1 14 2. This section applies to the following classes of third- 1 15 party payment provider contracts or policies delivered, issued 1 16 for delivery, continued, or renewed in this state on or after 1 17 July 1, 1995: 1 18 a. Individual or group accident and sickness insurance 1 19 providing coverage on an expense-incurred basis. 1 20 b. An individual or group hospital or medical service 1 21 contract issued pursuant to chapter 509, 514, or 514A. 1 22 c. An individual or group health maintenance organization 1 23 contract regulated under chapter 514B. 1 24 d. An individual or group Medicare supplemental policy, 1 25 unless coverage pursuant to such policy is preempted by 1 26 federal law. 1 27 3. This section shall not be construed to affect any other 1 28 coverage required under such policies or contracts, or to 1 29 restrict the scope of coverage under any such policies or 1 30 contracts. This section shall not be construed to encourage 1 31 surgical procedures over appropriate nonsurgical procedures, 1 32 or to prohibit the continued coverage of nonsurgical 1 33 procedures in the treatment of a bone or joint of the face, 1 34 neck, or head. 1 35 EXPLANATION 2 1 This bill provides that a policy or contract providing for 2 2 third-party payment or prepayment of health or medical 2 3 expenses for any diagnostic or surgical procedure involving a 2 4 bone or joint of the skeletal structure shall not exclude or 2 5 deny coverage for the same diagnostic or surgical procedure, 2 6 excluding intraoral prosthetic devices, involving any other 2 7 bone or joint of the face, neck, or head, if under the 2 8 accepted standards of the profession of the provider rendering 2 9 the service, the procedure is medically necessary to treat a 2 10 condition caused by congenital deformity, disease, or injury. 2 11 LSB 1755HH 76 2 12 mj/cf/24
Text: HF00203 Text: HF00205 Text: HF00200 - HF00299 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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