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
Iowa General Assembly
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