Text: SF00189 Text: SF00191 Text: SF00100 - SF00199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514F.4 REIMBURSEMENT FOR HEALTH
1 2 CARE SERVICES.
1 3 1. Nothing contained in Title XIII, subtitle 1, shall be
1 4 construed to authorize a carrier to deny a claim and refuse to
1 5 pay benefits under a plan or contract for services provided by
1 6 a licensed health care provider not approved under the plan or
1 7 contract if the cost of such services would be paid if
1 8 performed by a licensed health care provider approved under
1 9 the plan or contract. Notwithstanding section 514C.6, each
1 10 policy or contract of a carrier shall include a provision
1 11 providing for the payment or prepayment of health or medical
1 12 expenses provided by health care providers not approved under
1 13 the plan or contract if such services would be paid if
1 14 performed by a licensed health care provider approved under
1 15 the plan or contract.
1 16 2. Any copayment required under the plan or contract for a
1 17 covered service provided by a licensed health care provider
1 18 not approved under the plan or contract shall remain the same
1 19 as if the covered service had been provided by an approved
1 20 licensed health care provider.
1 21 3. Payment for covered services under a plan or contract
1 22 provided by a licensed health care provider not approved under
1 23 the plan or contract shall be for no less than eighty-five
1 24 percent of the amount which would be paid for such covered
1 25 services if the services were provided by an approved licensed
1 26 health care provider.
1 27 4. A carrier shall provide to a prospective insured,
1 28 subscriber, or enrollee, written information concerning the
1 29 policy or contract provisions relating to the payment or
1 30 prepayment of covered services by a licensed health care
1 31 provider not approved under the plan or contract.
1 32 5. For purposes of this section, "carrier" means any
1 33 entity that provides individual or group health benefit plans
1 34 in this state. For purposes of this section, "carrier"
1 35 includes an insurance company, a group hospital or medical
2 1 service corporation, a fraternal benefit society, a health
2 2 maintenance organization, an organized delivery system
2 3 licensed by the director of public health, and any other
2 4 entity providing a plan of health insurance or health benefits
2 5 subject to state insurance regulation.
2 6 EXPLANATION
2 7 This bill provides that a carrier providing individual or
2 8 group health benefit plans in this state must provide a
2 9 provision for the payment or prepayment of health or medical
2 10 expenses provided by licensed health care providers not
2 11 approved under a plan or contract if such services would be
2 12 paid if performed by a licensed health care provider approved
2 13 under the plan or contract. Payment for covered services
2 14 under a plan or contract provided by a licensed health care
2 15 provider not approved under the plan or contract must be for
2 16 no less than 85 percent of the amount which would be paid for
2 17 such covered services if the services were provided by an
2 18 approved licensed health care provider.
2 19 LSB 1943SS 76
2 20 mj/jj/8
Text: SF00189 Text: SF00191 Text: SF00100 - SF00199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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