Text: SF00338 Text: SF00340 Text: SF00300 - SF00399 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 therapeutically certified optometrist licensed under chapter
1 7 154 not approved under the plan or contract if the cost of
1 8 such services would be paid if performed by a licensed health
1 9 care provider approved under the plan or contract.
1 10 Notwithstanding section 514C.6, each policy or contract of a
1 11 carrier shall include a provision providing for the payment or
1 12 prepayment of health or medical expenses provided by such
1 13 therapeutically certified optometrist not approved under the
1 14 plan or contract if such services would be paid if performed
1 15 by a licensed health care provider approved under the plan or
1 16 contract.
1 17 2. Any copayment required under the plan or contract for a
1 18 covered service provided by a therapeutically certified
1 19 optometrist not approved under the plan or contract shall
1 20 remain the same as if the covered service had been provided by
1 21 an approved licensed health care provider.
1 22 3. Payment for covered services under a plan or contract
1 23 provided by a therapeutically certified optometrist not
1 24 approved under the plan or contract shall be for no less than
1 25 eighty-five percent of the amount which would be paid for such
1 26 covered services if the services were provided by an approved
1 27 licensed health care provider.
1 28 4. A carrier shall provide to a prospective insured,
1 29 subscriber, or enrollee, written information concerning the
1 30 policy or contract provisions relating to the payment or
1 31 prepayment of covered services by a therapeutically certified
1 32 optometrist not approved under the plan or contract.
1 33 5. For purposes of this section, "carrier" means any
1 34 entity that provides individual or group health benefit plans
1 35 in this state. For purposes of this section, "carrier"
2 1 includes an insurance company, a group hospital or medical
2 2 service corporation, a fraternal benefit society, a health
2 3 maintenance organization, an organized delivery system
2 4 licensed by the director of public health, and any other
2 5 entity providing a plan of health insurance or health benefits
2 6 subject to state insurance regulation.
2 7 EXPLANATION
2 8 This bill provides that a carrier providing individual or
2 9 group health benefit plans in this state must provide a
2 10 provision for the payment or prepayment of health or medical
2 11 expenses provided by therapeutically certified optometrists
2 12 licensed under chapter 154 not approved under a plan or
2 13 contract if such services would be paid if performed by a
2 14 licensed health care provider approved under the plan or
2 15 contract. Payment for covered services under a plan or
2 16 contract provided by a therapeutically certified optometrist
2 17 not approved under the plan or contract must be for no less
2 18 than 85 percent of the amount which would be paid for such
2 19 covered services if the services were provided by an approved
2 20 licensed health care provider.
2 21 LSB 2594SV 76
2 22 mj/jj/8
Text: SF00338 Text: SF00340 Text: SF00300 - SF00399 Text: SF Index Bills and Amendments: General Index Bill History: General Index
Iowa General Assembly
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