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
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