Text: HF00376 Text: HF00378 Text: HF00300 - HF00399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514F.4 PROHIBITED CONDUCT.
1 2 1. An insurer shall not prohibit, or attempt to prohibit,
1 3 a provider furnishing covered health care services from
1 4 discussing treatment options with an insured, notwithstanding
1 5 the insurer's position or policy regarding such treatment
1 6 options.
1 7 2. An insurer shall not prohibit, or attempt to prohibit,
1 8 such a provider from advocating on behalf of an insured during
1 9 any utilization review or grievance process established by the
1 10 insurer or with a person under contract with the insurer.
1 11 3. An insurer shall not penalize, in any manner, such a
1 12 provider who in good faith reports to state or federal
1 13 authorities any act or practice by the insurer which is in
1 14 violation of this section or which jeopardizes an insured's
1 15 health or welfare.
1 16 4. For purposes of this section unless the context
1 17 otherwise requires, an insurer means:
1 18 a. An accident and sickness insurer, subject to chapter
1 19 509 or 514A.
1 20 b. A nonprofit health service corporation, subject to
1 21 chapter 514.
1 22 c. A health maintenance organization, subject to chapter
1 23 514B.
1 24 d. Any other entity engaged in the business of insurance,
1 25 risk transfer, or risk retention, which is subject to the
1 26 jurisdiction of the commissioner of insurance.
1 27 e. An organized delivery system licensed by the director
1 28 of public health.
1 29 5. The commissioner of insurance and the director of
1 30 public health shall adopt rules pursuant to chapter 17A to
1 31 administer this section.
1 32 EXPLANATION
1 33 This bill prohibits an insurer from prohibiting, or
1 34 attempting to prohibit, a provider furnishing covered health
1 35 care services from discussing treatment options with an
2 1 insured, notwithstanding the insurer's position or policy
2 2 regarding such treatment options, or from prohibiting, or
2 3 attempting to prohibit, such a provider from advocating on
2 4 behalf of an insured during any utilization review or
2 5 grievance process established by the insurer, or with a person
2 6 under contract with the insurer.
2 7 The bill also prohibits an insurer from penalizing, in any
2 8 manner, such a provider who in good faith reports to state or
2 9 federal authorities any act or practice by the insurer which
2 10 is in violation of the bill or which jeopardizes an enrollee's
2 11 or insured's health or welfare.
2 12 The bill defines an insurer as an accident and sickness
2 13 insurer, subject to chapter 509 or 514A; a nonprofit health
2 14 service corporation, subject to chapter 514; a health
2 15 maintenance organization, subject to chapter 514B; any other
2 16 entity engaged in the business of insurance, risk transfer, or
2 17 risk retention, which is subject to the jurisdiction of the
2 18 insurance commissioner; or an organized delivery system
2 19 licensed by the director of public health.
2 20 LSB 1150HH 77
2 21 mj/sc/14
Text: HF00376 Text: HF00378 Text: HF00300 - HF00399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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