Text: HF02356 Text: HF02358 Text: HF02300 - HF02399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514I.1 TITLE.
1 2 This chapter shall be known and may be cited as the "state
1 3 children's health insurance program Act".
1 4 Sec. 2. NEW SECTION. 514I.2 PURPOSE.
1 5 The purpose of this chapter is to create a state children's
1 6 health insurance program which complies with Title XXI of the
1 7 federal Social Security Act and which provides health
1 8 insurance to eligible children through participating private
1 9 health insurers that contract with the division of insurance.
1 10 Sec. 3. NEW SECTION. 514I.3 DEFINITIONS.
1 11 As used in this chapter unless the context otherwise
1 12 requires:
1 13 1. "Child" means a natural person who is less than
1 14 nineteen years of age who is a resident of this state.
1 15 2. "Creditable health coverage" means as defined in 42
1 16 U.S.C. } 300 gg (c) and includes coverage that meets the
1 17 requirements of Title XXI of the federal Social Security Act.
1 18 3. "Division" means the division of insurance of the
1 19 department of commerce.
1 20 4. "Eligible child" means a child who is a low-income
1 21 child who is not eligible for medical assistance or is not
1 22 covered under a group health plan or under other health
1 23 insurance coverage. "Eligible child" does not include a child
1 24 who is an inmate of a public institution, a patient in an
1 25 institution or a patient in an institution for mental
1 26 diseases, and does not include a child who is a member of a
1 27 family that is eligible for health benefits coverage under a
1 28 state employee health benefits plan.
1 29 5. "Group health plan" means a group health plan as
1 30 defined in 42 U.S.C. } 300 gg (91).
1 31 6. "Health insurance coverage" means health insurance
1 32 coverage as defined in 42 U.S.C. } 300 gg (91).
1 33 7. "Low-income child" means a child whose family income is
1 34 at or below two hundred percent of the federal poverty level,
1 35 as defined in 42 U.S.C. } 9902(2) including any revision
2 1 required by that section.
2 2 8. "Participating insurer" means any entity licensed to
2 3 provide health insurance in Iowa that has contracted with the
2 4 division to offer health insurance coverage to eligible
2 5 children under this chapter.
2 6 9. "Preexisting condition exclusion" means as defined in
2 7 42 U.S.C. } 300 gg(b)(1)(A).
2 8 10. "Qualified child health plan" means health insurance
2 9 coverage provided by a participating insurer under this
2 10 chapter.
2 11 Sec. 4. NEW SECTION. 514I.4 PROGRAM ADMINISTRATION AND
2 12 FINANCING.
2 13 1. The division shall prepare a state children's health
2 14 insurance program plan for submission to the secretary of the
2 15 United States department of health and human services.
2 16 2. The division shall enter into contracts with at least
2 17 two entities licensed to provide health insurance in Iowa and
2 18 at least two health maintenance organizations that offer a
2 19 qualified child health plan to provide health care coverage
2 20 under this chapter.
2 21 3. The department of human services shall certify the
2 22 eligibility of children for the state children's health
2 23 insurance program.
2 24 4. Upon notice of enrollment of an eligible child in a
2 25 qualified child health plan, the division shall forward the
2 26 annual negotiated cost of insuring each eligible child to the
2 27 appropriate participating insurer.
2 28 Sec. 5. NEW SECTION. 514I.5 INSURER PROVISIONS.
2 29 1. To be eligible for the state payment, a participating
2 30 insurer shall offer a qualified child health plan to eligible
2 31 children without regard to health status and without the
2 32 imposition of preexisting condition exclusions, except that a
2 33 preexisting condition exclusion may be applied if the
2 34 qualified child health plan is provided through a group health
2 35 plan or group health insurance coverage, consistent with the
3 1 limitation on the imposition of preexisting condition
3 2 exclusions in connection with such coverage under state and
3 3 federal law.
3 4 2. Premium and cost-sharing amounts shall be limited to
3 5 the following:
3 6 a. Deductibles, coinsurance, or other cost sharing are not
3 7 permitted with respect to benefits for well-baby and well-
3 8 child care, including age-appropriate immunizations.
3 9 b. For children whose family income is at or below one
3 10 hundred fifty percent of the federal poverty level all of the
3 11 following apply:
3 12 (1) Premiums, enrollment fees, or similar charges shall
3 13 not exceed the maximum monthly charge permitted consistent
3 14 with standards established to carry out 42 U.S.C. } 1396(o).
3 15 (2) Deductibles and other cost sharing shall not exceed an
3 16 amount that is nominally consistent with standards provided
3 17 under 42 U.S.C. } 1396(o), as adjusted.
3 18 c. For children whose family income is more than one
3 19 hundred fifty percent of the federal poverty level, premiums,
3 20 deductibles, and other cost sharing may be imposed on a
3 21 sliding scale related to income, provided that the total
3 22 annual aggregate cost sharing with respect to all eligible
3 23 children in a family shall not exceed five percent of the
3 24 family's income for the year involved.
3 25 3. Existing health insurance sales and marketing methods,
3 26 including the use of agents and payment of commissions, shall
3 27 be utilized to inform families of the availability of the
3 28 state children's health insurance program and to assist
3 29 families in obtaining coverage for children under the program.
3 30 Sec. 6. NEW SECTION. 514I.6 ELIGIBILITY PROVISIONS.
3 31 1. Eligible children shall be eligible for coverage with a
3 32 participating insurer regardless of health status.
3 33 2. Eligible children shall be allowed to change enrollment
3 34 between participating insurers upon the annual coverage
3 35 renewal date, provided that at least six months notice of an
4 1 election to change enrollment is provided to the participating
4 2 insurer with which the child is currently enrolled. The
4 3 notice provision shall be reduced to sixty days if the child
4 4 has changed residence to an area outside the geographic
4 5 service area of the participating insurer with which the child
4 6 is currently enrolled.
4 7 Sec. 7. NEW SECTION. 514I.7 SCOPE OF BENEFITS.
4 8 Nothing in this chapter shall be construed to prevent a
4 9 qualified child health plan from offering a category of
4 10 benefits that are not specified in this section. A qualified
4 11 child health plan shall contain benefits consistent with one
4 12 of the following:
4 13 1. Health insurance coverage equivalent to one of the
4 14 following:
4 15 a. The standard blue cross/blue shield preferred provider
4 16 option under the federal employees health benefit plan as
4 17 codified in 5 U.S.C. } 8903 (1).
4 18 b. A health benefits coverage plan that is offered and
4 19 generally available to state employees.
4 20 c. Health insurance coverage offered by the health
4 21 maintenance organization that has the largest insured
4 22 commercial, nonmedical assistance enrollment of covered lives
4 23 in the state.
4 24 2. a. Health insurance coverage that has an aggregate
4 25 actuarial value at least equivalent to that of the coverage
4 26 described in subsection 1, paragraph "a", "b", or "c", and
4 27 that includes coverage for all of the following basic
4 28 services:
4 29 (1) Inpatient and outpatient hospital services.
4 30 (2) Physicians' surgical and medical services.
4 31 (3) Laboratory and x-ray services.
4 32 (4) Well-baby and well-child care, including age-
4 33 appropriate immunizations.
4 34 b. Health insurance coverage based on actuarial
4 35 equivalence for basic services as described in paragraph "a"
5 1 shall provide the following additional services if the
5 2 coverage for such services has an actuarial value of at least
5 3 seventy-five percent of the actuarial value of the coverage
5 4 provided in that category of services:
5 5 (1) Coverage of prescription drugs.
5 6 (2) Mental health services.
5 7 (3) Vision services.
5 8 (4) Hearing services.
5 9 (5) Dental services.
5 10 3. Upon application by the state, any other health
5 11 insurance coverage that has been approved by the secretary of
5 12 the United States department of health and human services.
5 13 EXPLANATION
5 14 This bill establishes the state children's health insurance
5 15 program which provides health care coverage for children in
5 16 the state in compliance with the federal state child health
5 17 insurance program (Title XXI of the federal Social Security
5 18 Act).
5 19 The bill provides definitions, criteria for eligibility
5 20 under the program, benefits to be provided under the program,
5 21 cost-sharing limitations under the program, and for
5 22 administration of the program by the division of insurance of
5 23 the department of commerce.
5 24 LSB 3602HH 77
5 25 pf/cf/24
Text: HF02356 Text: HF02358 Text: HF02300 - HF02399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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