Text: HF02382 Text: HF02384 Text: HF02300 - HF02399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514C.19 PRESCRIPTION
1 2 CONTRACEPTIVE COVERAGE.
1 3 1. Notwithstanding the uniformity of treatment
1 4 requirements of section 514C.6, an individual or group policy
1 5 or contract providing for third-party payment or prepayment of
1 6 health or medical expenses shall not do either of the
1 7 following:
1 8 a. Exclude or restrict benefits for prescription
1 9 contraceptive drugs or prescription contraceptive devices
1 10 approved by the United States food and drug administration, or
1 11 generic equivalents approved as substitutable by the United
1 12 States food and drug administration, if such policy or
1 13 contract provides benefits for other outpatient prescription
1 14 drugs or devices.
1 15 b. Exclude or restrict benefits for outpatient
1 16 contraceptive services if such policy or contract provides
1 17 benefits for other outpatient services provided by a health
1 18 care professional.
1 19 2. A person who provides an individual or group policy or
1 20 contract providing for third-party payment or prepayment of
1 21 health or medical expenses which is subject to subsection 1
1 22 shall not do any of the following:
1 23 a. Deny to an individual eligibility, or continued
1 24 eligibility, to enroll in or to renew coverage under the terms
1 25 of the policy or contract because of the individual's use or
1 26 potential use of such prescription contraceptive drugs or
1 27 devices, or use or potential use of outpatient contraceptive
1 28 services.
1 29 b. Provide a monetary payment or rebate to a covered
1 30 individual to encourage such individual to accept less than
1 31 the minimum benefits provided for under subsection 1.
1 32 c. Penalize or otherwise reduce or limit the reimbursement
1 33 of a health care professional because such professional
1 34 prescribes contraceptive drugs or devices, or provides
1 35 contraceptive services.
2 1 d. Provide incentives, monetary or otherwise, to a health
2 2 care professional to induce such professional to withhold from
2 3 a covered individual contraceptive drugs or devices, or
2 4 contraceptive services.
2 5 3. This section shall not be construed to prevent a third-
2 6 party payor from including deductibles, coinsurance, or
2 7 copayments under the policy or contract, as follows:
2 8 a. A deductible, coinsurance, or copayment for benefits
2 9 for prescription contraceptive drugs shall not be greater than
2 10 such deductible, coinsurance, or copayment for any outpatient
2 11 prescription drug for which coverage under the policy or
2 12 contract is provided.
2 13 b. A deductible, coinsurance, or copayment for benefits
2 14 for prescription contraceptive devices shall not be greater
2 15 than such deductible, coinsurance, or copayment for any
2 16 outpatient prescription device for which coverage under the
2 17 policy or contract is provided.
2 18 c. A deductible, coinsurance, or copayment for benefits
2 19 for outpatient contraceptive services shall not be greater
2 20 than such deductible, coinsurance, or copayment for any
2 21 outpatient health care services for which coverage under the
2 22 policy or contract is provided.
2 23 4. This section shall not be construed to require a third-
2 24 party payor under a policy or contract to provide benefits for
2 25 experimental or investigational contraceptive drugs or
2 26 devices, or experimental or investigational contraceptive
2 27 services, except to the extent that such policy or contract
2 28 provides coverage for other experimental or investigational
2 29 outpatient prescription drugs or devices, or experimental or
2 30 investigational outpatient health care services.
2 31 5. a. This section applies to the following classes of
2 32 third-party payment provider contracts or policies delivered,
2 33 issued for delivery, continued, or renewed in this state on or
2 34 after July 1, 2000:
2 35 (1) Individual or group accident and sickness insurance
3 1 providing coverage on an expense-incurred basis.
3 2 (2) An individual or group hospital or medical service
3 3 contract issued pursuant to chapter 509, 514, or 514A.
3 4 (3) An individual or group health maintenance organization
3 5 contract regulated under chapter 514B.
3 6 (4) Any other entity engaged in the business of insurance,
3 7 risk transfer, or risk retention, which is subject to the
3 8 jurisdiction of the commissioner.
3 9 (5) A plan established pursuant to chapter 509A for public
3 10 employees.
3 11 (6) An organized delivery system licensed by the director
3 12 of public health.
3 13 b. This section shall not apply to accident only,
3 14 specified disease, short-term hospital or medical, hospital
3 15 confinement indemnity, credit, dental, vision, Medicare
3 16 supplement, long-term care, basic hospital and medical-
3 17 surgical expense coverage as defined by the commissioner,
3 18 disability income insurance coverage, coverage issued as a
3 19 supplement to liability insurance, workers' compensation or
3 20 similar insurance, or automobile medical payment insurance.
3 21 EXPLANATION
3 22 This bill creates new Code section 514C.19 which provides
3 23 that an individual or group policy or contract providing for
3 24 third-party payment or prepayment of health or medical
3 25 expenses shall not exclude or restrict benefits for
3 26 prescription contraceptive drugs or prescription contraceptive
3 27 devices approved by the federal food and drug administration,
3 28 or generic equivalents approved as substitutable by the
3 29 federal food and drug administration, if such policy or
3 30 contract provides benefits for other outpatient prescription
3 31 drugs or devices; and shall not exclude or restrict benefits
3 32 for outpatient contraceptive services if such policy or
3 33 contract provides benefits for other outpatient services
3 34 provided by a health care professional.
3 35 The bill also provides that a person who provides an
4 1 individual or group policy or contract providing for third-
4 2 party payment or prepayment of health or medical expenses
4 3 which is subject to the new Code section shall not: deny to an
4 4 individual eligibility, or continued eligibility, to enroll or
4 5 to renew coverage under the terms of such policy or contract
4 6 because of the individual's use or potential use of such
4 7 prescription contraceptive drugs or devices, or use or
4 8 potential use of outpatient contraceptive services; provide a
4 9 monetary payment or rebate to a covered individual to
4 10 encourage such individual to accept less than the minimum
4 11 benefits provided for under the new Code section; penalize or
4 12 otherwise reduce or limit the reimbursement of a health care
4 13 professional because such professional prescribes
4 14 contraceptive drugs or devices, or provides contraceptive
4 15 services; or provide incentives, monetary or otherwise, to a
4 16 health care professional to induce such professional to
4 17 withhold from a covered individual contraceptive drugs or
4 18 devices, or contraceptive services.
4 19 The bill provides that the new Code section applies to
4 20 third-party payment provider contracts or policies and public
4 21 employer plans delivered, issued for delivery, continued, or
4 22 renewed in this state on or after July 1, 2000.
4 23 LSB 5871HH 78
4 24 mj/as/5.1
Text: HF02382 Text: HF02384 Text: HF02300 - HF02399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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