Text: SF02125 Text: SF02127 Text: SF02100 - SF02199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 SENATE FILE 2126
1 2
1 3 AN ACT
1 4 RELATING TO THIRD-PARTY PAYMENT OF HEALTH CARE COVERAGE
1 5 COSTS FOR PRESCRIPTION CONTRACEPTIVE DRUGS, DEVICES,
1 6 AND SERVICES.
1 7
1 8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 9
1 10 Section 1. NEW SECTION. 514C.19 PRESCRIPTION
1 11 CONTRACEPTIVE COVERAGE.
1 12 1. Notwithstanding the uniformity of treatment
1 13 requirements of section 514C.6, a group policy or contract
1 14 providing for third-party payment or prepayment of health or
1 15 medical expenses shall not do either of the following:
1 16 a. Exclude or restrict benefits for prescription
1 17 contraceptive drugs or prescription contraceptive devices
1 18 which prevent conception and which are approved by the United
1 19 States food and drug administration, or generic equivalents
1 20 approved as substitutable by the United States food and drug
1 21 administration, if such policy or contract provides benefits
1 22 for other outpatient prescription drugs or devices.
1 23 b. Exclude or restrict benefits for outpatient
1 24 contraceptive services which are provided for the purpose of
1 25 preventing conception if such policy or contract provides
1 26 benefits for other outpatient services provided by a health
1 27 care professional.
1 28 2. A person who provides a group policy or contract
1 29 providing for third-party payment or prepayment of health or
1 30 medical expenses which is subject to subsection 1 shall not do
1 31 any of the following:
1 32 a. Deny to an individual eligibility, or continued
1 33 eligibility, to enroll in or to renew coverage under the terms
1 34 of the policy or contract because of the individual's use or
1 35 potential use of such prescription contraceptive drugs or
2 1 devices, or use or potential use of outpatient contraceptive
2 2 services.
2 3 b. Provide a monetary payment or rebate to a covered
2 4 individual to encourage such individual to accept less than
2 5 the minimum benefits provided for under subsection 1.
2 6 c. Penalize or otherwise reduce or limit the reimbursement
2 7 of a health care professional because such professional
2 8 prescribes contraceptive drugs or devices, or provides
2 9 contraceptive services.
2 10 d. Provide incentives, monetary or otherwise, to a health
2 11 care professional to induce such professional to withhold from
2 12 a covered individual contraceptive drugs or devices, or
2 13 contraceptive services.
2 14 3. This section shall not be construed to prevent a third-
2 15 party payor from including deductibles, coinsurance, or
2 16 copayments under the policy or contract, as follows:
2 17 a. A deductible, coinsurance, or copayment for benefits
2 18 for prescription contraceptive drugs shall not be greater than
2 19 such deductible, coinsurance, or copayment for any outpatient
2 20 prescription drug for which coverage under the policy or
2 21 contract is provided.
2 22 b. A deductible, coinsurance, or copayment for benefits
2 23 for prescription contraceptive devices shall not be greater
2 24 than such deductible, coinsurance, or copayment for any
2 25 outpatient prescription device for which coverage under the
2 26 policy or contract is provided.
2 27 c. A deductible, coinsurance, or copayment for benefits
2 28 for outpatient contraceptive services shall not be greater
2 29 than such deductible, coinsurance, or copayment for any
2 30 outpatient health care services for which coverage under the
2 31 policy or contract is provided.
2 32 4. This section shall not be construed to require a third-
2 33 party payor under a policy or contract to provide benefits for
2 34 experimental or investigational contraceptive drugs or
2 35 devices, or experimental or investigational contraceptive
3 1 services, except to the extent that such policy or contract
3 2 provides coverage for other experimental or investigational
3 3 outpatient prescription drugs or devices, or experimental or
3 4 investigational outpatient health care services.
3 5 5. This section shall not be construed to limit or
3 6 otherwise discourage the use of generic equivalent drugs
3 7 approved by the United States food and drug administration,
3 8 whenever available and appropriate. This section, when a
3 9 brand name drug is requested by a covered individual and a
3 10 suitable generic equivalent is available and appropriate,
3 11 shall not be construed to prohibit a third-party payor from
3 12 requiring the covered individual to pay a deductible,
3 13 coinsurance, or copayment consistent with subsection 3, in
3 14 addition to the difference of the cost of the brand name drug
3 15 less the maximum covered amount for a generic equivalent.
3 16 6. A person who provides an individual policy or contract
3 17 providing for third-party payment or prepayment of health or
3 18 medical expenses shall make available a coverage provision
3 19 that satisfies the requirements in subsections 1 through 5 in
3 20 the same manner as such requirements are applicable to a group
3 21 policy or contract under those subsections. The policy or
3 22 contract shall provide that the individual policyholder may
3 23 reject the coverage provision at the option of the
3 24 policyholder.
3 25 7. a. This section applies to the following classes of
3 26 third-party payment provider contracts or policies delivered,
3 27 issued for delivery, continued, or renewed in this state on or
3 28 after July 1, 2000:
3 29 (1) Individual or group accident and sickness insurance
3 30 providing coverage on an expense-incurred basis.
3 31 (2) An individual or group hospital or medical service
3 32 contract issued pursuant to chapter 509, 514, or 514A.
3 33 (3) An individual or group health maintenance organization
3 34 contract regulated under chapter 514B.
3 35 (4) Any other entity engaged in the business of insurance,
4 1 risk transfer, or risk retention, which is subject to the
4 2 jurisdiction of the commissioner.
4 3 (5) A plan established pursuant to chapter 509A for public
4 4 employees.
4 5 (6) An organized delivery system licensed by the director
4 6 of public health.
4 7 b. This section shall not apply to accident only,
4 8 specified disease, short-term hospital or medical, hospital
4 9 confinement indemnity, credit, dental, vision, Medicare
4 10 supplement, long-term care, basic hospital and medical-
4 11 surgical expense coverage as defined by the commissioner,
4 12 disability income insurance coverage, coverage issued as a
4 13 supplement to liability insurance, workers' compensation or
4 14 similar insurance, or automobile medical payment insurance.
4 15
4 16
4 17
4 18 MARY E. KRAMER
4 19 President of the Senate
4 20
4 21
4 22
4 23 BRENT SIEGRIST
4 24 Speaker of the House
4 25
4 26 I hereby certify that this bill originated in the Senate and
4 27 is known as Senate File 2126, Seventy-eighth General Assembly.
4 28
4 29
4 30
4 31 MICHAEL E. MARSHALL
4 32 Secretary of the Senate
4 33 Approved , 2000
4 34
4 35
5 1
5 2 THOMAS J. VILSACK
5 3 Governor
Text: SF02125 Text: SF02127 Text: SF02100 - SF02199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
© 2000 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Mon Aug 28 13:36:55 CDT 2000
URL: /DOCS/GA/78GA/Legislation/SF/02100/SF02126/000417.html
jhf