Text: S05495                            Text: S05497
Text: S05400 - S05499                   Text: S Index
Bills and Amendments: General Index     Bill History: General Index



Senate Amendment 5496

Amendment Text

PAG LIN
  1  1    Amend the House amendment, S-5475, to Senate File
  1  2 2318, as amended, passed, and reprinted by the Senate,
  1  3 as follows:
  1  4    #1.  Page 1, by inserting after line 2 the
  1  5 following:
  1  6    "#   .  Page 2, by striking lines 10 through 15 and
  1  7 inserting the following:
  1  8    "b.  For the 2003 calendar year:
  1  9    (1)  One and three-fourths percent if the company
  1 10 or association is described as any of the following:
  1 11    (a)  It is taxed under section 432.2.
  1 12    (b)  Its policies and contracts provide for third-
  1 13 party payments or prepayments of health or medical
  1 14 expenses which include coverage benefits for treatment
  1 15 for neurobiological disorders and underlying co-
  1 16 morbidity as provided in section 514C.21 and it meets
  1 17 the requirements of subparagraph subdivision (d), (e),
  1 18 or (f).
  1 19    (c)  Its commercial domicile is not in Iowa.
  1 20    (d)  Its commercial domicile is in Iowa and its
  1 21 total premiums received in the previous calendar year
  1 22 are less than ten million dollars and in the case of a
  1 23 health insurance company or association it meets the
  1 24 requirements of subparagraph subdivision (b).
  1 25    (e)  Its commercial domicile is in Iowa, its total
  1 26 premiums received in the previous calendar year are at
  1 27 least ten million dollars but not more than one
  1 28 hundred million dollars, and it has purchased equity
  1 29 interests in the Iowa fund of funds created pursuant
  1 30 to section 15E.225 through the end of the previous
  1 31 calendar year of at least five hundred thousand
  1 32 dollars and in the case of a health insurance company
  1 33 or association it meets the requirements of
  1 34 subparagraph subdivision (b).
  1 35    (f)  Its commercial domicile is in Iowa, its total
  1 36 premiums received in the previous calendar year are
  1 37 more than one hundred million dollars, and it has
  1 38 purchased equity interests in the Iowa fund of funds
  1 39 through the end of the previous calendar year of at
  1 40 least one million dollars and in the case of a health
  1 41 insurance company or association it meets the
  1 42 requirements of subparagraph subdivision (b).
  1 43    (2)  Two percent if the company or association does
  1 44 not meet any of the descriptions in subparagraph (1).
  1 45    c.  For the 2004 calendar year:
  1 46    (1)  One and one-half percent if the company or
  1 47 association is described as any of the following:
  1 48    (a)  It is taxed under section 432.2.
  1 49    (b)  Its policies and contracts provide for third-
  1 50 party payments or prepayments of health or medical
  2  1 expenses which include coverage benefits for treatment
  2  2 for neurobiological disorders and underlying co-
  2  3 morbidity as provided in section 514C.21 and it meets
  2  4 the requirements of subparagraph subdivision (d), (e),
  2  5 or (f).
  2  6    (c)  Its commercial domicile is not in Iowa.
  2  7    (d)  Its commercial domicile is in Iowa and its
  2  8 total premiums received in the previous calendar year
  2  9 are less than ten million dollars and in the case of a
  2 10 health insurance company or association it meets the
  2 11 requirements of subparagraph subdivision (b).
  2 12    (e)  Its commercial domicile is in Iowa, its total
  2 13 premiums received in the previous calendar year are at
  2 14 least ten million dollars but not more than one
  2 15 hundred million dollars, and it has purchased equity
  2 16 interests in the Iowa fund of funds through the end of
  2 17 the previous calendar year of at least one million
  2 18 dollars and in the case of a health insurance company
  2 19 or association it meets the requirements of
  2 20 subparagraph subdivision (b).
  2 21    (f)  Its commercial domicile is in Iowa, its total
  2 22 premiums received in the previous calendar year are
  2 23 more than one hundred million dollars, and it has
  2 24 purchased equity interests in the Iowa fund of funds
  2 25 through the end of the previous calendar year of at
  2 26 least two million dollars and in the case of a health
  2 27 insurance company or association it meets the
  2 28 requirements of subparagraph subdivision (b).
  2 29    (2)  Two percent if the company or association does
  2 30 not meet any of the descriptions in subparagraph (1).
  2 31    d.  For the 2005 calendar year:
  2 32    (1)  One and one-fourth percent if the company or
  2 33 association is described as any of the following:
  2 34    (a)  It is taxed under section 432.2.
  2 35    (b)  Its policies and contracts provide for third-
  2 36 party payments or prepayments of health or medical
  2 37 expenses which include coverage benefits for treatment
  2 38 for neurobiological disorders and underlying co-
  2 39 morbidity as provided in section 514C.21 and it meets
  2 40 the requirements of subparagraph subdivision (d), (e),
  2 41 or (f).
  2 42    (c)  Its commercial domicile is not in Iowa.
  2 43    (d)  Its commercial domicile is in Iowa and its
  2 44 total premiums received in the previous calendar year
  2 45 are less than ten million dollars and in the case of a
  2 46 health insurance company or association it meets the
  2 47 requirements of subparagraph subdivision (b).
  2 48    (e)  Its commercial domicile is in Iowa, its total
  2 49 premiums received in the previous calendar year are at
  2 50 least ten million dollars but not more than one
  3  1 hundred million dollars, and it has purchased equity
  3  2 interests in the Iowa fund of funds through the end of
  3  3 the previous calendar year of at least one million
  3  4 five hundred thousand dollars and in the case of a
  3  5 health insurance company or association it meets the
  3  6 requirements of subparagraph subdivision (b).
  3  7    (f)  Its commercial domicile is in Iowa, its total
  3  8 premiums received in the previous calendar year are
  3  9 more than one hundred million dollars, and it has
  3 10 purchased equity interests in the Iowa fund of funds
  3 11 through the end of the previous calendar year of at
  3 12 least three million dollars and in the case of a
  3 13 health insurance company or association it meets the
  3 14 requirements of subparagraph subdivision (b).
  3 15    (2)  Two percent if the company or association does
  3 16 not meet any of the descriptions in subparagraph (1).
  3 17    e.  For the 2006 and subsequent calendar years:
  3 18    (1)  One percent if the company or association is
  3 19 described as any of the following:
  3 20    (a)  It is taxed under section 432.2.
  3 21    (b)  Its policies and contracts provide for third-
  3 22 party payments or prepayments of health or medical
  3 23 expenses which include coverage benefits for treatment
  3 24 for neurobiological disorders and underlying co-
  3 25 morbidity as provided in section 514C.21 and it meets
  3 26 the requirements of subparagraph subdivision (d), (e),
  3 27 or (f).
  3 28    (c)  Its commercial domicile is not in Iowa.
  3 29    (d)  Its commercial domicile is in Iowa and its
  3 30 total premiums received in the previous calendar year
  3 31 are less than ten million dollars and in the case of a
  3 32 health insurance company or association it meets the
  3 33 requirements of subparagraph subdivision (b).
  3 34    (e)  Its commercial domicile is in Iowa, its total
  3 35 premiums received in the previous calendar year are at
  3 36 least ten million dollars but not more than one
  3 37 hundred million dollars, and it has purchased equity
  3 38 interests in the Iowa fund of funds through the end of
  3 39 the previous calendar year of at least two million
  3 40 dollars and in the case of a health insurance company
  3 41 or association it meets the requirements of
  3 42 subparagraph subdivision (b).
  3 43    (f)  Its commercial domicile is in Iowa, its total
  3 44 premiums received in the previous calendar year are
  3 45 more than one hundred million dollars, and it has
  3 46 purchased equity interests in the Iowa fund of funds
  3 47 through the end of the previous calendar year of at
  3 48 least four million dollars and in the case of a health
  3 49 insurance company or association it meets the
  3 50 requirements of subparagraph subdivision (b).
  4  1    (2)  Two percent if the company or association does
  4  2 not meet any of the descriptions in subparagraph (1)."
  4  3    #   .  By striking page 2, line 34 through page 3,
  4  4 line 4 and inserting the following:
  4  5    "b.  For the 2004 calendar year:
  4  6    (1)  One and three-fourths percent if the company
  4  7 or association is described as any of the following:
  4  8    (a)  Its commercial domicile is not in Iowa.
  4  9    (b)  Its commercial domicile is in Iowa and its
  4 10 total premiums received in the previous calendar year
  4 11 are less than ten million dollars.
  4 12    (c)  Its commercial domicile is in Iowa, its total
  4 13 premiums received in the previous calendar year are at
  4 14 least ten million dollars but not more than one
  4 15 hundred million dollars, and it has purchased equity
  4 16 interests in the Iowa fund of funds through the end of
  4 17 the previous calendar year of at least five hundred
  4 18 thousand dollars.
  4 19    (d)  Its commercial domicile is in Iowa, its total
  4 20 premiums received in the previous calendar year are
  4 21 more than one hundred million dollars, and it has
  4 22 purchased equity interests in the Iowa fund of funds
  4 23 through the end of the previous calendar year of at
  4 24 least one million dollars.
  4 25    (2)  Two percent if the company or association does
  4 26 not meet any of the descriptions in subparagraph (1).
  4 27    c.  For the 2005 calendar year:
  4 28    (1)  One and one-half percent if the company or
  4 29 association is described as any of the following:
  4 30    (a)  Its commercial domicile is not in Iowa.
  4 31    (b)  Its commercial domicile is in Iowa and its
  4 32 total premiums received in the previous calendar year
  4 33 are less than ten million dollars.
  4 34    (c)  Its commercial domicile is in Iowa, its total
  4 35 premiums received in the previous calendar year are at
  4 36 least ten million dollars but not more than one
  4 37 hundred million dollars, and it has purchased equity
  4 38 interests in the Iowa fund of funds through the end of
  4 39 the previous calendar year of at least one million
  4 40 dollars.
  4 41    (d)  Its commercial domicile is in Iowa, its total
  4 42 premiums received in the previous calendar year are
  4 43 more than one hundred million dollars, and it has
  4 44 purchased equity interests in the Iowa fund of funds
  4 45 through the end of the previous calendar year of at
  4 46 least two million dollars.
  4 47    (2)  Two percent if the company or association does
  4 48 not meet any of the descriptions in subparagraph (1).
  4 49    d.  For the 2006 calendar year:
  4 50    (1)  One and one-fourth percent if the company or
  5  1 association is described as any of the following:
  5  2    (a)  Its commercial domicile is not in Iowa.
  5  3    (b)  Its commercial domicile is in Iowa and its
  5  4 total premiums received in the previous calendar year
  5  5 are less than ten million dollars.
  5  6    (c)  Its commercial domicile is in Iowa, its total
  5  7 premiums received in the previous calendar year are at
  5  8 least ten million dollars but not more than one
  5  9 hundred million dollars, and it has purchased equity
  5 10 interests in the Iowa fund of funds through the end of
  5 11 the previous calendar year of at least one million
  5 12 five hundred thousand dollars.
  5 13    (d)  Its commercial domicile is in Iowa, its total
  5 14 premiums received in the previous calendar year are
  5 15 more than one hundred million dollars, and it has
  5 16 purchased equity interests in the Iowa fund of funds
  5 17 through the end of the previous calendar year of at
  5 18 least three million dollars.
  5 19    (2)  Two percent if the company or association does
  5 20 not meet any of the descriptions in subparagraph (1).
  5 21    e.  For the 2007 and subsequent calendar years:
  5 22    (1)  One percent if the company or association is
  5 23 described as any of the following:
  5 24    (a)  Its commercial domicile is not in Iowa.
  5 25    (b)  Its commercial domicile is in Iowa and its
  5 26 total premiums received in the previous calendar year
  5 27 are less than ten million dollars.
  5 28    (c)  Its commercial domicile is in Iowa, its total
  5 29 premiums received in the previous calendar year are at
  5 30 least ten million dollars but not more than one
  5 31 hundred million dollars, and it has purchased equity
  5 32 interests in the Iowa fund of funds the end of the
  5 33 previous calendar year of at least two million
  5 34 dollars.
  5 35    (d)  Its commercial domicile is in Iowa, its total
  5 36 premiums received in the previous calendar year are
  5 37 more than one hundred million dollars, and it has
  5 38 purchased equity interests in the Iowa fund of funds
  5 39 through the end of the previous calendar year of at
  5 40 least four million dollars.
  5 41    (2)  Two percent if the company or association does
  5 42 not meet any of the descriptions in subparagraph
  5 43 (1).""
  5 44    #2.  Page 1, by inserting after line 18 the
  5 45 following:
  5 46    "#   .  Page 5, by inserting after line 16 the
  5 47 following:
  5 48    "Sec.    .  NEW SECTION.  514C.21  MANDATED
  5 49 COVERAGE FOR NEUROBIOLOGICAL DISORDERS AND UNDERLYING
  5 50 CO-MORBIDITY.
  6  1    1.  For purposes of this section, unless the
  6  2 context otherwise requires:
  6  3    a.  "Co-morbidity" means the coexistence of
  6  4 conditions or diagnosable disorders such as
  6  5 neurobiological disorders and substance abuse.  For
  6  6 purposes of this section, "substance abuse" means a
  6  7 pattern of pathological use of alcohol or a drug that
  6  8 causes impairment in social or occupational
  6  9 functioning, or that produces physiological dependency
  6 10 evidenced by physical tolerance or by physical
  6 11 symptoms when the alcohol or drug is withdrawn.
  6 12    b.  "Neurobiological disorder" means the following:
  6 13    (1)  Schizophrenia and other psychotic disorders.
  6 14    (2)  Affective disorders.
  6 15    (3)  Anxiety disorders.
  6 16    (4)  Pervasive developmental disorders.
  6 17    (5)  Attention deficit hyperactivity disorder and
  6 18 related disorders.
  6 19    (6)  Disorders identified in childhood and
  6 20 adolescence.
  6 21    The commissioner, by rule, shall identify the
  6 22 neurobiological disorders covered by this definition,
  6 23 consistent with the guidelines provided in the most
  6 24 recent edition of the American psychiatric
  6 25 association's diagnostic and statistical manual of
  6 26 mental disorders, as such definitions may be amended
  6 27 from time to time.  The commissioner may adopt the
  6 28 definitions provided in the manual by reference.
  6 29    c.  "Rates, terms, and conditions" means any
  6 30 lifetime or annual payment limits, deductibles,
  6 31 copayments, coinsurance, and any other cost-sharing
  6 32 requirements, out-of-pocket limits, visit limitations,
  6 33 and any other financial component of benefits coverage
  6 34 that affects the covered individual.
  6 35    2.  a.  Notwithstanding the uniformity of treatment
  6 36 requirements of section 514C.6, a policy, contract, or
  6 37 plan providing for third-party payment or prepayment
  6 38 of health or medical expenses shall provide coverage
  6 39 benefits for treatment for neurobiological disorders
  6 40 and underlying co-morbidity based on rates, terms, and
  6 41 conditions that are no more restrictive than the
  6 42 rates, terms, and conditions for coverage benefits
  6 43 provided for other health or medical conditions under
  6 44 the policy, contract, or plan.
  6 45    b.  Any restrictions or limitations with respect to
  6 46 rates, terms, and conditions involving deductibles,
  6 47 copayments, coinsurance, and any other cost-sharing
  6 48 requirements shall be cumulative for coverage of
  6 49 treatment for neurobiological disorders and underlying
  6 50 co-morbidity and other health or medical conditions
  7  1 under a policy, contract, or plan.  A policy,
  7  2 contract, or plan subject to this section shall not
  7  3 impose an aggregate lifetime or annual limit on
  7  4 treatment for neurobiological disorders and underlying
  7  5 co-morbidity coverage benefits unless the policy,
  7  6 contract, or plan imposes an aggregate lifetime or
  7  7 annual limit on substantially all health or medical
  7  8 coverage benefits.  A policy, contract, or plan
  7  9 subject to this section that imposes an aggregate
  7 10 lifetime or annual limit on substantially all medical
  7 11 and surgical coverage benefits shall not impose an
  7 12 aggregate lifetime or annual limit on treatment for
  7 13 neurobiological disorders and underlying co-morbidity
  7 14 coverage benefits that is less than the aggregate
  7 15 lifetime or annual limit imposed on substantially all
  7 16 health or medical coverage benefits.
  7 17    c.  Coverage required under this section shall be
  7 18 for the treatment of neurobiological disorders and
  7 19 underlying co-morbidity, for services provided by a
  7 20 health professional licensed under chapter 147A, 148,
  7 21 150A, 152, 154B, 154C, or 154D, for services provided
  7 22 in a hospital, clinic, office, community mental health
  7 23 center, health care facility, outpatient treatment
  7 24 facility, residential treatment facility, halfway
  7 25 house, or similar facility for the provision of health
  7 26 care services, and for services provided pursuant to
  7 27 the comprehensive program for treatment for substance
  7 28 abuse maintained by the department of public health
  7 29 pursuant to section 125.12 in a hospital licensed
  7 30 under chapter 135B or a facility licensed under
  7 31 chapter 125.
  7 32    3.  This section applies to the following classes
  7 33 of third-party payment provider policies, contracts,
  7 34 or plans delivered, issued for delivery, continued, or
  7 35 renewed in this state on or after January 1, 2003:
  7 36    a.  Individual or group accident and sickness
  7 37 insurance providing coverage on an expense-incurred
  7 38 basis.
  7 39    b.  An individual or group hospital or medical
  7 40 service contract issued pursuant to chapter 509, 514,
  7 41 or 514A.
  7 42    c.  A plan established pursuant to chapter 509A for
  7 43 public employees.
  7 44    d.  An individual or group health maintenance
  7 45 organization contract regulated under chapter 514B.
  7 46    e.  An individual or group Medicare supplemental
  7 47 policy, unless coverage pursuant to such policy is
  7 48 preempted by federal law.
  7 49    f.  Any other entity engaged in the business of
  7 50 insurance, risk transfer, or risk retention, which is
  8  1 subject to the jurisdiction of the commissioner.
  8  2    g.  An organized delivery system licensed by the
  8  3 director of public health.
  8  4    4.  The commissioner shall adopt rules pursuant to
  8  5 chapter 17A to administer this section."
  8  6    #   .  By renumbering, redesignating, and
  8  7 correcting internal references as necessary." 
  8  8 
  8  9 
  8 10                               
  8 11 THOMAS FIEGEN 
  8 12 MARK SHEARER
  8 13 STEVEN D. HANSEN
  8 14 AMANDA RAGAN
  8 15 JOE BOLKCOM
  8 16 MIKE CONNOLLY 
  8 17 BETTY A. SOUKUP
  8 18 PATRICIA HARPER 
  8 19 BILL FINK 
  8 20 ROBERT E. DVORSKY 
  8 21 JOHNIE HAMMOND 
  8 22 MICHAEL E. GRONSTAL 
  8 23 JOHN P. KIBBIE 
  8 24 DENNIS H. BLACK 
  8 25 WALLY E. HORN 
  8 26 DICK L. DEARDEN 
  8 27 EUGENE S. FRAISE 
  8 28 MARY A. LUNDBY 
  8 29 SF 2318.208 79
  8 30 mg/sh
     

Text: S05495                            Text: S05497
Text: S05400 - S05499                   Text: S Index
Bills and Amendments: General Index     Bill History: General Index

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