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