Text: S05509 Text: S05511 Text: S05500 - S05599 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Amend House File 2623, as amended, passed, and
1 2 reprinted by the House, as follows:
1 3 #1. Page 27, by inserting after line 35 the
1 4 following:
1 5 "Sec. . Section 432.1, subsections 1A and 2A,
1 6 if enacted by 2002 Iowa Acts, Senate File 2318, are
1 7 amended by striking the subsections and inserting in
1 8 lieu thereof the following:
1 9 1A. The "applicable percent" for purposes of
1 10 subsection 1 of this section and section 432.2 is the
1 11 following:
1 12 a. For calendar years beginning before the 2003
1 13 calendar year, two percent.
1 14 b. For the 2003 calendar year:
1 15 (1) One and three-fourths percent if the company
1 16 or association is described as any of the following:
1 17 (a) It is taxed under section 432.2.
1 18 (b) Its policies and contracts provide for third-
1 19 party payments or prepayments of health or medical
1 20 expenses which include coverage benefits for treatment
1 21 for neurobiological disorders and underlying co-
1 22 morbidity as provided in section 514C.21 and it meets
1 23 the requirements of subparagraph subdivision (d), (e),
1 24 or (f).
1 25 (c) Its commercial domicile is not in Iowa.
1 26 (d) Its commercial domicile is in Iowa and its
1 27 total premiums received in the previous calendar year
1 28 are less than ten million dollars and in the case of a
1 29 health insurance company or association it meets the
1 30 requirements of subparagraph subdivision (b).
1 31 (e) Its commercial domicile is in Iowa, its total
1 32 premiums received in the previous calendar year are at
1 33 least ten million dollars but not more than one
1 34 hundred million dollars, and it has purchased equity
1 35 interests in the Iowa fund of funds created pursuant
1 36 to section 15E.225 through the end of the previous
1 37 calendar year of at least five hundred thousand
1 38 dollars and in the case of a health insurance company
1 39 or association it meets the requirements of
1 40 subparagraph subdivision (b).
1 41 (f) Its commercial domicile is in Iowa, its total
1 42 premiums received in the previous calendar year are
1 43 more than one hundred million dollars, and it has
1 44 purchased equity interests in the Iowa fund of funds
1 45 through the end of the previous calendar year of at
1 46 least one million dollars and in the case of a health
1 47 insurance company or association it meets the
1 48 requirements of subparagraph subdivision (b).
1 49 (2) Two percent if the company or association does
1 50 not meet any of the descriptions in subparagraph (1).
2 1 c. For the 2004 calendar year:
2 2 (1) One and one-half percent if the company or
2 3 association is described as any of the following:
2 4 (a) It is taxed under section 432.2.
2 5 (b) Its policies and contracts provide for third-
2 6 party payments or prepayments of health or medical
2 7 expenses which include coverage benefits for treatment
2 8 for neurobiological disorders and underlying co-
2 9 morbidity as provided in section 514C.21 and it meets
2 10 the requirements of subparagraph subdivision (d), (e),
2 11 or (f).
2 12 (c) Its commercial domicile is not in Iowa.
2 13 (d) Its commercial domicile is in Iowa and its
2 14 total premiums received in the previous calendar year
2 15 are less than ten million dollars and in the case of a
2 16 health insurance company or association it meets the
2 17 requirements of subparagraph subdivision (b).
2 18 (e) Its commercial domicile is in Iowa, its total
2 19 premiums received in the previous calendar year are at
2 20 least ten million dollars but not more than one
2 21 hundred million dollars, and it has purchased equity
2 22 interests in the Iowa fund of funds through the end of
2 23 the previous calendar year of at least one million
2 24 dollars and in the case of a health insurance company
2 25 or association it meets the requirements of
2 26 subparagraph subdivision (b).
2 27 (f) Its commercial domicile is in Iowa, its total
2 28 premiums received in the previous calendar year are
2 29 more than one hundred million dollars, and it has
2 30 purchased equity interests in the Iowa fund of funds
2 31 through the end of the previous calendar year of at
2 32 least two million dollars and in the case of a health
2 33 insurance company or association it meets the
2 34 requirements of subparagraph subdivision (b).
2 35 (2) Two percent if the company or association does
2 36 not meet any of the descriptions in subparagraph (1).
2 37 d. For the 2005 calendar year:
2 38 (1) One and one-fourth percent if the company or
2 39 association is described as any of the following:
2 40 (a) It is taxed under section 432.2.
2 41 (b) Its policies and contracts provide for third-
2 42 party payments or prepayments of health or medical
2 43 expenses which include coverage benefits for treatment
2 44 for neurobiological disorders and underlying co-
2 45 morbidity as provided in section 514C.21 and it meets
2 46 the requirements of subparagraph subdivision (d), (e),
2 47 or (f).
2 48 (c) Its commercial domicile is not in Iowa.
2 49 (d) Its commercial domicile is in Iowa and its
2 50 total premiums received in the previous calendar year
3 1 are less than ten million dollars and in the case of a
3 2 health insurance company or association it meets the
3 3 requirements of subparagraph subdivision (b).
3 4 (e) Its commercial domicile is in Iowa, its total
3 5 premiums received in the previous calendar year are at
3 6 least ten million dollars but not more than one
3 7 hundred million dollars, and it has purchased equity
3 8 interests in the Iowa fund of funds through the end of
3 9 the previous calendar year of at least one million
3 10 five hundred thousand dollars and in the case of a
3 11 health insurance company or association it meets the
3 12 requirements of subparagraph subdivision (b).
3 13 (f) Its commercial domicile is in Iowa, its total
3 14 premiums received in the previous calendar year are
3 15 more than one hundred million dollars, and it has
3 16 purchased equity interests in the Iowa fund of funds
3 17 through the end of the previous calendar year of at
3 18 least three million dollars and in the case of a
3 19 health insurance company or association it meets the
3 20 requirements of subparagraph subdivision (b).
3 21 (2) Two percent if the company or association does
3 22 not meet any of the descriptions in subparagraph (1).
3 23 e. For the 2006 and subsequent calendar years:
3 24 (1) One percent if the company or association is
3 25 described as any of the following:
3 26 (a) It is taxed under section 432.2.
3 27 (b) Its policies and contracts provide for third-
3 28 party payments or prepayments of health or medical
3 29 expenses which include coverage benefits for treatment
3 30 for neurobiological disorders and underlying co-
3 31 morbidity as provided in section 514C.21 and it meets
3 32 the requirements of subparagraph subdivision (d), (e),
3 33 or (f).
3 34 (c) Its commercial domicile is not in Iowa.
3 35 (d) Its commercial domicile is in Iowa and its
3 36 total premiums received in the previous calendar year
3 37 are less than ten million dollars and in the case of a
3 38 health insurance company or association it meets the
3 39 requirements of subparagraph subdivision (b).
3 40 (e) Its commercial domicile is in Iowa, its total
3 41 premiums received in the previous calendar year are at
3 42 least ten million dollars but not more than one
3 43 hundred million dollars, and it has purchased equity
3 44 interests in the Iowa fund of funds through the end of
3 45 the previous calendar year of at least two million
3 46 dollars and in the case of a health insurance company
3 47 or association it meets the requirements of
3 48 subparagraph subdivision (b).
3 49 (f) Its commercial domicile is in Iowa, its total
3 50 premiums received in the previous calendar year are
4 1 more than one hundred million dollars, and it has
4 2 purchased equity interests in the Iowa fund of funds
4 3 through the end of the previous calendar year of at
4 4 least four million dollars and in the case of a health
4 5 insurance company or association it meets the
4 6 requirements of subparagraph subdivision (b).
4 7 (2) Two percent if the company or association does
4 8 not meet any of the descriptions in subparagraph (1).
4 9 2A. The "applicable percent" for purposes of
4 10 subsection 2 is the following:
4 11 a. For calendar years beginning before the 2004
4 12 calendar year, two percent.
4 13 b. For the 2004 calendar year:
4 14 (1) One and three-fourths percent if the company
4 15 or association is described as any of the following:
4 16 (a) Its commercial domicile is not in Iowa.
4 17 (b) Its commercial domicile is in Iowa and its
4 18 total premiums received in the previous calendar year
4 19 are less than ten million dollars.
4 20 (c) Its commercial domicile is in Iowa, its total
4 21 premiums received in the previous calendar year are at
4 22 least ten million dollars but not more than one
4 23 hundred million dollars, and it has purchased equity
4 24 interests in the Iowa fund of funds through the end of
4 25 the previous calendar year of at least five hundred
4 26 thousand dollars.
4 27 (d) Its commercial domicile is in Iowa, its total
4 28 premiums received in the previous calendar year are
4 29 more than one hundred million dollars, and it has
4 30 purchased equity interests in the Iowa fund of funds
4 31 through the end of the previous calendar year of at
4 32 least one million dollars.
4 33 (2) Two percent if the company or association does
4 34 not meet any of the descriptions in subparagraph (1).
4 35 c. For the 2005 calendar year:
4 36 (1) One and one-half percent if the company or
4 37 association is described as any of the following:
4 38 (a) Its commercial domicile is not in Iowa.
4 39 (b) Its commercial domicile is in Iowa and its
4 40 total premiums received in the previous calendar year
4 41 are less than ten million dollars.
4 42 (c) Its commercial domicile is in Iowa, its total
4 43 premiums received in the previous calendar year are at
4 44 least ten million dollars but not more than one
4 45 hundred million dollars, and it has purchased equity
4 46 interests in the Iowa fund of funds through the end of
4 47 the previous calendar year of at least one million
4 48 dollars.
4 49 (d) Its commercial domicile is in Iowa, its total
4 50 premiums received in the previous calendar year are
5 1 more than one hundred million dollars, and it has
5 2 purchased equity interests in the Iowa fund of funds
5 3 through the end of the previous calendar year of at
5 4 least two million dollars.
5 5 (2) Two percent if the company or association does
5 6 not meet any of the descriptions in subparagraph (1).
5 7 d. For the 2006 calendar year:
5 8 (1) One and one-fourth percent if the company or
5 9 association is described as any of the following:
5 10 (a) Its commercial domicile is not in Iowa.
5 11 (b) Its commercial domicile is in Iowa and its
5 12 total premiums received in the previous calendar year
5 13 are less than ten million dollars.
5 14 (c) Its commercial domicile is in Iowa, its total
5 15 premiums received in the previous calendar year are at
5 16 least ten million dollars but not more than one
5 17 hundred million dollars, and it has purchased equity
5 18 interests in the Iowa fund of funds through the end of
5 19 the previous calendar year of at least one million
5 20 five hundred thousand dollars.
5 21 (d) Its commercial domicile is in Iowa, its total
5 22 premiums received in the previous calendar year are
5 23 more than one hundred million dollars, and it has
5 24 purchased equity interests in the Iowa fund of funds
5 25 through the end of the previous calendar year of at
5 26 least three million dollars.
5 27 (2) Two percent if the company or association does
5 28 not meet any of the descriptions in subparagraph (1).
5 29 e. For the 2007 and subsequent calendar years:
5 30 (1) One percent if the company or association is
5 31 described as any of the following:
5 32 (a) Its commercial domicile is not in Iowa.
5 33 (b) Its commercial domicile is in Iowa and its
5 34 total premiums received in the previous calendar year
5 35 are less than ten million dollars.
5 36 (c) Its commercial domicile is in Iowa, its total
5 37 premiums received in the previous calendar year are at
5 38 least ten million dollars but not more than one
5 39 hundred million dollars, and it has purchased equity
5 40 interests in the Iowa fund of funds the end of the
5 41 previous calendar year of at least two million
5 42 dollars.
5 43 (d) Its commercial domicile is in Iowa, its total
5 44 premiums received in the previous calendar year are
5 45 more than one hundred million dollars, and it has
5 46 purchased equity interests in the Iowa fund of funds
5 47 through the end of the previous calendar year of at
5 48 least four million dollars.
5 49 (2) Two percent if the company or association does
5 50 not meet any of the descriptions in subparagraph (1).
6 1 Sec. . NEW SECTION. 514C.21 MANDATED COVERAGE
6 2 FOR NEUROBIOLOGICAL DISORDERS AND UNDERLYING CO-
6 3 MORBIDITY.
6 4 1. For purposes of this section, unless the
6 5 context otherwise requires:
6 6 a. "Co-morbidity" means the coexistence of
6 7 conditions or diagnosable disorders such as
6 8 neurobiological disorders and substance abuse. For
6 9 purposes of this section, "substance abuse" means a
6 10 pattern of pathological use of alcohol or a drug that
6 11 causes impairment in social or occupational
6 12 functioning, or that produces physiological dependency
6 13 evidenced by physical tolerance or by physical
6 14 symptoms when the alcohol or drug is withdrawn.
6 15 b. "Neurobiological disorder" means the following:
6 16 (1) Schizophrenia and other psychotic disorders.
6 17 (2) Affective disorders.
6 18 (3) Anxiety disorders.
6 19 (4) Pervasive developmental disorders.
6 20 (5) Attention deficit hyperactivity disorder and
6 21 related disorders.
6 22 (6) Disorders identified in childhood and
6 23 adolescence.
6 24 The commissioner, by rule, shall identify the
6 25 neurobiological disorders covered by this definition,
6 26 consistent with the guidelines provided in the most
6 27 recent edition of the American psychiatric
6 28 association's diagnostic and statistical manual of
6 29 mental disorders, as such definitions may be amended
6 30 from time to time. The commissioner may adopt the
6 31 definitions provided in the manual by reference.
6 32 c. "Rates, terms, and conditions" means any
6 33 lifetime or annual payment limits, deductibles,
6 34 copayments, coinsurance, and any other cost-sharing
6 35 requirements, out-of-pocket limits, visit limitations,
6 36 and any other financial component of benefits coverage
6 37 that affects the covered individual.
6 38 2. a. Notwithstanding the uniformity of treatment
6 39 requirements of section 514C.6, a policy, contract, or
6 40 plan providing for third-party payment or prepayment
6 41 of health or medical expenses shall provide coverage
6 42 benefits for treatment for neurobiological disorders
6 43 and underlying co-morbidity based on rates, terms, and
6 44 conditions that are no more restrictive than the
6 45 rates, terms, and conditions for coverage benefits
6 46 provided for other health or medical conditions under
6 47 the policy, contract, or plan.
6 48 b. Any restrictions or limitations with respect to
6 49 rates, terms, and conditions involving deductibles,
6 50 copayments, coinsurance, and any other cost-sharing
7 1 requirements shall be cumulative for coverage of
7 2 treatment for neurobiological disorders and underlying
7 3 co-morbidity and other health or medical conditions
7 4 under a policy, contract, or plan. A policy,
7 5 contract, or plan subject to this section shall not
7 6 impose an aggregate lifetime or annual limit on
7 7 treatment for neurobiological disorders and underlying
7 8 co-morbidity coverage benefits unless the policy,
7 9 contract, or plan imposes an aggregate lifetime or
7 10 annual limit on substantially all health or medical
7 11 coverage benefits. A policy, contract, or plan
7 12 subject to this section that imposes an aggregate
7 13 lifetime or annual limit on substantially all medical
7 14 and surgical coverage benefits shall not impose an
7 15 aggregate lifetime or annual limit on treatment for
7 16 neurobiological disorders and underlying co-morbidity
7 17 coverage benefits that is less than the aggregate
7 18 lifetime or annual limit imposed on substantially all
7 19 health or medical coverage benefits.
7 20 c. Coverage required under this section shall be
7 21 for the treatment of neurobiological disorders and
7 22 underlying co-morbidity, for services provided by a
7 23 health professional licensed under chapter 147A, 148,
7 24 150A, 152, 154B, 154C, or 154D, for services provided
7 25 in a hospital, clinic, office, community mental health
7 26 center, health care facility, outpatient treatment
7 27 facility, residential treatment facility, halfway
7 28 house, or similar facility for the provision of health
7 29 care services, and for services provided pursuant to
7 30 the comprehensive program for treatment for substance
7 31 abuse maintained by the department of public health
7 32 pursuant to section 125.12 in a hospital licensed
7 33 under chapter 135B or a facility licensed under
7 34 chapter 125.
7 35 3. This section applies to the following classes
7 36 of third-party payment provider policies, contracts,
7 37 or plans delivered, issued for delivery, continued, or
7 38 renewed in this state on or after January 1, 2003:
7 39 a. Individual or group accident and sickness
7 40 insurance providing coverage on an expense-incurred
7 41 basis.
7 42 b. An individual or group hospital or medical
7 43 service contract issued pursuant to chapter 509, 514,
7 44 or 514A.
7 45 c. A plan established pursuant to chapter 509A for
7 46 public employees.
7 47 d. An individual or group health maintenance
7 48 organization contract regulated under chapter 514B.
7 49 e. An individual or group Medicare supplemental
7 50 policy, unless coverage pursuant to such policy is
8 1 preempted by federal law.
8 2 f. Any other entity engaged in the business of
8 3 insurance, risk transfer, or risk retention, which is
8 4 subject to the jurisdiction of the commissioner.
8 5 g. An organized delivery system licensed by the
8 6 director of public health.
8 7 4. The commissioner shall adopt rules pursuant to
8 8 chapter 17A to administer this section."
8 9
8 10
8 11
8 12 THOMAS FIEGEN
8 13
8 14
8 15
8 16
8 17
8 18
8 19
8 20
8 21
8 22 HF 2623.312 79
8 23 mg/cf
Text: S05509 Text: S05511 Text: S05500 - S05599 Text: S Index Bills and Amendments: General Index Bill History: General Index
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