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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