House Journal: Page 1376: Thursday, April 11, 2002
34 from time to time. The commissioner may adopt the
35 definitions provided in the manual by reference.
36 c. "Rates, terms, and conditions" means any
37 lifetime or annual payment limits, deductibles,
38 copayments, coinsurance, and any other cost-sharing
39 requirements, out-of-pocket limits, visit limitations,
40 and any other financial component of benefits coverage
41 that affects the covered individual.
42 2. a. Notwithstanding the uniformity of treatment
43 requirements of section 514C.6, a policy, contract, or
44 plan providing for third-party payment or prepayment
45 of health or medical expenses shall provide coverage
46 benefits for treatment for neurobiological disorders
47 and underlying co-morbidity based on rates, terms, and
48 conditions that are no more restrictive than the
49 rates, terms, and conditions for coverage benefits
50 provided for other health or medical conditions under
Page 2
1 the policy, contract, or plan.
2 b. Any restrictions or limitations with respect to
3 rates, terms, and conditions involving deductibles,
4 copayments, coinsurance, and any other cost-sharing
5 requirements shall be cumulative for coverage of
6 treatment for neurobiological disorders and underlying
7 co-morbidity and other health or medical conditions
8 under a policy, contract, or plan. A policy,
9 contract, or plan subject to this section shall not
10 impose an aggregate lifetime or annual limit on
11 treatment for neurobiological disorders and underlying
12 co-morbidity coverage benefits unless the policy,
13 contract, or plan imposes an aggregate lifetime or
14 annual limit on substantially all health or medical
15 coverage benefits. A policy, contract, or plan
16 subject to this section that imposes an aggregate
17 lifetime or annual limit on substantially all medical
18 and surgical coverage benefits shall not impose an
19 aggregate lifetime or annual limit on treatment for
20 neurobiological disorders and underlying co-morbidity
21 coverage benefits that is less than the aggregate
22 lifetime or annual limit imposed on substantially all
23 health or medical coverage benefits.
24 c. Coverage required under this section shall be
25 for the treatment of neurobiological disorders and
26 underlying co-morbidity, for services provided by a
27 health professional licensed under chapter 147A, 148,
28 150A, 152, 154B, 154C, or 154D, for services provided
29 in a hospital, clinic, office, community mental health
30 center, health care facility, outpatient treatment
31 facility, residential treatment facility, halfway
32 house, or similar facility for the provision of health
© 2002 Cornell College and
League of Women Voters of Iowa
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