H-8059

   Amend House File 2236 as follows:
   1.  Page 8, after line 4 by inserting: 
   <Sec. ___.  Section 514C.19, Code 2018, is amended to read as follows:
   514C.19  Prescription contraceptive coverage. 
   1.  For purposes of this section:
   a.  “Dispense” means the same as defined in section 155A.3.
   b.  “Health care professional” means the same as defined in section 514J.102.
   c.  “Prescription contraceptive” means a medically acceptable oral drug or contraceptive patch or ring that is used to prevent pregnancy, and requires a prescription.
   1.  2.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a group policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not do either of the following:
   a.  Exclude or restrict benefits for a prescription contraceptive drugs or prescription contraceptive devices which prevent conception and which are contraceptive that is approved by the United States food and drug administration, or a generic equivalents equivalent approved as substitutable a substitute by the United States food and drug administration, if such policy, or contract, or plan provides benefits a benefit for any other outpatient prescription drugs drug or devices device. Such policy, contract, or plan shall provide for payment to a health care professional that dispenses any of the following to a covered person:
   (1)  A three-month supply of a prescription contraceptive the first time the prescription contraceptive is dispensed to the covered person.
   (2)  A twelve-month supply of a prescription contraceptive for any subsequent dispensing of the same prescription contraceptive to the covered person. 
   (3)  A three-month supply of a prescription vaginal contraceptive ring. 
   b.  Exclude or restrict benefits for an outpatient contraceptive services which are service that is provided for the purpose of preventing conception if such policy, or contract, or plan provides benefits a benefit for any other outpatient services service provided by a health care professional.
   2.  3.  A person who provides a group policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses which is subject to subsection 1 2 shall not do any of the following:
   a.  Deny to an individual eligibility, or continued eligibility, to enroll in or to renew coverage under the terms of the policy, or contract, or plan because of the individual’s use or potential use of such a prescription contraceptive drugs drug or devices device, or use or potential use of an outpatient contraceptive services service.
   b.  Provide a monetary payment or rebate to a covered individual to encourage such individual to accept less than the minimum benefits provided for under subsection 1 2.
   c.  Penalize or otherwise reduce or limit the reimbursement of a health care professional because such professional prescribes a contraceptive drugs drug or devices device, or provides a contraceptive services service.
   d.  Provide incentives an incentive, monetary or otherwise, to a health care professional to induce such professional to withhold from a covered individual a contraceptive drugs drug or devices device, or a contraceptive services service from a covered individual.
   3.  4.  This section shall not be construed to prevent a third-party payor from including deductibles, coinsurance, or copayments under the policy, or contract, or plan as follows:
   a.  A deductible, coinsurance, or copayment for benefits a benefit for a prescription contraceptive drugs drug shall not be greater than such deductible, coinsurance, or copayment for any outpatient prescription drug for which coverage under the policy, or contract, or plan is provided.
   b.  A deductible, coinsurance, or copayment for benefits a benefit for a prescription contraceptive devices device shall not be greater than such deductible, coinsurance, or copayment for any outpatient prescription device for which coverage under the policy, or contract, or plan is provided.
   c.  A deductible, coinsurance, or copayment for benefits a benefit for an outpatient contraceptive services service shall not be greater than such deductible, coinsurance, or copayment for any outpatient health care services service for which coverage under the policy, or contract, or plan is provided.
   4.  5.  This section shall not be construed to require a third-party payor under a policy, or contract, or plan to provide benefits a benefit for an experimental or investigational contraceptive drugs drug or devices device, or experimental or investigational contraceptive services service, except to the extent that such policy, or contract, or plan provides coverage for any other experimental or investigational outpatient prescription drugs drug or devices device, or experimental or investigational outpatient health care services service.
   5.  6.  This section shall not be construed to limit or otherwise discourage the any of the following:
   a.  The use of a generic equivalent drugs drug approved by the United States food and drug administration, whenever if available and appropriate. This section, when a brand name drug is requested by a covered individual and a suitable generic equivalent is available and appropriate, shall not be construed to prohibit a
   b.  A third-party payor from requiring the a covered individual to pay a deductible, coinsurance, or copayment consistent with subsection 3 4, in addition to the difference of the cost of the brand name drug less the maximum covered amount for a generic equivalent.
   7.  This section shall not be construed to require a third-party payor to provide payment to a health care professional for dispensing a prescription contraceptive to replace a prescription contraceptive that has been dispensed to a covered person and that has been misplaced, stolen, or destroyed. This section shall not be construed to require a third-party payor to replace covered prescriptions that are misplaced, stolen, or destroyed.
   6.  8.  A person who provides an individual policy, or contract, or plan providing for third-party payment or prepayment of health or medical expenses shall make available a coverage provision that satisfies the requirements in subsections 1 2 through 5 7 in the same manner as such requirements are applicable to a group policy, or contract, or plan under those subsections. The policy, or contract, or plan shall provide that the individual policyholder may reject the coverage provision at the option of the policyholder.
   7.  9.  a.  This section applies shall apply to the following classes of third-party payment provider policies, contracts, or policies and plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2000 2018:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  Any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
   (5)  A plan established pursuant to chapter 509A for public employees.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.>
   2.  Title page, by striking lines 1 through 3 and inserting <An Act relating to the commissioner of insurance as the agent or attorney for service of process and as the regulator of insurance coverage for dispensing of prescription contraceptives, and resolving>
   3.  By renumbering as necessary.

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BENNETT of Linn