Senate File 359 H-8446 Amend the amendment, H-8269, to Senate File 359, as passed by 1 the Senate, as follows: 2 1. Page 3, after line 19 by inserting: 3 < DIVISION ___ 4 PRESCRIPTION CONTRACEPTIVE COVERAGE 5 Sec. ___. Section 514C.19, Code 2018, is amended to read as 6 follows: 7 514C.19 Prescription contraceptive coverage. 8 1. For purposes of this section: 9 a. “Dispense” means the same as defined in section 155A.3. 10 b. “Health care professional” means the same as defined in 11 section 514J.102. 12 c. “Prescription contraceptive” means a medically acceptable 13 oral drug or contraceptive patch or ring that is used to 14 prevent pregnancy, and requires a prescription. 15 1. 2. Notwithstanding the uniformity of treatment 16 requirements of section 514C.6 , a group policy , or contract , or 17 plan providing for third-party payment or prepayment of health 18 or medical expenses shall not do either of the following: 19 a. Exclude or restrict benefits for a prescription 20 contraceptive drugs or prescription contraceptive devices which 21 prevent conception and which are contraceptive that is approved 22 by the United States food and drug administration, or a generic 23 equivalents equivalent approved as substitutable a substitute 24 by the United States food and drug administration, if such 25 policy , or contract , or plan provides benefits a benefit for 26 any other outpatient prescription drugs drug or devices device . 27 Such policy, contract, or plan shall provide for payment to a 28 health care professional that dispenses any of the following to 29 a covered person: 30 (1) A three-month supply of a prescription contraceptive 31 the first time the prescription contraceptive is dispensed to 32 the covered person. 33 (2) A twelve-month supply of a prescription contraceptive 34 for any subsequent dispensing of the same prescription 35 -1- H8269.5595 (1) 87 pf/rh 1/ 5 #1.

contraceptive to the covered person. 1 (3) A three-month supply of a prescription vaginal 2 contraceptive ring. 3 b. Exclude or restrict benefits for an outpatient 4 contraceptive services which are service that is provided 5 for the purpose of preventing conception if such policy , 6 or contract , or plan provides benefits a benefit for any 7 other outpatient services service provided by a health care 8 professional. 9 2. 3. A person who provides a group policy , or contract , or 10 plan providing for third-party payment or prepayment of health 11 or medical expenses which is subject to subsection 1 2 shall 12 not do any of the following: 13 a. Deny to an individual eligibility, or continued 14 eligibility, to enroll in or to renew coverage under the terms 15 of the policy , or contract , or plan because of the individual’s 16 use or potential use of such a prescription contraceptive 17 drugs drug or devices device , or use or potential use of an 18 outpatient contraceptive services service . 19 b. Provide a monetary payment or rebate to a covered 20 individual to encourage such individual to accept less than the 21 minimum benefits provided for under subsection 1 2 . 22 c. Penalize or otherwise reduce or limit the reimbursement 23 of a health care professional because such professional 24 prescribes a contraceptive drugs drug or devices device , or 25 provides a contraceptive services service . 26 d. Provide incentives an incentive , monetary or otherwise, 27 to a health care professional to induce such professional to 28 withhold from a covered individual a contraceptive drugs drug 29 or devices device , or a contraceptive services service from a 30 covered individual . 31 3. 4. This section shall not be construed to prevent a 32 third-party payor from including deductibles, coinsurance, or 33 copayments under the policy , or contract, or plan as follows: 34 a. A deductible, coinsurance, or copayment for benefits a 35 -2- H8269.5595 (1) 87 pf/rh 2/ 5

benefit for a prescription contraceptive drugs drug shall not 1 be greater than such deductible, coinsurance, or copayment for 2 any outpatient prescription drug for which coverage under the 3 policy , or contract , or plan is provided. 4 b. A deductible, coinsurance, or copayment for benefits a 5 benefit for a prescription contraceptive devices device shall 6 not be greater than such deductible, coinsurance, or copayment 7 for any outpatient prescription device for which coverage under 8 the policy , or contract , or plan is provided. 9 c. A deductible, coinsurance, or copayment for benefits a 10 benefit for an outpatient contraceptive services service shall 11 not be greater than such deductible, coinsurance, or copayment 12 for any outpatient health care services service for which 13 coverage under the policy , or contract , or plan is provided. 14 4. 5. This section shall not be construed to require 15 a third-party payor under a policy , or contract , or plan 16 to provide benefits a benefit for an experimental or 17 investigational contraceptive drugs drug or devices device , or 18 experimental or investigational contraceptive services service , 19 except to the extent that such policy , or contract , or plan 20 provides coverage for any other experimental or investigational 21 outpatient prescription drugs drug or devices device , or 22 experimental or investigational outpatient health care services 23 service . 24 5. 6. This section shall not be construed to limit or 25 otherwise discourage the any of the following: 26 a. The use of a generic equivalent drugs drug approved 27 by the United States food and drug administration , whenever 28 if available and appropriate. This section , when a brand 29 name drug is requested by a covered individual and a suitable 30 generic equivalent is available and appropriate, shall not be 31 construed to prohibit a 32 b. A third-party payor from requiring the a covered 33 individual to pay a deductible, coinsurance, or copayment 34 consistent with subsection 3 4 , in addition to the difference 35 -3- H8269.5595 (1) 87 pf/rh 3/ 5

of the cost of the brand name drug less the maximum covered 1 amount for a generic equivalent. 2 7. This section shall not be construed to require a 3 third-party payor to provide payment to a health care 4 professional for dispensing a prescription contraceptive to 5 replace a prescription contraceptive that has been dispensed 6 to a covered person and that has been misplaced, stolen, or 7 destroyed. This section shall not be construed to require a 8 third-party payor to replace covered prescriptions that are 9 misplaced, stolen, or destroyed. 10 6. 8. A person who provides an individual policy , or 11 contract , or plan providing for third-party payment or 12 prepayment of health or medical expenses shall make available 13 a coverage provision that satisfies the requirements in 14 subsections 1 2 through 5 7 in the same manner as such 15 requirements are applicable to a group policy , or contract , or 16 plan under those subsections. The policy , or contract , or plan 17 shall provide that the individual policyholder may reject the 18 coverage provision at the option of the policyholder. 19 7. 9. a. This section applies shall apply to the following 20 classes of third-party payment provider policies, contracts , or 21 policies and plans delivered, issued for delivery, continued, 22 or renewed in this state on or after July 1, 2000 2018 : 23 (1) Individual or group accident and sickness insurance 24 providing coverage on an expense-incurred basis. 25 (2) An individual or group hospital or medical service 26 contract issued pursuant to chapter 509 , 514 , or 514A . 27 (3) An individual or group health maintenance organization 28 contract regulated under chapter 514B . 29 (4) Any other entity engaged in the business of insurance, 30 risk transfer, or risk retention, which is subject to the 31 jurisdiction of the commissioner. 32 (5) A plan established pursuant to chapter 509A for public 33 employees. 34 b. This section shall not apply to accident-only, 35 -4- H8269.5595 (1) 87 pf/rh 4/ 5

specified disease, short-term hospital or medical, hospital 1 confinement indemnity, credit, dental, vision, Medicare 2 supplement, long-term care, basic hospital and medical-surgical 3 expense coverage as defined by the commissioner, disability 4 income insurance coverage, coverage issued as a supplement 5 to liability insurance, workers’ compensation or similar 6 insurance, or automobile medical payment insurance. > 7 2. Page 3, line 22, after < fetus > by inserting < and 8 contraception > 9 ______________________________ HINSON of Linn -5- H8269.5595 (1) 87 pf/rh 5/ 5 #2.