House File 444
HOUSE FILE
BY PETERSEN, CONNORS, DANDEKAR,
D. OLSON, LYKAM, MURPHY,
MASCHER, BUKTA, D. TAYLOR,
McCARTHY, GREIMANN, BERRY,
FREVERT, GASKILL, WHITEAD,
WHITAKER, QUIRK, STEVENS,
WISE, FALLON, SHOULTZ, OLDSON,
REASONER, SWAIM, LENSING, HOGG,
DAVITT, OSTERHAUS, WINCKLER,
JOCHUM, HUNTER, and T. TAYLOR
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to notice of rate increases for health insurance
2 coverage and short=term renewability of coverage.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
4 TLSB 1977HH 80
5 jj/cf/24
PAG LIN
1 1 Section 1. Section 509.3, Code 2003, is amended by adding
1 2 the following new subsection:
1 3 NEW SUBSECTION. 8. a. A provision under policies,
1 4 contracts, or plans with group health benefit coverages
1 5 permitting the policyholder to renew the coverage in one=month
1 6 increments, for up to two months, at a pro rata premium rate
1 7 that is proportional to the full policy term.
1 8 b. For purposes of this subsection, "policies, contracts,
1 9 or plans with group health benefit coverages" includes all of
1 10 the following:
1 11 (1) A group policy of accident or health insurance issued
1 12 pursuant to this chapter.
1 13 (2) A group contract of a nonprofit health service
1 14 corporation issued pursuant to chapter 514.
1 15 (3) A group contract of a health maintenance organization
1 16 issued pursuant to chapter 514B.
1 17 (4) A group contract relating to care furnished by an
1 18 organized delivery system authorized under 1993 Iowa Acts,
1 19 chapter 158, licensed by the director of public health.
1 20 (5) Group health benefits provided pursuant to a multiple
1 21 employer welfare arrangement, as defined in section 3 of the
1 22 federal Employee Retirement Income Security Act of 1974, 29
1 23 U.S.C. } 1002, paragraph 40, that meets the requirements of
1 24 section 507A.4, subsection 9, paragraph "a".
1 25 (6) A plan for public employees established pursuant to
1 26 chapter 509A.
1 27 (7) An association group policy issued under section
1 28 509.14.
1 29 Sec. 2. NEW SECTION. 509.20 NOTICE OF RATE INCREASE.
1 30 1. For purposes of this section, "policy or contract for
1 31 group health benefit coverages, including a contract to
1 32 provide services to a plan providing group health benefit
1 33 coverages" applies to all of the following:
1 34 a. A group policy of health insurance under this chapter.
1 35 b. A plan established pursuant to chapter 509A for public
2 1 employees.
2 2 c. A plan offered pursuant to chapter 513B.
2 3 d. A group contract of a nonprofit health service
2 4 corporation under chapter 514.
2 5 e. A group plan of a health maintenance organization under
2 6 chapter 514B.
2 7 f. An organized delivery system authorized under 1993 Iowa
2 8 Acts, chapter 158, and licensed by the director of public
2 9 health.
2 10 g. Preferred provider contracts limiting choice of
2 11 specific provider.
2 12 h. Any other policy, contract, or plan for covering the
2 13 health care costs of a defined group.
2 14 2. A person who issues a policy or contract for group
2 15 health benefit coverages, including a contract to provide
2 16 services to a plan providing group health benefit coverages to
2 17 a group, shall provide notice of a rate increase for the
2 18 policy or contract at least forty=five days prior to the
2 19 effective date of the rate increase to the policyholder,
2 20 contract holder, or sponsor of the group health benefit plan.
2 21 Sec. 3. Section 514.6, Code 2003, is amended to read as
2 22 follows:
2 23 514.6 RATES == APPROVAL BY COMMISSIONER == NOTICE OF
2 24 INCREASE.
2 25 1. The rates charged by any such corporation to the
2 26 subscribers for health care service shall at all times be
2 27 subject to the approval of the commissioner of insurance.
2 28 2. A corporation offering health care services to
2 29 subscribers pursuant to this chapter shall provide notice of a
2 30 rate increase to subscribers at least forty=five days prior to
2 31 the effective date of the rate increase.
2 32 Sec. 4. Section 514.7, Code 2003, is amended to read as
2 33 follows:
2 34 514.7 CONTRACTS == APPROVAL BY COMMISSIONER == PROVISIONS
2 35 TO BE AVAILABLE.
3 1 1. The contracts by any such corporation with the
3 2 subscribers for health care service shall at all times be
3 3 subject to the approval of the commissioner of insurance. The
3 4 commissioner shall require that participating pharmacies be
3 5 reimbursed by the pharmaceutical service corporation at rates
3 6 or prices equal to rates or prices charged nonsubscribers,
3 7 unless the commissioner determines otherwise to prevent loss
3 8 to subscribers.
3 9 2. a. A provision shall be available in approved
3 10 contracts with hospital and medical service corporate
3 11 subscribers under group subscriber contracts or plans covering
3 12 vision care services or procedures, for payment of necessary
3 13 medical or surgical care and treatment provided by an
3 14 optometrist licensed under chapter 154, if the care and
3 15 treatment are provided within the scope of the optometrist's
3 16 license and if the subscriber contract would pay for the care
3 17 and treatment if it were provided by a person engaged in the
3 18 practice of medicine or surgery as licensed under chapter 148
3 19 or 150A.
3 20 b. The subscriber contract shall also provide that the
3 21 subscriber may reject the coverage or provision if the
3 22 coverage or provision for services which may be provided by an
3 23 optometrist is rejected for all providers of similar vision
3 24 care services as licensed under chapter 148, 150A, or 154.
3 25 c. This paragraph subsection applies to group subscriber
3 26 contracts delivered after July 1, 1983, and to group
3 27 subscriber contracts on their anniversary or renewal date, or
3 28 upon the expiration of the applicable collective bargaining
3 29 contract, if any, whichever is the later.
3 30 d. This paragraph subsection does not apply to contracts
3 31 designed only for issuance to subscribers eligible for
3 32 coverage under Title XVIII of the Social Security Act, or any
3 33 other similar coverage under a state or federal government
3 34 plan.
3 35 3. a. A provision shall be made available in approved
4 1 contracts with hospital and medical subscribers under group
4 2 subscriber contracts or plans covering diagnosis and treatment
4 3 of human ailments, for payment or reimbursement for necessary
4 4 diagnosis or treatment provided by a chiropractor licensed
4 5 under chapter 151 if the diagnosis or treatment is provided
4 6 within the scope of the chiropractor's license and if the
4 7 subscriber contract would pay or reimburse for the diagnosis
4 8 or treatment of the human ailments, irrespective of and
4 9 disregarding variances in terminology employed by the various
4 10 licensed professions in describing the human ailments or their
4 11 diagnosis or treatment, if it were provided by a person
4 12 licensed under chapter 148, 150, or 150A.
4 13 b. The subscriber contract shall also provide that the
4 14 subscriber may reject the coverage or provision if the
4 15 coverage or provision for diagnosis or treatment of a human
4 16 ailment by a chiropractor is rejected for all providers of
4 17 diagnosis or treatment for similar human ailments licensed
4 18 under chapter 148, 150, 150A, or 151.
4 19 c. A group subscriber contract may limit or make optional
4 20 the payment or reimbursement for lawful diagnostic or
4 21 treatment service by all licensees under chapters 148, 150,
4 22 150A, and 151 on any rational basis which is not solely
4 23 related to the license under or the practices authorized by
4 24 chapter 151 or is not dependent upon a method of
4 25 classification, categorization, or description based upon
4 26 differences in terminology used by different licensees in
4 27 describing human ailments or their diagnosis or treatment.
4 28 d. This paragraph subsection applies to group subscriber
4 29 contracts delivered after July 1, 1986, and to group
4 30 subscriber contracts on their anniversary or renewal date, or
4 31 upon the expiration of the applicable collective bargaining
4 32 contract, if any, whichever is the later.
4 33 e. This paragraph subsection does not apply to contracts
4 34 designed only for issuance to subscribers eligible for
4 35 coverage under Title XVIII of the Social Security Act, or any
5 1 other similar coverage under a state or federal government
5 2 plan.
5 3 4. a. A provision shall be available in approved
5 4 contracts with hospital and medical service corporate
5 5 subscribers under group subscriber contracts or plans covering
5 6 medical and surgical service, for payment of covered services
5 7 determined to be medically necessary provided by certified
5 8 registered nurses certified by a national certifying
5 9 organization, which organization shall be identified by the
5 10 Iowa board of nursing pursuant to rules adopted by the board,
5 11 if the services are within the practice of the profession of a
5 12 registered nurse as that practice is defined in section 152.1,
5 13 under terms and conditions agreed upon between the corporation
5 14 and subscriber group, subject to utilization controls.
5 15 b. This paragraph subsection shall not require payment for
5 16 nursing services provided by a certified registered nurse
5 17 practicing in a hospital, nursing facility, health care
5 18 institution, a physician's office, or other noninstitutional
5 19 setting if the certified registered nurse is an employee of
5 20 the hospital, nursing facility, health care institution,
5 21 physician, or other health care facility or health care
5 22 provider.
5 23 c. This paragraph subsection applies to group subscriber
5 24 contracts delivered in this state on or after July 1, 1989,
5 25 and to group subscriber contracts on their anniversary or
5 26 renewal date, or upon the expiration of the applicable
5 27 collective bargaining contract, if any, whichever is the
5 28 later.
5 29 d. This paragraph subsection does not apply to limited or
5 30 specified disease or individual contracts or contracts
5 31 designed only for issuance to subscribers eligible for
5 32 coverage under Title XVIII of the federal Social Security Act,
5 33 contracts which that are rated on a community basis, or any
5 34 other similar coverage under a state or federal government
5 35 plan.
6 1 5. The commissioner shall require a provision permitting
6 2 the policyholder to renew the coverage in one=month
6 3 increments, for up to two months, at a pro rata premium rate
6 4 that is proportional to the full policy term.
6 5 EXPLANATION
6 6 This bill amends various Code chapters dealing with group
6 7 health insurance, to require a 45=day notice of rate increases
6 8 in premiums, and to permit a policyholder to renew the
6 9 coverage in one=month increments, for up to two months, at pro
6 10 rata rates compared to the premiums for the full policy term.
6 11 The bill adds new Code section 509.20 to require such
6 12 notice for group health insurance policies, contracts, and
6 13 plans. Code section 514.6 addresses coverage provided by a
6 14 nonprofit health service corporation.
6 15 The bill adds a new subsection to Code section 509.3 to
6 16 require a provision for policyholder renewability for up to
6 17 two months for group health insurance policies, contracts, and
6 18 plans. A new subsection in Code section 514.7 addresses the
6 19 renewability requirements with respect to coverage provided by
6 20 a nonprofit health service corporation. The bill also divides
6 21 existing Code language into subsections and paragraphs, and
6 22 makes appropriate internal language changes.
6 23 LSB 1977HH 80
6 24 jj/cf/24.1