House File 2533 - Introduced
HOUSE FILE
BY KRESSIG
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to third=party payment of health care coverage
2 costs for hyperbaric oxygen treatments.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
4 TLSB 6272HH 81
5 av/sh/8
PAG LIN
1 1 Section 1. NEW SECTION. 514C.23 HYPERBARIC OXYGEN
1 2 THERAPY COVERAGE.
1 3 1. Notwithstanding the uniformity of treatment
1 4 requirements of section 514C.6, a policy, contract, or plan
1 5 providing for third=party payment or prepayment of health or
1 6 medical expenses shall provide hyperbaric oxygen therapy
1 7 coverage, including but not limited to the following classes
1 8 of third=party payment provider contracts or policies
1 9 delivered, issued for delivery, continued, or renewed in this
1 10 state:
1 11 a. Individual or group accident and sickness insurance
1 12 providing coverage on an expense=incurred basis.
1 13 b. An individual or group hospital or medical service
1 14 contract issued pursuant to chapter 509, 509A, 514, or 514A.
1 15 c. An individual or group health maintenance organization
1 16 contract regulated under chapter 514B.
1 17 d. An individual or group Medicare supplemental policy,
1 18 unless coverage pursuant to such policy is preempted by
1 19 federal law.
1 20 2. This section shall not apply to accident only,
1 21 specified disease, short=term hospital or medical, hospital
1 22 confinement indemnity, credit, dental, vision, long=term care,
1 23 basic hospital, and medical=surgical expense coverage as
1 24 defined by the commissioner, disability income insurance
1 25 coverage, coverage issued as a supplement to liability
1 26 insurance, workers' compensation or similar insurance, or
1 27 automobile medical payment insurance.
1 28 3. As used in this section, "hyperbaric oxygen therapy
1 29 coverage" means benefits for the medical use of oxygen at a
1 30 higher than atmospheric pressure for the treatment of either a
1 31 traumatic brain injury or any other disorder affecting the
1 32 central nervous system, including cerebral edema, cerebral
1 33 palsy, multiple sclerosis, anoxic encephalopathies, and any
1 34 other autoimmune or other disease affecting the central
1 35 nervous system.
2 1 4. An annual deductible or coinsurance for hyperbaric
2 2 oxygen therapy coverage shall not be greater than the annual
2 3 deductible or coinsurance established for similar benefits
2 4 under the policy, contract, or plan. If the policy, contract,
2 5 or plan does not provide similar benefits, the deductible or
2 6 coinsurance for hyperbaric oxygen therapy coverage shall not
2 7 be an amount that materially diminishes the value of the
2 8 required coverage.
2 9 5. The commissioner of insurance shall adopt rules under
2 10 chapter 17A as necessary to do all of the following:
2 11 a. Administer the provisions of this section.
2 12 b. Ensure that policies, contracts, or plans that provide
2 13 third=party payment or prepayment of health or medical
2 14 expenses do not include burdensome criteria or other obstacles
2 15 which interfere with access to and provision of the benefits
2 16 required by this section.
2 17 6. This section applies to third=party payment provider
2 18 policies, contracts, or plans that are delivered, issued for
2 19 delivery, continued, or renewed in this state on or after
2 20 January 1, 2007.
2 21 EXPLANATION
2 22 This bill creates new Code section 514C.23 which mandates
2 23 payment of health care costs for hyperbaric oxygen therapy
2 24 coverage in certain policies, contracts, or plans providing
2 25 for third=party payment or prepayment of health or medical
2 26 expenses. The bill provides that the mandate does not apply
2 27 to certain specified types of insurance coverage.
2 28 The bill defines "hyperbaric oxygen therapy coverage" as
2 29 benefits for the medical use of oxygen at a higher than
2 30 atmospheric pressure for the treatment of either a traumatic
2 31 brain injury or any other disorder affecting the central
2 32 nervous system, including cerebral edema, cerebral palsy,
2 33 multiple sclerosis, anoxic encephalopathies, and any other
2 34 autoimmune or other disease affecting the central nervous
2 35 system.
3 1 The covered benefits cannot be subject to an annual
3 2 deductible or coinsurance that is greater than that
3 3 established for similar benefits, or if there are no similar
3 4 covered benefits, then the deductible or coinsurance cannot be
3 5 in an amount that materially diminishes the value of the
3 6 required coverage.
3 7 The bill also requires the commissioner of insurance to
3 8 adopt rules under Code chapter 17A as necessary to administer
3 9 the new section and to prevent insurers from adopting
3 10 burdensome criteria or creating other obstacles which
3 11 interfere with access to or provision of the benefits required
3 12 by the new section.
3 13 The new Code section applies to third=party payment
3 14 provider policies, contracts, or plans that are delivered,
3 15 issued for delivery, continued, or renewed in this state on or
3 16 after January 1, 2007.
3 17 LSB 6272HH 81
3 18 av:nh/sh/8