House File 321 - Introduced
HOUSE FILE
BY HEDDENS, WESSEL=KROESCHELL,
GAYMAN, SHOMSHOR, FREVERT,
BUKTA, ABDUL-SAMAD, H. MILLER,
JOCHUM, BELL, PETERSEN,
T. TAYLOR, R. OLSON, SCHUELLER,
BAILEY, WENTHE, LENSING, FORD,
FOEGE, SMITH, KRESSIG, REASONER,
and D. TAYLOR
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act requiring health insurance coverage for certain dependent
2 children who are full=time students and require a medically
3 necessary leave of absence from school.
4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
5 TLSB 1437HH 82
6 av/cf/24
PAG LIN
1 1 Section 1. NEW SECTION. 514C.23 COVERAGE OF STUDENTS.
1 2 1. Notwithstanding the uniformity of treatment
1 3 requirements of section 514C.6, a policy or contract providing
1 4 for third=party payment or prepayment of health or medical
1 5 expenses, which provides coverage for dependent children of an
1 6 insured or subscriber beyond the age of eighteen years if the
1 7 child is a full=time student, shall include coverage during a
1 8 dependent's medically necessary leave of absence from school
1 9 for a period not to exceed twelve months or until the date on
1 10 which coverage would otherwise end pursuant to the terms and
1 11 conditions of the policy or contract, whichever comes first.
1 12 Any breaks in the school semester shall not disqualify a
1 13 dependent child from coverage under this section. Entitlement
1 14 to coverage under this section shall be established by
1 15 submitting documentation and certification of medical
1 16 necessity to the insurer from the student's attending
1 17 physician, which shall be considered prima facie evidence of
1 18 entitlement to coverage under this section. The date of the
1 19 documentation and certification of medical necessity of a
1 20 leave of absence shall be the date the entitlement to
1 21 insurance coverage required by this section commences.
1 22 2. a. This section applies to the following classes of
1 23 third=party payment provider contracts or policies delivered,
1 24 issued for delivery, continued, or renewed in this state on or
1 25 after July 1, 2007:
1 26 (1) Individual or group accident and sickness insurance
1 27 providing coverage on an expense=incurred basis.
1 28 (2) Any individual or group hospital or medical service
1 29 contract issued pursuant to chapter 509, 514, or 514A.
1 30 (3) Any individual or group health maintenance
1 31 organization contract regulated under chapter 514B.
1 32 (4) Any other entity engaged in the business of insurance,
1 33 risk transfer, or risk retention, which is subject to the
1 34 jurisdiction of the commissioner.
1 35 (5) A plan established pursuant to chapter 509A for public
2 1 employees.
2 2 (6) An organized delivery system licensed by the director
2 3 of public health.
2 4 b. This section shall not apply to accident=only,
2 5 specified disease, short=term hospital or medical, hospital
2 6 confinement indemnity, credit, dental, vision, Medicare
2 7 supplement, long=term care, basic hospital and medical=
2 8 surgical expense coverage as defined by the commissioner,
2 9 disability income insurance coverage, coverage issued as a
2 10 supplement to liability insurance, workers' compensation or
2 11 similar insurance, or automobile medical payment insurance, or
2 12 individual accident and sickness policies issued to
2 13 individuals or to individual members of a member association.
2 14 EXPLANATION
2 15 This bill requires health insurance coverage for certain
2 16 dependent children who are full=time students.
2 17 The bill provides that a policy or contract providing for
2 18 third=party payment or prepayment of health or medical
2 19 expenses, which provides coverage for dependent children of an
2 20 insured or subscriber beyond the age of 18 years if the child
2 21 is a full=time student, shall include coverage during a
2 22 dependent's medically necessary leave of absence from school
2 23 for a period not to exceed 12 months or until the date on
2 24 which coverage would otherwise end pursuant to the terms and
2 25 conditions of the policy, whichever comes first. The bill
2 26 provides that entitlement to the coverage must be established
2 27 by submitting documentation and certification of medical
2 28 necessity to the insurer from the student's treating
2 29 physician, which shall be considered prima facie evidence of
2 30 entitlement to coverage under the new provision. The date of
2 31 such documentation and certification is the date the
2 32 entitlement to such insurance coverage commences.
2 33 The coverage requirement applies to third=party payment
2 34 provider contracts or policies that are individual or group
2 35 accident and sickness insurance providing coverage on an
3 1 expense=incurred basis; individual or group hospital or
3 2 medical service contracts issued pursuant to Code chapter 509,
3 3 514, or 514A; individual or group health maintenance
3 4 organization contracts regulated under Code chapter 514B;
3 5 other entities engaged in the business of insurance, risk
3 6 transfer, or risk retention, which are subject to the
3 7 jurisdiction of the commissioner; plans established pursuant
3 8 to Code chapter 509A for public employees; and organized
3 9 delivery systems licensed by the director of public health.
3 10 The bill requirements are applicable to such contracts or
3 11 policies delivered, issued for delivery, continued, or renewed
3 12 in this state on or after July 1, 2007.
3 13 The bill requirements do not apply to accident=only,
3 14 specified disease, short=term hospital or medical, hospital
3 15 confinement indemnity, credit, dental, vision, Medicare
3 16 supplement, long=term care, basic hospital and medical=
3 17 surgical expense coverage as defined by the commissioner,
3 18 disability income insurance coverage, coverage issued as a
3 19 supplement to liability insurance, workers' compensation or
3 20 similar insurance, automobile medical payment insurance, or
3 21 individual accident and sickness policies issued to
3 22 individuals or to individual members of a member association.
3 23 LSB 1437HH 82
3 24 av:nh/cf/24