S.F. 2362 Section 1. NEW SECTION . 505.32 Certified health insurance 1 policies, contracts, and plans —— wellness programs —— premium 2 credits. 3 1. As used in this section, unless the context otherwise 4 requires: 5 a. “Carrier” means the same as defined in section 513B.2. 6 b. “Certified health insurance policy, contract, or plan” 7 means a carrier’s policy, contract, or plan that has been 8 certified by the commissioner as meeting or exceeding the 9 criteria established pursuant to this section. 10 c. “Commissioner” means the commissioner of insurance. 11 d. “Insured” means an individual whose medical expenses are 12 paid by a carrier’s policy, contract, or plan. 13 2. The commissioner shall adopt provisions, by rule, to 14 promote wellness by establishing criteria and procedures for 15 the designation of health insurance policies, contracts, and 16 plans that meet or exceed such criteria as certified health 17 insurance policies, contracts, or plans. A policy, contract, 18 or plan so certified shall meet, including but not limited to 19 the following objectives: 20 a. Provide significant economic incentives to insureds 21 designed to encourage their participation in the practice 22 of healthy lifestyle behaviors. Such incentives may be in 23 the form of health insurance premium reductions, benefit 24 enhancements, or in the case of employer-paid plans, direct 25 financial compensation. 26 b. Provide significant economic disincentives and penalties 27 to insureds who incorrectly certify participation in the 28 practice of healthy lifestyle behaviors. Such disincentives 29 and penalties may be in the form of increased deductibles and 30 copayments, or surcharges. 31 c. Set forth economic incentives and disincentives 32 substantial enough to encourage behavior modification. 33 d. Provide benefits for appropriate screening examinations 34 and designated adult immunizations. 35 -1- LSB 5246XS (5) 83 av/nh 1/ 5

S.F. 2362 3. The commissioner may certify a carrier’s health 1 insurance policy, contract, or plan that encourages, including 2 but not limited to the following healthy lifestyle behaviors 3 and provides the following minimum premium credits for those 4 insureds who are nonsmokers and who certify that they adhere to 5 the prescribed behaviors: 6 a. No use of tobacco products at least six months prior to 7 the issuance of the policy, contract, or plan and while the 8 policy, contract, or plan is in effect, a premium credit of ten 9 percent. 10 b. Participation, three or more times per week, in an 11 aerobic activity such as brisk walking, running, swimming, or 12 bicycling, a premium credit of one percent. 13 c. Blood pressure maintenance, with or without 14 physician-prescribed medication, at a level as prescribed by 15 the commissioner by rule, a premium credit of one percent. 16 d. Maintaining a desirable weight as determined by the 17 commissioner by rule using the 1983 Metropolitan life insurance 18 company tables, lean body mass calculations, or skin fold 19 measurements, a premium credit of one percent. 20 e. Participating in an annual wellness check, as prescribed 21 by the commissioner by rule, a premium credit of one percent. 22 f. Maintaining healthy cholesterol levels, with or 23 without physician-prescribed medication, as prescribed by the 24 commissioner by rule, a premium credit of one percent. 25 4. A certified health insurance policy, contract, or plan 26 may also provide benefits for periodic preventive screening 27 examinations as appropriate to the insured’s age, sex, and 28 health condition as prescribed by the commissioner by rule. 29 5. The commissioner may certify health insurance policies, 30 contracts, or plans developed and submitted by carriers that 31 do not meet the criteria set forth in subsection 3 but, as 32 determined by the commissioner, are designed to further the 33 objectives of this section in encouraging insureds to practice 34 healthy lifestyle behaviors. 35 -2- LSB 5246XS (5) 83 av/nh 2/ 5

S.F. 2362 6. In order to be certified, a health insurance policy, 1 contract, or plan shall provide that, upon determination by a 2 carrier that an insured has incorrectly certified in a material 3 way that the insured has complied with the requirements of the 4 policy, contract, or plan, the carrier will assess a surcharge 5 or increase the insured’s applicable deductibles or copayments. 6 The surcharge per insured shall not exceed an amount equal to 7 three times the credit received as a result of the material 8 incorrect certification and no increases in copayment or 9 deductible shall exceed the copayment or deductible by more 10 than two times the copayment or deductible. 11 7. a. A carrier may apply to have a health insurance 12 policy, contract, or plan certified by filing a copy of the 13 policy, contract, or plan with the commissioner together with 14 documentation sufficient to demonstrate that the policy, 15 contract, or plan meets or exceeds the criteria specified 16 in this section. The commissioner may request additional 17 information to support the application. 18 b. If, after thirty days from the date of the application, 19 or after fifteen days from the date of submission of additional 20 material requested by the commissioner, whichever is later, 21 the commissioner has not acted, the carrier may notify the 22 commissioner in writing that the carrier will deem the health 23 insurance policy, contract, or plan as certified on the tenth 24 day following receipt of such notification by the commissioner. 25 8. A carrier that issues a health insurance policy, 26 contract, or plan certified under this section shall provide a 27 certification form to all insureds under the policy, contract, 28 or plan whereby the insured may certify participation in the 29 practice of healthy lifestyle behaviors as required by the 30 certified policy, contract, or plan. This form shall be filed 31 with and approved by the commissioner prior to its use and 32 shall include notification to an insured of the applicable 33 penalties for incorrectly certifying in a material way that the 34 insured has participated in the practice of healthy lifestyle 35 -3- LSB 5246XS (5) 83 av/nh 3/ 5

S.F. 2362 behaviors required by the certified policy, contract, or plan. 1 9. This section shall not be construed to preclude a carrier 2 from offering health insurance policies, contracts, or plans 3 that are not certified pursuant to this section but otherwise 4 meet the requirements of law. 5 10. The commissioner shall adopt, by rule, provisions 6 allowing suspension or modification of premium rate 7 restrictions to enable a carrier to provide premium credits as 8 set forth in this section. 9 11. This section applies to policies, contracts, or plans 10 of health insurance delivered, issued for delivery, continued, 11 or renewed in this state on or after January 1, 2011. The 12 commissioner shall adopt rules to implement this section prior 13 to that date. 14 EXPLANATION 15 This bill requires the commissioner of insurance to certify 16 certain health insurance policies, contracts, or plans that 17 promote healthy lifestyles and provides for premium credits, 18 and includes applicability provisions. 19 The bill requires the commissioner to adopt rules to promote 20 wellness by establishing criteria and procedures for certifying 21 health insurance policies, contracts, and plans that meet 22 objectives such as providing significant economic incentives 23 to insureds to participate in healthy lifestyle behaviors; 24 providing significant economic disincentives to insureds who 25 incorrectly say they participated in such behaviors; setting 26 forth economic incentives and disincentives substantial enough 27 to encourage behavior modification; and providing benefits 28 for appropriate screening examinations and designated adult 29 immunizations. 30 The commissioner may certify a health insurance policy, 31 contract, or plan that includes premium credits in designated 32 amounts for insureds who are nonsmokers and do not use tobacco 33 products, and who participate in regular exercise, maintain 34 a healthy blood pressure, control their weight, participate 35 -4- LSB 5246XS (5) 83 av/nh 4/ 5

S.F. 2362 in annual wellness checks, and maintain healthy cholesterol 1 levels. 2 Certified health insurance policies, contracts, or plans 3 must also include penalties such as surcharges or increases 4 in copayments or deductibles for insureds who represent 5 incorrectly in a material way that they have complied with the 6 behaviors for which a premium credit was given. 7 Carriers must apply to have a health insurance policy, 8 contract, or plan certified by filing an application with the 9 commissioner. Such a policy, contract, or plan is deemed 10 certified if the application is not acted upon within 30 days 11 of its filing or within 15 days of the commissioner’s receipt 12 of requested additional information. 13 The commissioner is required to adopt, by rule, provisions 14 that allow suspension or modification of premium rate 15 restrictions to enable a carrier to provide premium credits as 16 set forth in the bill. 17 The bill is applicable to health insurance policies, 18 contracts, or plans delivered, issued for delivery, continued, 19 or renewed in this state on or after January 1, 2011, and the 20 commissioner is required to adopt rules to implement the bill’s 21 provisions prior to that date. 22 -5- LSB 5246XS (5) 83 av/nh 5/ 5