HOUSE FILE 67

BY  HUNTER

A BILL FOR

An Act relating to the provision of certain information for insureds regarding external review of health care coverage decisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

   Section 1.  Section 514J.3A, Code 2011, is amended to read as follows:
   514J.3ANotice External review —— notice.
   1.  An insurance card issued by a carrier or organized delivery system for a policy or contract providing for third- party payment or prepayment of health or medical expenses subject to this section shall contain a telephone number or internet site information for an insured to obtain more information regarding initiation of the external review process for coverage decisions under this chapter.
   2.  The telephone number or internet site information for an insured to obtain more information regarding initiation of the external review process in this chapter shall also be posted in a prominent place in the office of a private practitioner or group of practitioners who are health care providers as defined in section 135.61, or an institutional health care facility as defined in section 135.61.
   3.  When a claim is denied in whole or in part based on medical necessity, the carrier or organized delivery system shall provide a notice in writing to the enrollee of the internal appeal mechanism provided under the carrier or organized delivery system’s plan or policy.
   4.  At the time of a coverage decision, the carrier or organized delivery system shall notify the enrollee in writing of the right to have the coverage decision reviewed under the external review process.
EXPLANATION
   This bill amends Code section 514J.3A, relating to notice provisions for the external review process for health care coverage decisions under Code chapter 514J. The bill adds a requirement that a telephone number or internet site information allowing for an insured to obtain more information about the external review process be printed on the insured’s insurance card, and be posted in a prominent place in health care facilities and health care provider offices.