Senate File 72 - Introduced SENATE FILE 72 BY HATCH , McCOY , JOCHUM , QUIRMBACH , HORN , TAYLOR , BRASE , DOTZLER , DVORSKY , BOLKCOM , PETERSEN , SODDERS , MATHIS , HART , and BEALL A BILL FOR An Act providing for the establishment of the Iowa health 1 benefit marketplace and including effective date provisions. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1060XS (6) 85 av/rj

S.F. 72 DIVISION I 1 IOWA HEALTH BENEFIT MARKETPLACE ACT 2 Section 1. NEW SECTION . 514M.1 Title. 3 This chapter shall be known and may be cited as the “Iowa 4 Health Benefit Marketplace Act” . 5 Sec. 2. NEW SECTION . 514M.2 Purpose and intent. 6 The purpose of this chapter is to provide for the 7 establishment of a health benefit marketplace in this state to 8 facilitate the sale and purchase of qualified health benefit 9 plans by qualified individuals in the individual market in 10 this state and by qualified small employers in the small 11 group market in this state. The intent of authorizing the 12 establishment of a health benefit marketplace in this state is 13 to reduce the number of uninsured individuals in this state, 14 provide a transparent marketplace and consumer education, and 15 assist individuals with access to relevant federal and state 16 programs, premium assistance tax credits, and cost-sharing 17 reductions. 18 Sec. 3. NEW SECTION . 514M.3 Definitions. 19 As used in this chapter, unless the context otherwise 20 requires: 21 1. “Board” means the board of directors of the Iowa health 22 benefit marketplace as provided in section 514M.5. 23 2. “Commissioner” means the commissioner of insurance. 24 3. “Executive director” means the executive director of the 25 Iowa health benefit marketplace. 26 4. “Federal Act” means the federal Patient Protection and 27 Affordable Care Act, Pub. L. No. 111-148, as amended by the 28 federal Health Care and Education Reconciliation Act of 2010, 29 Pub. L. No. 111-152, and any amendments thereto, or regulations 30 or guidance issued under, those Acts. 31 5. a. “Health benefit plan” means a policy, contract, 32 certificate, or agreement offered or issued by a health carrier 33 to provide, deliver, arrange for, pay for, or reimburse any of 34 the costs of health care services. 35 -1- LSB 1060XS (6) 85 av/rj 1/ 31

S.F. 72 b. “Health benefit plan” does not include any of the 1 following: 2 (1) Coverage only for accident, or disability income 3 insurance, or any combination thereof. 4 (2) Coverage issued as a supplement to liability insurance. 5 (3) Liability insurance, including general liability 6 insurance and automobile liability insurance. 7 (4) Workers’ compensation or similar insurance. 8 (5) Automobile medical payment insurance. 9 (6) Credit-only insurance. 10 (7) Coverage for on-site medical clinics. 11 (8) Other similar insurance coverage, specified in federal 12 regulations issued pursuant to Tit. XXVII of the federal Public 13 Health Service Act, as enacted by the federal Health Insurance 14 Portability and Accountability Act of 1996, Pub. L. No. 15 104-191, and amended by the federal Act, under which benefits 16 for health care services are secondary or incidental to other 17 insurance benefits. 18 c. “Health benefit plan” does not include any of the 19 following benefits if they are provided under a separate 20 policy, certificate, or contract of insurance or are otherwise 21 not an integral part of the plan: 22 (1) Limited scope dental or vision benefits. 23 (2) Benefits for long-term care, nursing home care, home 24 health care, community-based care, or any combination thereof. 25 (3) Other similar, limited benefits specified in federal 26 regulations issued pursuant to the federal Health Insurance 27 Portability and Accountability Act of 1996, Pub. L. No. 28 104-191. 29 d. “Health benefit plan” does not include any of the 30 following benefits if the benefits are provided under a 31 separate policy, certificate, or contract of insurance, there 32 is no coordination between the provision of the benefits and 33 any exclusion of benefits under any group health benefit plan 34 maintained by the same plan sponsor, and the benefits are paid 35 -2- LSB 1060XS (6) 85 av/rj 2/ 31

S.F. 72 with respect to an event without regard to whether benefits are 1 provided with respect to such an event under any group health 2 benefit plan maintained by the same plan sponsor: 3 (1) Coverage only for a specified disease or illness. 4 (2) Hospital indemnity or other fixed indemnity insurance. 5 e. “Health benefit plan” does not include any of the 6 following if offered as a separate policy, certificate, or 7 contract of insurance: 8 (1) Medicare supplemental health insurance as defined under 9 section 1882(g)(1) of the federal Social Security Act. 10 (2) Coverage supplemental to the coverage provided under 10 11 U.S.C. ch. 55, by the civilian health and medical program of 12 the uniformed services. 13 (3) Supplemental coverage similar to that provided under a 14 group health benefit plan. 15 6. “Health carrier” means an entity subject to the insurance 16 laws and rules of this state, or subject to the jurisdiction 17 of the commissioner, that contracts or offers to contract to 18 provide, deliver, arrange for, pay for, or reimburse any of 19 the costs of health care services, including an insurance 20 company offering sickness and accident plans, a health 21 maintenance organization, a nonprofit hospital or health 22 service corporation, or any other entity providing a plan of 23 health insurance, health benefits, or health services. 24 7. “Insurance producer” means a person required to be 25 licensed under chapter 522B. 26 8. “Marketplace” means the Iowa health benefit marketplace 27 established pursuant to section 514M.4. 28 9. “Navigator” means a person selected, licensed, and 29 regulated by the marketplace in accordance with section 1311(i) 30 of the federal Act, standards developed by the secretary, and 31 chapter 522D. 32 10. “Qualified dental plan” means a limited scope dental 33 plan that has been certified in accordance with section 34 514M.10. 35 -3- LSB 1060XS (6) 85 av/rj 3/ 31

S.F. 72 11. “Qualified employer” means a small employer that 1 elects to make its full-time employees eligible for one or 2 more qualified health benefit plans offered through the small 3 business health options program of the marketplace, and at 4 the option of the employer, make some or all of its part-time 5 employees so eligible, provided that the employer does either 6 of the following: 7 a. Has its principal place of business in this state and 8 elects to provide coverage through the marketplace to all of 9 its eligible employees wherever employed. 10 b. Elects to provide coverage through the marketplace to all 11 of its eligible employees who are principally employed in this 12 state. 13 12. “Qualified health benefit plan” means a health benefit 14 plan that has in effect a certification as described in section 15 1311(c) of the federal Act and section 514M.10. 16 13. “Qualified individual” means an individual, including a 17 minor, who is all of the following: 18 a. Is seeking to enroll in a qualified health benefit plan 19 offered to individuals through the marketplace. 20 b. Is a resident of this state. 21 c. At the time of enrollment, is not incarcerated, other 22 than incarceration pending the disposition of charges. 23 d. Is, and is reasonably expected to be, for the entire 24 period for which enrollment is sought, a citizen or national of 25 the United States or an alien lawfully present in the United 26 States. 27 14. “Secretary” means the secretary of the United States 28 department of health and human services. 29 15. “Secretary of the board” means the secretary of the 30 board of directors of the Iowa health benefit marketplace. 31 16. “Small business health options program” means the small 32 business health options program component of the marketplace 33 established under section 514M.8. 34 17. a. “Small employer” means an employer that employed 35 -4- LSB 1060XS (6) 85 av/rj 4/ 31

S.F. 72 an average of at least one and not more than fifty employees 1 during the preceding calendar year. 2 b. For the purposes of this subsection: 3 (1) All persons treated as a single employer under 4 subsection (b), (c), (m), or (o) of section 414 of the Internal 5 Revenue Code of 1986 shall be treated as a single employer. 6 (2) An employer and any predecessor employer shall be 7 treated as a single employer. 8 (3) All employees shall be counted, including part-time 9 employees and employees who are not eligible for coverage 10 through the employer. 11 (4) If an employer was not in existence throughout the 12 preceding calendar year, the determination of whether that 13 employer is a small employer shall be based on the average 14 number of employees that the employer is reasonably expected to 15 employ on business days in the current calendar year. 16 (5) An employer that makes enrollment in qualified health 17 benefit plans available to its employees through the small 18 business health options program component of the marketplace, 19 and would cease to be a small employer by reason of an increase 20 in the number of its employees, shall continue to be treated 21 as a small employer for purposes of this chapter as long as 22 the employer continuously makes enrollment through the small 23 business health options program component of the marketplace 24 available to its employees. 25 Sec. 4. NEW SECTION . 514M.4 Establishment of Iowa health 26 benefit marketplace. 27 1. The Iowa health benefit marketplace is established as a 28 nonprofit corporation. The marketplace shall be established 29 for the purpose of facilitating the sale and purchase of 30 qualified health benefit plans by qualified individuals in 31 the individual market in this state and by qualified small 32 employers in the small group market in this state. 33 2. The powers and duties of the marketplace are vested in 34 and shall be exercised by a board of directors established 35 -5- LSB 1060XS (6) 85 av/rj 5/ 31

S.F. 72 under section 514M.5. 1 3. The marketplace shall operate under a plan of operation 2 established and approved by the board of directors, in 3 consultation with the commissioner. The plan shall effectuate 4 the purposes of this chapter and assure the fair, reasonable, 5 and equitable administration of the marketplace. The board 6 shall do all of the following pursuant to the plan, including 7 but not limited to: 8 a. Plan, direct, coordinate, and execute the administrative 9 functions of the marketplace. 10 b. Employ professional and clerical staff as necessary. 11 c. Keep an accurate account of all activities, receipts, 12 and expenditures of the marketplace and annually submit a 13 report to the commissioner, governor, general assembly, and 14 the auditor of state concerning such accountings pursuant to 15 section 514M.14. 16 4. The marketplace shall be operated on a statewide basis. 17 5. The marketplace shall include separate marketplace 18 components which facilitate the sale and purchase of qualified 19 health benefit plans to eligible individuals and to small 20 employers as described in this chapter and in the federal Act. 21 6. The marketplace may establish a reimbursement system 22 for health benefit plans issued in this state that all health 23 carriers and health care providers may join to facilitate fair 24 and reasonable payments for the cost of health care services 25 provided pursuant to a health benefit plan. 26 7. The marketplace shall do all of the following: 27 a. Facilitate the purchase and sale of qualified health 28 benefit plans to qualified individuals and qualified employers 29 as described in this chapter and in the federal Act. 30 b. Establish rate schedules for commissions paid to 31 insurance producers by qualified health benefit plans offered 32 through the marketplace. 33 c. Meet the requirements of this chapter and any rules 34 adopted pursuant to this chapter. 35 -6- LSB 1060XS (6) 85 av/rj 6/ 31

S.F. 72 8. a. A person who selects, purchases, or enrolls in a 1 qualified health benefit plan offered through the marketplace 2 shall be enrolled in the plan by an insurance producer or may 3 enroll in the plan directly through the marketplace internet 4 site. The commission paid to an insurance producer who enrolls 5 a person in a plan offered through the marketplace shall be 6 established by the marketplace. 7 b. On the anniversary date of coverage obtained through 8 the marketplace, an enrollee may renew or enroll in coverage 9 offered through the marketplace through any insurance producer 10 of the enrollee’s choice or may enroll directly through the 11 marketplace internet site. A commission shall be paid to an 12 insurance producer who renews or enrolls a person in coverage 13 under this paragraph in the same manner as is provided in 14 paragraph “a” . 15 9. The marketplace may employ staff to carry out the 16 functions of the marketplace, but no employee of the 17 marketplace shall sell, solicit, or negotiate enrollment in 18 a health benefit plan or otherwise offer services for which 19 a license as an insurance producer is required pursuant to 20 chapter 522B. 21 10. The marketplace may contract with an eligible entity to 22 fulfill any of its specialized duties or responsibilities as 23 described in this chapter. An eligible entity includes but is 24 not limited to an entity that has experience in individual and 25 small group health benefit plans, benefit administration, or 26 other experience relevant to the responsibilities to be assumed 27 by the entity. However, a health carrier or an affiliate of a 28 health carrier is not an eligible entity for the purposes of 29 this subsection. 30 11. The marketplace may enter into information-sharing 31 agreements with federal and state agencies to carry out 32 its responsibilities under this chapter provided such 33 agreements include adequate protections with respect to the 34 confidentiality of the information to be shared and comply with 35 -7- LSB 1060XS (6) 85 av/rj 7/ 31

S.F. 72 all state laws and rules and federal laws and regulations. 1 12. Each qualified health benefit plan offered through 2 the marketplace shall be assigned a rating by the marketplace 3 in accordance with criteria developed by the secretary under 4 section 1311(c)(3) of the federal Act, and the marketplace 5 shall determine the level of coverage of each qualified health 6 benefit plan in accordance with regulations issued by the 7 secretary under section 1302(d)(2)(A) of the federal Act and 8 applicable state law. 9 13. If a qualified health benefit plan offered through 10 the marketplace meets or exceeds the criteria for a qualified 11 health benefit plan set forth by the secretary, the plan shall 12 be reviewed and assigned a rating by the marketplace. 13 Sec. 5. NEW SECTION . 514M.5 Board of directors —— executive 14 director —— secretary. 15 1. The board of directors of the Iowa health benefit 16 marketplace shall effectuate the powers and duties of the 17 marketplace as set forth in this chapter. 18 2. The board shall consist of seven voting members and 19 five ex officio, nonvoting members. The voting members shall 20 be appointed by the governor, subject to confirmation by the 21 senate. The voting members of the board shall annually elect 22 one voting member as chairperson and one voting member as vice 23 chairperson. 24 a. The voting members shall be appointed by the governor as 25 follows: 26 (1) Two persons who represent the interests of small 27 business from nominations made to the governor by nationally 28 recognized groups that represent the interests of small 29 business. 30 (2) Three persons who represent the interests of consumers 31 from nominations made to the governor by nationally recognized 32 groups that represent the interests of consumers. 33 (3) One person who is an insurance producer licensed under 34 chapter 522B. 35 -8- LSB 1060XS (6) 85 av/rj 8/ 31

S.F. 72 (4) One person who is a health care provider. 1 b. The ex officio, nonvoting members of the board are as 2 follows: 3 (1) Four members of the general assembly, one appointed 4 by the speaker of the house of representatives, one appointed 5 by the minority leader of the house of representatives, 6 one appointed by the majority leader of the senate, and one 7 appointed by the minority leader of the senate. 8 (2) A person who shall serve as the secretary of the board, 9 appointed by the board. 10 3. The governor shall not appoint to the board any person 11 who is either the spouse or a relative within the first degree 12 of consanguinity of a serving member of the board. 13 4. Each member of the board appointed by the governor shall 14 be a resident of this state and the composition of voting 15 members of the board shall be in compliance with sections 16 69.16, 69.16A, and 69.16C. 17 5. The voting members of the board shall be appointed for 18 staggered terms of three years on or before March 1, 2014, and 19 by December 15 of each year thereafter. The initial terms 20 of the voting members of the board shall be staggered at the 21 discretion of the governor. A voting member of the board is 22 eligible for reappointment. The governor shall fill a vacancy 23 on the board in the same manner as the original appointment 24 for the remainder of the term. A voting member of the board 25 may be removed by the governor for misfeasance, malfeasance, 26 willful neglect of duty, failure to actively participate in the 27 affairs of the board, or other cause after notice and a public 28 hearing unless the notice and hearing are waived by the member 29 in writing. 30 6. A voting member of the board shall not be an employee 31 of, a consultant to, a member of the board of directors of, 32 affiliated with, have an ownership interest in, or otherwise 33 be a representative of any health carrier, insurance producer 34 agency, insurance consultant organization, trade association of 35 -9- LSB 1060XS (6) 85 av/rj 9/ 31

S.F. 72 insurers, or association offering health benefit plans to its 1 members, while serving on the board. 2 7. Voting members of the board shall be reimbursed from the 3 moneys of the marketplace for all actual and necessary expenses 4 incurred in the performance of their duties as members, and 5 shall receive per diem at the rate of fifty dollars per day for 6 their services. 7 8. A majority of the voting members of the board constitutes 8 a quorum. The affirmative vote of a majority of the voting 9 members is necessary for any action taken by the board. The 10 majority shall not include a member who has a conflict of 11 interest and a statement by a member of a conflict of interest 12 is conclusive for this purpose. A vacancy in the membership of 13 the board does not impair the right of a quorum to exercise the 14 rights and perform the duties of the board. An action taken by 15 the board under this chapter may be authorized by resolution 16 at a regular or special meeting and each resolution shall take 17 effect immediately and need not be published or posted. 18 9. The voting members of the board shall give bond as 19 required for public officers by chapter 64. 20 10. The voting members of the board are subject to and are 21 officials within the meaning of chapter 68B. 22 11. The board shall meet at the call of the chairperson, 23 or in the absence of the chairperson, at the call of the vice 24 chairperson, or when any four voting members of the board file 25 a written request with the chairperson for a meeting. Written 26 notice of the time and place of each meeting shall be given to 27 each member of the board. 28 12. a. The voting members of the board shall appoint an 29 executive director, subject to confirmation by the senate, to 30 supervise the administrative affairs and general management and 31 operations of the marketplace. 32 b. The voting members of the board may appoint other 33 officers as the members of the board determine. The officers 34 shall not be members of the board, with the exception of the 35 -10- LSB 1060XS (6) 85 av/rj 10/ 31

S.F. 72 secretary of the board, and shall serve at the pleasure of the 1 voting members of the board, and shall receive compensation as 2 fixed by the board. 3 c. The board may employ other staff to carry out the 4 functions of the marketplace, but no employee of the 5 marketplace shall sell, solicit, or negotiate enrollment in 6 a health benefit plan or otherwise offer services for which 7 a license as an insurance producer is required pursuant to 8 chapter 522B. All employees of the marketplace are exempt from 9 chapter 8A, subchapter IV, and chapter 97B. 10 13. a. The voting members of the board shall appoint a 11 secretary of the board who shall be an ex officio member of the 12 board as provided in subsection 2, shall keep a record of the 13 proceedings of the board, and shall be the custodian of all 14 books, documents, and papers filed with the board, including 15 information filed in an electronic format, and the minute book 16 or journal of the board. 17 b. The secretary of the board shall serve at the pleasure 18 of the board, and shall receive compensation as fixed by the 19 board. 20 14. Members of the board, or persons acting on behalf of 21 the marketplace, while acting in the scope of their agency or 22 employment, are not subject to personal liability resulting 23 from carrying out the powers and duties in this chapter. 24 Sec. 6. NEW SECTION . 514M.6 General powers. 25 1. The marketplace has any and all powers necessary and 26 convenient to carry out its purposes and duties and exercise 27 its specific powers, including but not limited to the power to: 28 a. Sue and be sued in its own name. 29 b. Have and alter a corporate seal. 30 c. Make and alter bylaws for its management consistent with 31 the provisions of this chapter. 32 d. Make and execute agreements, contracts, and other 33 instruments of any and all types on such terms and conditions 34 as the marketplace may find necessary or convenient to the 35 -11- LSB 1060XS (6) 85 av/rj 11/ 31

S.F. 72 purpose of the marketplace, with any public or private entity, 1 including but not limited to contracts for goods and services. 2 All political subdivisions, other public agencies, and state 3 departments and agencies may enter into contracts and otherwise 4 cooperate with the marketplace. 5 e. Adopt procedures relating to competitive bidding, 6 including the identification of those circumstances under which 7 competitive bidding by the marketplace, either formally or 8 informally, shall be required. In any bidding process, the 9 marketplace may administer its own bidding and procurement or 10 may utilize the services of the department of administrative 11 services or any other agency. Except when such rules apply, 12 the marketplace and all contracts made by it in carrying out 13 its public and essential governmental functions with respect 14 to any of its purposes shall be exempt from the provisions 15 and requirements of all laws or rules of the state which 16 require competitive bids in connection with the letting of such 17 contracts. 18 f. Acquire, hold, improve, mortgage, lease, and dispose of 19 real and personal property, including but not limited to the 20 power to sell at public or private sale, with or without public 21 bidding, any such property, or other obligation held by it. 22 g. Procure insurance against any loss in connection with its 23 operations and property interests. 24 h. Accept appropriations, gifts, grants, loans, or other 25 aid from public or private entities. A record of all gifts or 26 grants, stating the type, amount, and donor, shall be clearly 27 set out in the marketplace’s annual report along with the 28 record of other receipts. 29 i. Provide to public and private entities technical 30 assistance and counseling related to the marketplace’s 31 purposes. 32 j. In cooperation with other local, state, or federal 33 governmental agencies, conduct research studies, develop 34 estimates of unmet health insurance needs, gather and compile 35 -12- LSB 1060XS (6) 85 av/rj 12/ 31

S.F. 72 data useful to facilitating decision making, and enter into 1 agreements to carry out programs within or without the state 2 which the marketplace finds to be consistent with the goals of 3 the marketplace. 4 k. Enter into agreements with the federal government, 5 tribes, and other states to facilitate the sale or purchase of 6 qualified health benefit plans by qualified individuals and 7 qualified small employers in this state. 8 l. Own or acquire intellectual property rights including 9 but not limited to copyrights, trademarks, service marks, and 10 patents, and enforce the rights of the marketplace with respect 11 to such intellectual property rights. 12 m. Form committees or panels as necessary to facilitate the 13 marketplace’s duties. Committees or panels formed pursuant to 14 this paragraph shall be subject to the provisions of chapters 15 21 and 22. 16 n. Establish one or more funds within the state treasury 17 under the control of the marketplace. Notwithstanding section 18 8.33 or 12C.7, or any other provision to the contrary, moneys 19 invested by the treasurer of state pursuant to this paragraph 20 shall not revert to the general fund of the state and interest 21 accrued on the moneys shall be moneys of the marketplace and 22 shall not be credited to the general fund of the state. The 23 nonreversion of moneys allowed under this paragraph does not 24 apply to moneys appropriated to the marketplace by the general 25 assembly. 26 o. Exercise generally all powers typically exercised by 27 private enterprises engaged in business pursuits unless the 28 exercise of such a power would violate the terms of this 29 chapter or the Constitution of the State of Iowa. 30 2. Notwithstanding any other provision of law, any purchase 31 or lease of real property, other than on a temporary basis, 32 when necessary in order to implement the purposes of the 33 marketplace or protect the investments of the marketplace, 34 shall require written notice from the marketplace to the 35 -13- LSB 1060XS (6) 85 av/rj 13/ 31

S.F. 72 government oversight committees of the general assembly or 1 their successor committees and the prior approval of the 2 executive council. 3 3. The powers enumerated in this section are cumulative of 4 and in addition to those powers enumerated elsewhere in this 5 chapter and such powers do not limit or restrict any other 6 powers of the marketplace. 7 Sec. 7. NEW SECTION . 514M.7 Specific powers. 8 1. In addition to the general powers described in section 9 514M.6, the marketplace shall have all powers convenient and 10 necessary to carry out the purpose and intent of this chapter. 11 2. The marketplace established pursuant to section 514M.4 12 shall make qualified health benefit plans that are effective 13 on January 1, 2015, available to qualified individuals and 14 qualified employers in this state. 15 3. At such time as applications for waivers from the 16 requirements of the federal Act are accepted by the secretary, 17 the marketplace may request such waivers from the secretary. 18 4. The marketplace shall allow a health carrier to offer a 19 plan that provides limited scope dental benefits meeting the 20 requirements of section 9832(c)(2)(A) of the Internal Revenue 21 Code of 1986 through the marketplace, either separately or in 22 conjunction with a qualified health benefit plan, if the plan 23 provides pediatric dental benefits meeting the requirements of 24 section 1302(b)(1)(J) of the federal Act. 25 5. The marketplace or a health carrier offering qualified 26 health benefit plans through the marketplace shall not charge 27 an individual a fee or penalty for termination of coverage if 28 the individual enrolls in another type of minimum essential 29 coverage because the individual has become newly eligible for 30 that coverage or because the individual’s employer-sponsored 31 coverage has become affordable using the standards of the 32 federal Act, as codified at section 36B(c)(2)(C) of the 33 Internal Revenue Code of 1986. 34 Sec. 8. NEW SECTION . 514M.8 Duties of the marketplace. 35 -14- LSB 1060XS (6) 85 av/rj 14/ 31

S.F. 72 The marketplace shall do all of the following: 1 1. Implement procedures for the certification, 2 recertification, and decertification of health benefit plans 3 as qualified health benefit plans, consistent with guidelines 4 developed by the secretary under section 1311(c) of the federal 5 Act and applicable state law. 6 2. Provide for the operation of a toll-free telephone 7 hotline to respond to requests for assistance. 8 3. Provide for enrollment periods, as determined by the 9 secretary under section 1311(c)(6) of the federal Act and 10 applicable state law. 11 4. Utilize a standardized format for presenting health 12 benefit plan options in the marketplace, including the use of 13 the uniform outline of coverage established under section 2715 14 of the Public Health Service Act and applicable state law. 15 5. In accordance with section 1413 of the federal Act 16 and applicable state law, inform individuals of eligibility 17 requirements for the Medicaid program under Tit. XIX of the 18 federal Social Security Act, the children’s health insurance 19 program under Tit. XXI of the federal Social Security Act, or 20 any applicable state or local public program and, if through 21 screening of an application by the marketplace, the marketplace 22 determines that any individual is eligible for any such 23 program, enroll that individual in that program. 24 6. Establish and make available by electronic means a 25 calculator to determine the actual cost of coverage after 26 application of any premium tax credit for which an individual 27 is eligible using the standards of the federal Act as codified 28 at section 36B(c)(2)(C) of the Internal Revenue Code of 1986 29 and any cost-sharing reductions under section 1402 of the 30 federal Act. 31 7. Establish a small business health options program 32 component of the marketplace through which individuals employed 33 by a qualified employer may enroll in any qualified health 34 benefit plan offered through the small business health options 35 -15- LSB 1060XS (6) 85 av/rj 15/ 31

S.F. 72 program at the level of coverage specified by the employer. 1 In establishing a small business health options program 2 marketplace component, the marketplace shall do all of the 3 following: 4 a. Provide consolidated billing and premium payment by 5 qualified employers including detailed information to those 6 employers about health benefit plans chosen by their employees 7 and the cost of those plans. 8 b. Establish an electronic interface and facilitate the flow 9 of funds between health carriers, employers, and employees, 10 including subsidiaries. 11 c. Provide for the dissemination of health benefit plan 12 enrollment information to employers. 13 8. Establish an individual health options marketplace 14 component through which individuals may enroll in any qualified 15 health benefit plan for individuals. 16 9. Select entities qualified and licensed to serve as 17 navigators in accordance with section 1311(i) of the federal 18 Act, standards developed by the secretary, section 514M.9, and 19 chapter 522D, and award grants to facilitate the function of 20 navigators as provided in section 514M.9. 21 10. Encourage and review the development of cafeteria plans 22 pursuant to section 125 of the Internal Revenue Code of 1986, 23 for use by employers participating in the marketplace. 24 11. Maintain an internet site through which enrollees, 25 employers, and prospective enrollees of qualified health 26 benefit plans, at a minimum, may obtain standardized 27 comparative information on qualified health benefit plans 28 and health benefit plans that are not offered through the 29 marketplace. In developing the electronic clearinghouse, 30 the marketplace may require health carriers participating in 31 the marketplace to make available and regularly update an 32 electronic directory of contracting health care providers so 33 individuals seeking coverage through the marketplace can search 34 by health care provider name to determine which qualified 35 -16- LSB 1060XS (6) 85 av/rj 16/ 31

S.F. 72 health benefit plans in the marketplace include that health 1 care provider in their network, and whether that health care 2 provider is accepting new patients for that particular health 3 benefit plan. 4 12. Consult with stakeholders who are relevant to carrying 5 out the activities required under this chapter. 6 13. Assist in the implementation of reinsurance and risk 7 adjustment mechanisms, as required by state and federal law. 8 14. Establish guidelines for determining qualifications for 9 marketplace employees and entities or persons who are licensed 10 and selected as navigators. 11 15. Subject to section 1411 of the federal Act and 12 applicable state law, grant a certification attesting that, for 13 purposes of the individual responsibility penalty under the 14 standards of the federal Act, as codified at section 5000A of 15 the Internal Revenue Code of 1986, an individual is exempt from 16 the individual responsibility requirement or from the penalty 17 imposed by that section because of any of the following: 18 a. There is no affordable qualified health benefit plan 19 available through the marketplace, or the individual’s 20 employer, covering the individual. 21 b. The individual meets the requirements for any other such 22 exemption from the individual responsibility requirement or 23 penalty. 24 16. Transfer to the United States secretary of the treasury 25 all of the following: 26 a. A list of the individuals who are issued a certification 27 under subsection 15, paragraph “a” , including the name and 28 taxpayer identification number of each individual. 29 b. The name and taxpayer identification number of each 30 individual who was an employee of an employer but who was 31 determined to be eligible for the premium tax credit using 32 the standards of the federal Act as codified at section 33 36B(c)(2)(C) of the Internal Revenue Code of 1986, because of 34 either of the following: 35 -17- LSB 1060XS (6) 85 av/rj 17/ 31

S.F. 72 (1) The employer did not provide minimum essential health 1 benefits coverage. 2 (2) The employer provided minimum essential health benefits 3 coverage, but it was determined using the standards of the 4 federal Act, as codified at section 36B(c)(2)(C) of the 5 Internal Revenue Code of 1986, to either be unaffordable to 6 the employee or not to provide the required minimum actuarial 7 value. 8 c. The name and taxpayer identification number of all of the 9 following: 10 (1) Each individual who notifies the marketplace under 11 section 1411(b)(4) of the federal Act that the individual has 12 changed employers. 13 (2) Each individual who ceases coverage under a qualified 14 health benefit plan during a plan year and the effective date 15 of that cessation. 16 17. Provide to each employer the name of each employee of 17 the employer described in subsection 16, paragraph “b” , who 18 ceases coverage under a qualified health benefit plan during a 19 plan year and the effective date of the cessation. 20 18. Perform duties required of, or delegated to, the 21 marketplace by the secretary, the United States secretary 22 of the treasury, or the commissioner related to determining 23 eligibility for premium tax credits, reduced cost-sharing, or 24 individual responsibility requirement exemptions. 25 19. In consultation with the commissioner, review the 26 rate of premium growth of health benefit plans within the 27 marketplace and outside the marketplace, and consider the 28 information obtained in developing recommendations on whether 29 to continue limiting qualified employer status to small 30 employers. 31 Sec. 9. NEW SECTION . 514M.9 Navigators. 32 1. The marketplace may select entities qualified and 33 licensed to serve as navigators in accordance with section 34 1311(i) of the federal Act, standards developed by the 35 -18- LSB 1060XS (6) 85 av/rj 18/ 31

S.F. 72 secretary, and applicable state law including chapter 522D, and 1 award grants to enable navigators to do all of the following: 2 a. Conduct public education activities to raise awareness of 3 the availability of qualified health benefit plans through the 4 marketplace. 5 b. Distribute fair and impartial information concerning 6 enrollment in qualified health benefit plans, and the 7 availability of premium tax credits for which an individual 8 may be eligible using the standards of the federal Act, as 9 codified at section 36B(c)(2)(C) of the Internal Revenue Code 10 of 1986, and any cost-sharing reductions under section 1402 of 11 the federal Act. 12 c. Facilitate enrollment in qualified health benefit plans 13 offered through the marketplace or in health benefit plans 14 offered outside the marketplace by referring consumers to 15 insurance producers and to the marketplace internet site for 16 enrollment. 17 d. Provide referrals to the office of health insurance 18 consumer assistance established under the federal Act pursuant 19 to section 2793 of the federal Public Health Service Act 20 and the office of the commissioner or any other appropriate 21 state agency, for any enrollee with a grievance, complaint, 22 or question regarding the enrollee’s health benefit plan or 23 coverage, or a determination under that plan or coverage. 24 e. Provide information in a manner that is culturally and 25 linguistically appropriate to the needs of the population being 26 served by the marketplace. 27 2. An entity selected and licensed as a navigator shall not 28 engage in any activities that require licensure as an insurance 29 producer under chapter 522B unless the entity is also licensed 30 as an insurance producer. 31 Sec. 10. NEW SECTION . 514M.10 Health benefit plan 32 certification. 33 1. The marketplace may certify a health benefit plan as 34 a qualified health benefit plan if the plan meets all of the 35 -19- LSB 1060XS (6) 85 av/rj 19/ 31