House File 2188 - Introduced HOUSE FILE 2188 BY RUNNING-MARQUARDT A BILL FOR An Act relating to health insurance coverage for mammograms and 1 including effective date and applicability provisions. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5484YH (2) 87 ko/rj

H.F. 2188 Section 1. Section 514C.4, Code 2018, is amended to read as 1 follows: 2 514C.4 Mandated coverage for mammography. 3 1. As used in this section: 4 a. “Health care professional” means the same as defined in 5 section 514J.102. 6 b. “Mammogram” means a radiographic image obtained using a 7 procedure, including two-dimensional mammography or three- 8 dimensional mammography, as recommended by a woman’s health 9 care professional. 10 1. 2. a. A policy or contract providing for third-party 11 payment or prepayment of health or medical expenses shall 12 provide minimum mammography examination coverage, including, 13 but not limited to, the following classes of third-party 14 payment provider contracts or policies delivered, issued for 15 delivery, continued, or renewed in this state. 16 (1) Individual or group accident and sickness insurance 17 providing coverage on an expense-incurred basis. 18 (2) An individual or group hospital or medical service 19 contract issued pursuant to chapter 509 , 514 , or 514A . 20 (3) An individual or group health maintenance organization 21 contract regulated under chapter 514B . 22 (4) An individual or group Medicare supplemental policy, 23 unless coverage pursuant to such policy is preempted by federal 24 law. 25 b. A long-term care policy or contract is specifically 26 excluded from regulation under this section . 27 2. 3. As used in this section , “minimum mammography 28 examination coverage” means benefits which are better than or 29 equal to the following minimum requirements: 30 a. One baseline mammogram for any woman who is thirty-five 31 through thirty-nine years of age, or more frequent mammograms 32 if recommended by the woman’s physician health care 33 professional . 34 b. A mammogram every two years for any woman who is 35 -1- LSB 5484YH (2) 87 ko/rj 1/ 3

H.F. 2188 forty through forty-nine years of age, or more frequently if 1 recommended by the woman’s physician health care professional . 2 c. A mammogram every year for any woman who is fifty years 3 of age or older, or more frequently if recommended by the 4 woman’s physician health care professional . 5 3. 4. Mammogram benefits may be subject to any policy or 6 contract provisions which apply generally to other services 7 covered by the policy or contract. 8 4. 5. The commissioner of insurance shall adopt rules under 9 chapter 17A necessary to implement this section . 10 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 11 importance, takes effect upon enactment. 12 Sec. 3. APPLICABILITY. This Act applies to the classes of 13 third-party payment provider contracts or policies specified 14 in section 514C.4, as amended by this Act, that are delivered, 15 issued for delivery, continued, or renewed in this state on or 16 after July 1, 2018. 17 EXPLANATION 18 The inclusion of this explanation does not constitute agreement with 19 the explanation’s substance by the members of the general assembly. 20 This bill relates to insurance coverage for a mammogram as 21 recommended by a woman’s health care professional. 22 The bill defines “mammogram” as a radiographic image 23 obtained using a procedure, including two-dimensional 24 mammography or three-dimensional mammography, as recommended by 25 a woman’s health care professional. The bill does not change 26 the minimum mammography examination coverage requirements. The 27 bill requires, however, that the insurance coverage apply to 28 two-dimensional mammograms and three-dimensional mammograms. 29 The bill also allows a woman’s health care professional, 30 defined to include licensed health care practitioners other 31 than a woman’s physician, to recommend a mammogram. 32 The bill applies to the classes of third-party payment 33 provider contracts or policies specified in Code section 514C.4 34 that are delivered, issued for delivery, continued, or renewed 35 -2- LSB 5484YH (2) 87 ko/rj 2/ 3

H.F. 2188 in this state on or after July 1, 2018. 1 -3- LSB 5484YH (2) 87 ko/rj 3/ 3