HF 2188 (LSB 5484YH (2) 87)

HOUSE FILE 2188

BY  RUNNING-MARQUARDT

A BILL FOR

An Act relating to health insurance coverage for mammograms and including effective date and applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 514C.4, Code 2018, is amended to read as follows:
   514C.4  Mandated coverage for mammography.
   1.  As used in this section:
   a.  “Health care professional” means the same as defined in section 514J.102.
   b.  “Mammogram” means a radiographic image obtained using a procedure, including two-dimensional mammography or three-
dimensional mammography, as recommended by a woman’s health care professional.
   1.  2.  a.  A policy or contract providing for third-party payment or prepayment of health or medical expenses shall provide minimum mammography examination coverage, including, but not limited to, the following classes of third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state.
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  An individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law.
   b.  A long-term care policy or contract is specifically excluded from regulation under this section.
   2.  3.  As used in this section, “minimum mammography examination coverage” means benefits which are better than or equal to the following minimum requirements:
   a.  One baseline mammogram for any woman who is thirty-five through thirty-nine years of age, or more frequent mammograms if recommended by the woman’s physician health care professional.
   b.  A mammogram every two years for any woman who is forty through forty-nine years of age, or more frequently if recommended by the woman’s physician health care professional.
   c.  A mammogram every year for any woman who is fifty years of age or older, or more frequently if recommended by the woman’s physician health care professional.
   3.  4.  Mammogram benefits may be subject to any policy or contract provisions which apply generally to other services covered by the policy or contract.
   4.  5.  The commissioner of insurance shall adopt rules under chapter 17A necessary to implement this section.
    Sec. 2.  EFFECTIVE DATE.  This Act, being deemed of immediate importance, takes effect upon enactment.
    Sec. 3.  APPLICABILITY.  This Act applies to the classes of third-party payment provider contracts or policies specified in section 514C.4, as amended by this Act, that are delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2018.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to insurance coverage for a mammogram as recommended by a woman’s health care professional.
   The bill defines “mammogram” as a radiographic image obtained using a procedure, including two-dimensional mammography or three-dimensional mammography, as recommended by a woman’s health care professional. The bill does not change the minimum mammography examination coverage requirements. The bill requires, however, that the insurance coverage apply to two-dimensional mammograms and three-dimensional mammograms. The bill also allows a woman’s health care professional, defined to include licensed health care practitioners other than a woman’s physician, to recommend a mammogram. 
   The bill applies to the classes of third-party payment provider contracts or policies specified in Code section 514C.4 that are delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2018.