Senate File 2368 - Introduced SENATE FILE 2368 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SSB 3177) 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 5661SV (1) 87 ko/rj

S.F. 2368 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 a health care 5 practitioner licensed, accredited, registered, or certified 6 consistent with state law to recommend the performance of a 7 mammogram. 8 b. “Mammogram” means a radiographic image obtained using a 9 procedure, including two-dimensional mammography or three- 10 dimensional mammography, as recommended by a woman’s health 11 care professional. 12 1. 2. a. A policy or contract providing for third-party 13 payment or prepayment of health or medical expenses shall 14 provide minimum mammography examination coverage, including, 15 but not limited to, the following classes of third-party 16 payment provider contracts or policies delivered, issued for 17 delivery, continued, or renewed in this state. 18 (1) Individual or group accident and sickness insurance 19 providing coverage on an expense-incurred basis. 20 (2) An individual or group hospital or medical service 21 contract issued pursuant to chapter 509 , 514 , or 514A . 22 (3) An individual or group health maintenance organization 23 contract regulated under chapter 514B . 24 (4) An individual or group Medicare supplemental policy, 25 unless coverage pursuant to such policy is preempted by federal 26 law. 27 b. A long-term care policy or contract is specifically 28 excluded from regulation under this section . 29 2. 3. As used in this section , “minimum mammography 30 examination coverage” means benefits which are better than or 31 equal to the following minimum requirements: 32 a. One baseline mammogram for any woman who is thirty-five 33 through thirty-nine years of age, or more frequent mammograms 34 if recommended by the woman’s physician health care 35 -1- LSB 5661SV (1) 87 ko/rj 1/ 3

S.F. 2368 professional . 1 b. A mammogram every two years for any woman who is 2 forty through forty-nine years of age, or more frequently if 3 recommended by the woman’s physician. 4 c. b. A mammogram every year for any woman who is fifty 5 forty years of age or older, or more frequently if recommended 6 by the woman’s physician health care professional . 7 3. 4. Mammogram benefits may be subject to any policy or 8 contract provisions which apply generally to other services 9 covered by the policy or contract. 10 4. 5. The commissioner of insurance shall adopt rules under 11 chapter 17A necessary to implement this section . 12 Sec. 2. EFFECTIVE DATE. This Act, being deemed of immediate 13 importance, takes effect upon enactment. 14 Sec. 3. APPLICABILITY. This Act applies to the classes of 15 third-party payment provider contracts or policies specified 16 in section 514C.4, as amended by this Act, that are delivered, 17 issued for delivery, continued, or renewed in this state on or 18 after July 1, 2018. 19 EXPLANATION 20 The inclusion of this explanation does not constitute agreement with 21 the explanation’s substance by the members of the general assembly. 22 This bill relates to insurance coverage for a mammogram as 23 recommended by a woman’s health care professional. 24 The bill defines “mammogram” as a radiographic image 25 obtained using a procedure, including two-dimensional 26 mammography or three-dimensional mammography, as recommended 27 by a woman’s health care professional. Currently, insurance 28 coverage is required for one mammogram every two years for 29 women age 40 through 49. The bill changes this to require 30 insurance coverage for an annual mammogram for women age 40 and 31 over. The bill requires that the insurance coverage apply to 32 two-dimensional mammograms and three-dimensional mammograms. 33 The bill also allows a woman’s health care professional, 34 defined to include licensed, accredited, registered, or 35 -2- LSB 5661SV (1) 87 ko/rj 2/ 3

S.F. 2368 certified health care practitioners, to recommend a mammogram. 1 Currently, a woman’s physician must recommend the performance 2 of a mammogram. 3 The bill applies to the classes of third-party payment 4 provider contracts or policies specified in Code section 514C.4 5 that are delivered, issued for delivery, continued, or renewed 6 in this state on or after July 1, 2018. 7 -3- LSB 5661SV (1) 87 ko/rj 3/ 3