House File 2327 - Introduced HOUSE FILE 2327 BY OLDSON , ABDUL-SAMAD , ANDERSON , BEARINGER , BENNETT , BRECKENRIDGE , BROWN-POWERS , COHOON , DERRY , DONAHUE , EHLERT , FORBES , GASKILL , HALL , HUNTER , ISENHART , JACOBY , JAMES , JUDGE , KACENA , KONFRST , KRESSIG , PRICHARD , GAINES , KURTZ , LENSING , MASCHER , MATSON , McCONKEY , McKEAN , B. MEYER , NIELSEN , OLSON , OURTH , KURTH , RUNNING-MARQUARDT , M. SMITH , R. SMITH , STAED , STECKMAN , SUNDE , THEDE , WESSEL-KROESCHELL , WILBURN , WILLIAMS , WINCKLER , and WOLFE A BILL FOR An Act relating to preexisting condition protections and 1 including applicability provisions. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5752YH (3) 88 ko/rn

H.F. 2327 Section 1. NEW SECTION . 514M.1 Short title. 1 This chapter shall be known and may be cited as “The Protect 2 Coverage for Preexisting Conditions Act” . 3 Sec. 2. NEW SECTION . 514M.2 Definitions. 4 As used in this chapter, unless the context otherwise 5 requires: 6 1. “Commissioner” means the commissioner of insurance. 7 2. “Health benefit plan” means any policy, contract, 8 certificate, or agreement, including a short-term, 9 limited-duration policy, offered or issued by a health carrier 10 to provide, deliver, arrange for, pay for, or reimburse any of 11 the costs of health care services. 12 3. “Health care services” means services for the diagnosis, 13 prevention, treatment, cure, or relief of a health condition, 14 illness, injury, or disease. 15 4. “Health carrier” means an entity subject to the 16 insurance laws and regulations of this state, or subject 17 to the jurisdiction of the commissioner, including an 18 insurance company offering sickness and accident plans, a 19 health maintenance organization, a nonprofit health service 20 corporation, a plan established pursuant to chapter 509A for 21 public employees, a plan offered or maintained by a multiple 22 employer welfare association, or any other entity providing 23 a plan of health insurance, health benefits, or health care 24 services. Notwithstanding section 505.20, subsection 1, “health 25 carrier” also includes a nonprofit agricultural organization 26 domiciled in the state that sponsors a health benefit plan 27 pursuant to section 505.20. 28 5. “Preexisting condition exclusion” means a limitation or 29 exclusion of benefits, or a denial of coverage, relating to 30 a condition based on the fact that the condition was present 31 before the date of enrollment for such coverage or the date 32 of denial of coverage, whether or not any medical advice, 33 diagnosis, care, or treatment was recommended or received for 34 the condition before the date of enrollment or the date of 35 -1- LSB 5752YH (3) 88 ko/rn 1/ 5

H.F. 2327 denial of coverage. 1 Sec. 3. NEW SECTION . 514M.3 Preexisting conditions. 2 Notwithstanding any other provision of law to the contrary, 3 a health carrier that offers an individual health benefit plan 4 or a group health benefit plan in this state shall not do 5 either of the following: 6 1. Deny coverage to any employer or to any individual that 7 is eligible to apply for the individual health benefit plan or 8 the group health benefit plan. 9 2. Impose any preexisting condition exclusion on an 10 employer or on an individual with respect to the individual 11 health benefit plan or the group health benefit plan. 12 Sec. 4. NEW SECTION . 514M.4 Premium rates. 13 1. a. Notwithstanding any other provision of law to the 14 contrary, a health carrier that offers an individual health 15 benefit plan or a group health benefit plan in this state shall 16 develop premium rates for the individual health benefit plan 17 or the group health benefit plan based only on the following 18 factors: 19 (1) Age, except that the rate shall not vary by more than 20 three-to-one for like individuals of different ages who are age 21 twenty-one and older. 22 (2) Whether the health benefit plan covers an individual or 23 family. 24 (3) Tobacco use, except that the rate shall not vary by more 25 than one and one-half times the rate charged to a non-tobacco 26 user. 27 (4) Geographic rating area established in compliance with 28 federal law. 29 b. Notwithstanding any other provision of law to the 30 contrary, with respect to premium rates for family coverage 31 under an individual health benefit plan or a group health 32 benefit plan offered in this state, a health carrier shall 33 apply the factors permitted pursuant to paragraph “a” based on 34 the premium that is attributable to each family member covered 35 -2- LSB 5752YH (3) 88 ko/rn 2/ 5

H.F. 2327 under the health benefit plan in accordance with rules adopted 1 by the commissioner. 2 2. Notwithstanding any other provision of law to the 3 contrary, a health carrier that offers an individual health 4 benefit plan or a group health benefit plan in this state shall 5 adjust the premium rates established pursuant to subsection 1 6 no more frequently than annually and based only on the factors 7 in subsection 1, paragraph “a” , except that the health carrier 8 may adjust the premium rates in the following circumstances: 9 a. With respect to a small group health plan, if there are 10 changes in enrollment. 11 b. There is a change to the family composition of an 12 individual enrolled in an individual health benefit plan or of 13 an employee enrolled in a group health benefit plan. 14 c. There is a change in the geographic rating area or in 15 tobacco use for an individual enrolled in an individual health 16 benefit plan. 17 d. An individual enrolled in an individual health benefit 18 plan requests changes to the health benefit plan or a small 19 employer requests changes to a group health benefit plan. 20 e. A change in federal law or federal regulations requiring 21 a premium rate adjustment. 22 Sec. 5. NEW SECTION . 514M.5 Rules. 23 The commissioner shall adopt rules pursuant to chapter 17A 24 as necessary to implement and administer this chapter. 25 Sec. 6. NEW SECTION . 514M.6 Enforcement. 26 The commissioner shall take any action within the 27 commissioner’s authority to enforce compliance with this 28 chapter. 29 Sec. 7. APPLICABILITY. This Act applies to health benefit 30 plans delivered, issued for delivery, continued, or renewed in 31 this state on or after January 1, 2021. 32 EXPLANATION 33 The inclusion of this explanation does not constitute agreement with 34 the explanation’s substance by the members of the general assembly. 35 -3- LSB 5752YH (3) 88 ko/rn 3/ 5

H.F. 2327 This bill relates to preexisting condition protections and 1 creates “The Protect Coverage for Preexisting Conditions Act”. 2 The bill prohibits a health carrier that offers an 3 individual health benefit plan (individual plan) or a group 4 health benefit plan (group plan) in this state from denying 5 coverage to any employer or to any individual that is eligible 6 to apply for the individual plan or the group plan, or from 7 imposing any preexisting condition exclusion on an employer or 8 on an individual with respect to the individual plan or the 9 group plan. “Health carrier” is defined in the bill as an 10 entity subject to the insurance laws and regulations of this 11 state, or subject to the jurisdiction of the commissioner, 12 including an insurance company offering sickness and accident 13 plans, a health maintenance organization, a nonprofit health 14 service corporation, a plan established pursuant to Code 15 chapter 509A for public employees, a plan offered or maintained 16 by a multiple employer welfare association, or any other 17 entity providing a plan of health insurance, health benefits, 18 or health care services. “Health carrier” also includes a 19 nonprofit agricultural organization domiciled in the state that 20 sponsors a health benefit plan pursuant to Code section 505.20. 21 The bill defines “preexisting condition exclusion” as a 22 limitation or exclusion of benefits, or a denial of coverage, 23 relating to a condition based on the fact that the condition 24 was present before the date of enrollment for such coverage 25 or the date of denial of coverage, whether or not any medical 26 advice, diagnosis, care, or treatment was recommended or 27 received for the condition before the date of enrollment or the 28 date of denial of coverage. 29 A health carrier that offers an individual plan or a group 30 plan must develop premium rates for the individual or group 31 plan based on age, whether the health benefit plan covers an 32 individual or family, tobacco use, and the geographic rating 33 area established in compliance with federal law. With respect 34 to premium rates for family coverage under an individual 35 -4- LSB 5752YH (3) 88 ko/rn 4/ 5

H.F. 2327 plan or a group plan, a health carrier must apply those same 1 factors, in accordance with rules adopted by the commissioner, 2 based on the premium attributable to each family member 3 covered under the plan. Premium rates can be adjusted no more 4 frequently than annually and based only on those same factors, 5 except that the health carrier may adjust the premium rates in 6 specified circumstances as detailed in the bill. 7 The bill directs the commissioner to adopt rules as 8 necessary to implement and administer the provisions of the 9 bill and to take any action within the commissioner’s authority 10 to enforce compliance with the provisions of the bill. 11 The bill applies to health benefit plans delivered, issued 12 for delivery, continued, or renewed in this state on or after 13 January 1, 2021. 14 -5- LSB 5752YH (3) 88 ko/rn 5/ 5