Senate
File
2064
-
Introduced
SENATE
FILE
2064
BY
PETERSEN
,
RAGAN
,
MATHIS
,
BOULTON
,
CELSI
,
J.
SMITH
,
JOCHUM
,
WAHLS
,
KINNEY
,
DOTZLER
,
R.
TAYLOR
,
BISIGNANO
,
LYKAM
,
GIDDENS
,
BOLKCOM
,
QUIRMBACH
,
HOGG
,
and
T.
TAYLOR
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
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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
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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
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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.
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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
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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.
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