House File 727 - Introduced HOUSE FILE 727 BY BROWN-POWERS and A. MEYER A BILL FOR An Act relating to health insurance coverage for certain 1 post-mastectomy related issues, and including applicability 2 provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 2587YH (5) 89 ko/rn

H.F. 727 Section 1. NEW SECTION . 514C.36 Mastectomies. 1 1. As used in this section, unless the context otherwise 2 requires: 3 a. “Cost sharing” means any coverage limit, copayment, 4 coinsurance, deductible, or other out-of-pocket expense 5 obligation imposed on a covered person by a policy, contract, 6 or plan providing for third-party payment or prepayment of 7 health or medical expenses. 8 b. “Covered person” means a policyholder, subscriber, or 9 other person participating in a policy, contract, or plan that 10 provides for third-party payment or prepayment of health or 11 medical expenses. 12 c. “Health care professional” means the same as defined in 13 section 514J.102. 14 d. “Mastectomy” means the removal of all or part of a breast 15 for a medically necessary reason as determined by a covered 16 person’s health care professional. 17 2. Notwithstanding the uniformity of treatment requirements 18 of section 514C.6, a policy, contract, or plan providing 19 for third-party payment or prepayment of health or medical 20 expenses, and that provides coverage for mastectomies, shall 21 provide coverage for all of the following: 22 a. Physical complications caused by a mastectomy, including 23 lymphedema. 24 b. Prosthetic devices. 25 c. A custom fabricated breast prothesis for each breast on 26 which a mastectomy has been performed. 27 d. One additional breast prothesis for each breast affected 28 by a mastectomy. 29 e. Reconstructive surgery incident to a mastectomy, in 30 the manner determined by the covered person and the covered 31 person’s health care professional to be appropriate, including 32 all of the following: 33 (1) All stages of reconstruction of the breast on which the 34 mastectomy has been performed. 35 -1- LSB 2587YH (5) 89 ko/rn 1/ 3

H.F. 727 (2) Surgery and reconstruction of the breast on which the 1 mastectomy was not performed to produce symmetry with the 2 breast on which the mastectomy was performed. 3 3. Coverage shall not be subject to cost sharing that is 4 greater than the cost sharing that a policy, contract, or plan 5 imposes for a mastectomy under the policy, contract, or plan. 6 4. a. This section shall apply to the following classes of 7 third-party payment provider contracts, policies, or plans: 8 (1) Individual or group accident and sickness insurance 9 providing coverage on an expense-incurred basis. 10 (2) An individual or group hospital or medical service 11 contract issued pursuant to chapter 509, 514, or 514A. 12 (3) An individual or group health maintenance organization 13 contract regulated under chapter 514B. 14 (4) A plan established for public employees pursuant to 15 chapter 509A. 16 b. This section shall not apply to accident-only, specified 17 disease, short-term hospital or medical, hospital confinement 18 indemnity, credit, dental, vision, Medicare supplement, 19 long-term care, basic hospital and medical-surgical expense 20 coverage as defined by the commissioner of insurance, 21 disability income insurance coverage, coverage issued as a 22 supplement to liability insurance, workers’ compensation or 23 similar insurance, or automobile medical payment insurance. 24 5. The commissioner of insurance shall adopt rules pursuant 25 to chapter 17A to administer this section. 26 Sec. 2. APPLICABILITY. This Act applies to third-party 27 payment provider contracts, policies, or plans delivered, 28 issued for delivery, continued, or renewed in this state on or 29 after January 1, 2022. 30 EXPLANATION 31 The inclusion of this explanation does not constitute agreement with 32 the explanation’s substance by the members of the general assembly. 33 This bill relates to health insurance coverage for certain 34 post-mastectomy related issues. 35 -2- LSB 2587YH (5) 89 ko/rn 2/ 3

H.F. 727 The bill defines “mastectomy” as the removal of all or part 1 of a breast for a medically necessary reason as determined by a 2 covered person’s health care professional. 3 The bill requires a health carrier that offers individual, 4 group, or small group contracts, policies, or plans (plans) in 5 this state that provide for third-party payment or prepayment 6 of health or medical expenses, and that provide coverage for 7 mastectomies, to provide coverage for physical complications 8 caused by a mastectomy, including lymphedema; prosthetic 9 devices; a custom fabricated breast prothesis for each breast 10 on which a mastectomy has been performed; one additional breast 11 prothesis for each breast affected by a mastectomy; all stages 12 of reconstruction of the breast on which the mastectomy has 13 been performed; and surgery and reconstruction of the breast on 14 which the mastectomy was not performed to produce symmetry with 15 the other breast. 16 The coverage cannot be subject to cost sharing that is 17 greater than the cost sharing that a plan imposes for a 18 mastectomy under the plan. 19 The bill applies to the third-party payment providers 20 enumerated in the bill. The bill specifies the types of 21 specialized health-related insurance which are not subject to 22 the coverage requirements of the bill. 23 The commissioner of insurance must adopt rules to administer 24 the requirements of the bill. 25 The bill applies to third-party payment provider plans 26 delivered, issued for delivery, continued, or renewed in this 27 state on or after January 1, 2022. 28 -3- LSB 2587YH (5) 89 ko/rn 3/ 3