House File 874 - Introduced HOUSE FILE 874 BY GAINES and THEDE A BILL FOR An Act relating to insurance coverage for diagnostic breast 1 cancer examinations, and including applicability provisions. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1644YH (1) 89 ko/rn

H.F. 874 Section 1. NEW SECTION . 514C.4A Diagnostic examinations 1 —— breast cancer. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Abnormality” means an abnormal feature, characteristic, 5 or occurrence in a covered person’s breast that meets any of 6 the following requirements: 7 (1) The abnormality is identified as a result of a covered 8 person’s screening mammogram. 9 (2) The abnormality is identified during the provision 10 of health care services to a covered person by a health care 11 professional. 12 (3) A health care professional determines an abnormality 13 exists based on a covered person’s medical history or the 14 covered person’s family medical history. 15 b. “Breast magnetic resonance imaging” or “breast MRI” means 16 an examination of a breast using a powerful magnetic field, 17 radio waves, and a computer to produce detailed pictures of the 18 structures within the breast. 19 c. “Breast ultrasound” means an examination of a breast 20 using sound waves to produce pictures of the internal 21 structures of the breast. 22 d. “Cost-sharing” means any coverage limit, copayment, 23 coinsurance, deductible, or other out-of-pocket expense 24 obligation imposed on a covered person by a policy, contract, 25 or plan providing for third-party payment or prepayment of 26 health or medical expenses. 27 e. “Covered person” means a policyholder, subscriber, or 28 other person participating in a policy, contract, or plan that 29 provides for third-party payment or prepayment of health or 30 medical expenses. 31 f. “Diagnostic breast cancer examination” means an 32 examination of an abnormality, deemed medically necessary by a 33 covered person’s health care professional, for the detection 34 of breast cancer. The examination may be conducted using a 35 -1- LSB 1644YH (1) 89 ko/rn 1/ 4

H.F. 874 diagnostic mammogram, breast magnetic resonance imaging, or a 1 breast ultrasound. 2 g. “Diagnostic mammogram” means a detailed examination of a 3 breast abnormality using X ray. 4 h. “Health care professional” means the same as defined in 5 section 514J.102. 6 i. “Health care services” means services for the diagnosis, 7 prevention, treatment, cure, or relief of a health condition, 8 illness, injury, or disease. 9 j. “Screening mammogram” means an examination of a breast 10 using a low-dose x-ray system to see inside the breast, and 11 that aids in the early detection and diagnosis of breast 12 cancer. 13 2. Notwithstanding the uniformity of treatment requirements 14 of section 514C.6, a policy, contract, or plan providing 15 for third-party payment or prepayment of health or medical 16 expenses shall provide coverage for diagnostic breast cancer 17 examinations. The policy, contract, or plan shall not require 18 cost-sharing greater than the cost-sharing that the policy, 19 contract, or plan requires for a screening mammogram. 20 3. a. This section shall apply to the following classes of 21 third-party payment provider contracts, policies, or plans: 22 (1) Individual or group accident and sickness insurance 23 providing coverage on an expense-incurred basis. 24 (2) An individual or group hospital or medical service 25 contract issued pursuant to chapter 509, 514, or 514A. 26 (3) An individual or group health maintenance organization 27 contract regulated under chapter 514B. 28 (4) A plan established for public employees pursuant to 29 chapter 509A. 30 b. This section shall not apply to accident-only, specified 31 disease, short-term hospital or medical, hospital confinement 32 indemnity, credit, dental, vision, Medicare supplement, 33 long-term care, basic hospital and medical-surgical expense 34 coverage as defined by the commissioner of insurance, 35 -2- LSB 1644YH (1) 89 ko/rn 2/ 4

H.F. 874 disability income insurance coverage, coverage issued as a 1 supplement to liability insurance, workers’ compensation or 2 similar insurance, or automobile medical payment insurance. 3 4. The commissioner of insurance shall adopt rules pursuant 4 to chapter 17A to administer this section. 5 Sec. 2. APPLICABILITY. This Act applies to third-party 6 payment provider contracts, policies, or plans delivered, 7 issued for delivery, continued, or renewed in this state on or 8 after January 1, 2022. 9 EXPLANATION 10 The inclusion of this explanation does not constitute agreement with 11 the explanation’s substance by the members of the general assembly. 12 This bill relates to insurance coverage for diagnostic 13 breast cancer examinations. 14 The bill requires a policy, contract, or plan providing for 15 third-party payment or prepayment of health or medical expenses 16 to provide coverage for diagnostic breast cancer examinations. 17 “Diagnostic breast cancer examination” is defined in the bill 18 as an examination of an abnormality, deemed medically necessary 19 by a covered person’s health care professional, for the 20 detection of breast cancer. The examination may be conducted 21 using a diagnostic mammogram, breast magnetic resonance 22 imaging, or breast ultrasound. “Abnormality”, “diagnostic 23 mammogram”, “breast magnetic resonance imaging”, and “breast 24 ultrasound” are also defined in the bill. 25 The policy, contract, or plan cannot require cost-sharing 26 greater than the cost-sharing that the policy, contract, or 27 plan requires for a screening mammogram. “Cost-sharing” and 28 “screening mammogram” are defined in the bill. 29 The bill applies to third-party payment providers enumerated 30 in the bill. The bill specifies the types of specialized 31 health-related insurance which are not subject to the bill. 32 The commissioner of insurance is required to adopt rules to 33 administer the requirements of the bill. 34 The bill applies to third-party payment provider contracts, 35 -3- LSB 1644YH (1) 89 ko/rn 3/ 4

H.F. 874 policies, or plans delivered, issued for delivery, continued, 1 or renewed in this state on or after January 1, 2022. 2 -4- LSB 1644YH (1) 89 ko/rn 4/ 4