House File 2651 - Introduced HOUSE FILE 2651 BY BEST A BILL FOR An Act relating to certain health care plan’s cost-sharing for 1 essential health benefits. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5626YH (3) 90 nls/ko

H.F. 2651 Section 1. NEW SECTION . 514K.3 Health care plans —— 1 cost-sharing for essential health benefits. 2 For purposes of calculating an enrollee’s contribution to 3 the annual limitation on cost-sharing under 42 U.S.C. §18022(c) 4 and 42 U.S.C. §300gg-6(b), a health care plan, or the health 5 care plan’s subcontractors, that provides small group health 6 coverage pursuant to chapter 513B, individual health coverage 7 pursuant to chapter 513C, or group health insurance coverage 8 pursuant to chapter 509, shall include expenditures for any 9 item or service covered under the health care plan if the 10 item or service is included within a category of essential 11 health benefits, as described in 42 U.S.C. §18022(b)(1), and 12 regardless of whether the health care plan, or the health 13 care plan’s subcontractors, classifies the item or service as 14 an essential health benefit. For purposes of this section, 15 “cost-sharing” means any coverage limit, copayment, coinsurance, 16 deductible, or other out-of-pocket cost obligation imposed by a 17 health care plan, or the health care plan’s subcontractors, on 18 an enrollee. 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 certain health care plan’s cost-sharing 23 for essential health benefits. Under the bill, when 24 calculating an enrollee’s contribution to the annual limitation 25 on cost-sharing under federal law, a health care plan, or its 26 subcontractors, that provides small group health coverage, 27 individual health coverage, or group health insurance coverage 28 shall include expenditures for any item or service covered 29 under the health care plan if the item or service is included 30 within a category of essential health benefits regardless 31 of whether the health care plan, or its subcontractors, 32 classifies the item or service as an essential health benefit. 33 “Cost-sharing” is defined in the bill as any coverage limit, 34 copayment, coinsurance, deductible, or other out-of-pocket cost 35 -1- LSB 5626YH (3) 90 nls/ko 1/ 2

H.F. 2651 obligation imposed by a health care plan, or the health care 1 plan’s subcontractors, on an enrollee. 2 -2- LSB 5626YH (3) 90 nls/ko 2/ 2