HF 2651 (LSB 5626YH (3) 90)

HOUSE FILE 2651

BY  BEST

A BILL FOR

An Act relating to certain health care plan’s cost-sharing for essential health benefits.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514K.3  Health care plans —— cost-sharing for essential health benefits.
   For purposes of calculating an enrollee’s contribution to the annual limitation on cost-sharing under 42 U.S.C. §18022(c) and 42 U.S.C. §300gg-6(b), a health care plan, or the health care plan’s subcontractors, that provides small group health coverage pursuant to chapter 513B, individual health coverage pursuant to chapter 513C, or group health insurance coverage pursuant to chapter 509, shall include expenditures for any item or service covered under the health care plan if the item or service is included within a category of essential health benefits, as described in 42 U.S.C. §18022(b)(1), and regardless of whether the health care plan, or the health care plan’s subcontractors, classifies the item or service as an essential health benefit. For purposes of this section, “cost-sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket cost obligation imposed by a health care plan, or the health care plan’s subcontractors, on an enrollee.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to certain health care plan’s cost-sharing for essential health benefits. Under the bill, when calculating an enrollee’s contribution to the annual limitation on cost-sharing under federal law, a health care plan, or its subcontractors, that provides small group health coverage, individual health coverage, or group health insurance coverage shall include expenditures for any item or service covered under the health care plan if the item or service is included within a category of essential health benefits regardless of whether the health care plan, or its subcontractors, classifies the item or service as an essential health benefit. “Cost-sharing” is defined in the bill as any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket cost obligation imposed by a health care plan, or the health care plan’s subcontractors, on an enrollee.