HF 462 (LSB 1083HV (1) 90)

HOUSE FILE 462

BY  COMMITTEE ON COMMERCE

(SUCCESSOR TO HF 228)

A BILL FOR

An Act relating to Medicare supplement policies and an annual open enrollment period.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514M.1  Medicare supplement insurance —— annual open enrollment.
   1.  For purposes of this section, unless the context otherwise requires:
   a.  “Applicant” means an individual who is at least sixty-five years old who seeks to contract for benefits under an individual Medicare supplement policy, or a proposed covered individual under a group Medicare supplement policy. “Applicant” includes an individual under the age of sixty-five who qualifies for Medicare due to disability, end-stage renal disease, or exposure to an environmental hazard. 
   b.  “Certificate” means any certificate of coverage delivered or issued for delivery in this state to a covered individual under a group Medicare supplement policy.
   c.  “Issuer” means an insurance company, a fraternal benefit society, a health care service plan, a health maintenance organization, or any other entity delivering or issuing for delivery in this state a Medicare supplement policy or certificate.
   d.  “Medicare supplement policy” means an individual or group policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations or health maintenance organizations, other than a policy issued pursuant to a contract under section 1876 of the federal Social Security Act, as codified in 42 U.S.C. §1395 et seq., or an issued policy under an approved demonstration project described in section 603(c) of the Social Security Amendments of 1983, section 2355 of the federal Deficit Reduction Act of 1984, or section 9412(b) of the federal Omnibus Budget Reconciliation Act of 1986, that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for hospital, medical, or surgical expenses of individuals covered by Medicare. “Medicare supplement policy” does not include Medicare advantage plans, outpatient prescription drug plans established under Medicare part D, or any health care prepayment plan that provides benefits pursuant to an agreement under section 1833(a)(1)(A) of the federal Social Security Act.
   2.  Beginning January 1, 2024, applicants shall have an annual thirty-day open enrollment period that begins on the date of the applicant’s birthday.
   3.  During the open enrollment period under subsection 2, an issuer shall be prohibited from doing any of the following:
   a.  Denying or conditioning the issuance or effectiveness of any Medicare supplement policy or certificate that the issuer offers and that is available for issuance in the state.
   b.  Subjecting an applicant to medical underwriting, or discriminating in the pricing of a Medicare supplement policy or certificate because of the applicant’s health status, claims experience, receipt of health care, or medical condition.
   c.  Imposing an exclusion of benefits based on an applicant’s preexisting condition.
   4.  An issuer shall provide notice, in a form prescribed by the commissioner of insurance, of the annual open enrollment period at the time an applicant applies for a Medicare supplement policy or certificate.
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 Medicare supplement policies and an annual open enrollment period.
   Beginning January 1, 2024, applicants shall have an annual 30-day open enrollment period that begins on the date of an applicant’s birthday. “Applicant” is defined in the bill as an individual who is at least 65 years old who seeks to contract for benefits under an individual Medicare supplement policy, or a proposed covered individual under a group Medicare supplement policy. “Applicant” includes an individual under the age of 65 who qualifies for Medicare due to disability, end-stage renal disease, or exposure to an environmental hazard. “Medicare supplement policy” is also defined in the bill.
   During the open enrollment period, an issuer is prohibited from denying or conditioning the issuance or effectiveness of any Medicare supplement policy that the issuer offers and that is available for issuance in the state; from subjecting an applicant to medical underwriting or discriminating in the pricing of a Medicare supplement policy because of the health status, claims experience, receipt of health care, or medical condition of an applicant; and from imposing an exclusion of benefits based on an applicant’s preexisting condition. An issuer shall provide notice, in a form prescribed by the commissioner of insurance, of the annual open enrollment period at the time an applicant applies for a Medicare supplement policy or certificate. “Issuer” is defined in the bill.