H.F. 467 Section 1. NEW SECTION . 514A.16 Explanation of benefits —— 1 secondary health benefit plans. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Covered person” means the same as defined in section 5 514J.102. 6 b. “Explanation of benefits” means a statement provided to a 7 covered person by the covered person’s health benefit plan that 8 explains the costs that the health benefit plan will cover for 9 the health care services received by the covered person. 10 c. “Health benefit plan” means a policy, contract, 11 certificate, or agreement offered or issued by a health carrier 12 to provide, deliver, arrange for, pay for, or reimburse any of 13 the costs of health care services. 14 d. “Health care services” means the same as defined in 15 section 514J.102. 16 2. If a covered person’s secondary health benefit plan 17 requests a copy of an explanation of benefits from a covered 18 person’s primary health benefit plan, the primary health 19 benefit plan shall provide a copy of the explanation of 20 benefits no later than twenty calendar days from the date of 21 the request. 22 EXPLANATION 23 The inclusion of this explanation does not constitute agreement with 24 the explanation’s substance by the members of the general assembly. 25 This bill relates to secondary health benefit plans’ (plan) 26 access to explanation of benefits from primary health benefit 27 plans. If a covered person’s secondary plan requests a copy 28 of an explanation of benefits (EOB) from a covered person’s 29 primary plan, the primary plan shall provide a copy of the EOB 30 no later than 20 calendar days from the date of the request. 31 “EOB” is defined in the bill. 32 -1- LSB 1565HV (1) 90 ko/rn 1/ 1