HF 467 (LSB 1565HV (1) 90)

HOUSE FILE 467

BY  COMMITTEE ON HEALTH AND HUMAN SERVICES

(SUCCESSOR TO HF 226)

A BILL FOR

An Act relating to secondary health benefit plans’ access to explanation of benefits from primary health benefit plans.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514A.16  Explanation of benefits —— secondary health benefit plans.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Covered person” means the same as defined in section 514J.102.
   b.  “Explanation of benefits” means a statement provided to a covered person by the covered person’s health benefit plan that explains the costs that the health benefit plan will cover for the health care services received by the covered person.
   c.  “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
   d.  “Health care services” means the same as defined in section 514J.102.
   2.  If a covered person’s secondary health benefit plan requests a copy of an explanation of benefits from a covered person’s primary health benefit plan, the primary health benefit plan shall provide a copy of the explanation of benefits no later than twenty calendar days from the date of the request.
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 secondary health benefit plans’ (plan) access to explanation of benefits from primary health benefit plans. If a covered person’s secondary plan requests a copy of an explanation of benefits (EOB) from a covered person’s primary plan, the primary plan shall provide a copy of the EOB no later than 20 calendar days from the date of the request. “EOB” is defined in the bill.