Senate File 2363 - Introduced SENATE FILE 2363 BY COMMITTEE ON COMMERCE (SUCCESSOR TO SSB 3078) A BILL FOR An Act relating to insurance coverage for health care services 1 related to the prevention of ovarian cancer. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5499SV (1) 90 nls/ko

S.F. 2363 Section 1. NEW SECTION . 514C.36 Ovarian cancer prevention 1 —— coverage. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “At risk for ovarian cancer” means any of the following: 5 (1) A family history that includes any of the following: 6 (a) One or more first degree relatives that have had ovarian 7 cancer. 8 (b) Clusters of female relatives that have had breast 9 cancer. 10 (c) Nonpolyposis colorectal cancer. 11 (2) Testing positive for either the BRCA1 or BRCA2 mutation. 12 b. “Cost-sharing” means any coverage limit, copayment, 13 coinsurance, deductible, or other out-of-pocket expense 14 obligation imposed on a covered person by a policy, contract, 15 or plan providing for third-party payment or prepayment of 16 health or medical expenses. 17 c. “Covered person” means a policyholder, subscriber, or 18 other person participating in a policy, contract, or plan that 19 provides for third-party payment or prepayment of health or 20 medical expenses. 21 d. “Health carrier” means the same as defined in section 22 514J.102. 23 e. “Surveillance testing for ovarian cancer” means 24 annual screening using CA 125 blood testing, a transvaginal 25 ultrasound, and a pelvic examination. 26 2. a. Notwithstanding the uniformity of treatment 27 requirements of section 514C.6, a health carrier that offers 28 individual, group, or small group contracts, policies, or 29 plans in this state that provide for third-party payment or 30 prepayment of health or medical expenses shall offer coverage 31 for all of the following: 32 (1) An annual cervical smear test or pap smear test. 33 (2) Surveillance testing for ovarian cancer for covered 34 persons at risk for ovarian cancer. 35 -1- LSB 5499SV (1) 90 nls/ko 1/ 3

S.F. 2363 b. Coverage required under this section shall not be less 1 favorable than coverage a health carrier offers for general 2 physical illness. 3 c. Cost-sharing requirements imposed for coverage 4 required under this section shall not be less favorable than 5 cost-sharing requirements imposed by a health carrier for 6 general physical illness. 7 3. a. This section shall apply to the following classes 8 of third-party payment provider contracts, policies, or plans 9 delivered, issued for delivery, continued, or renewed in this 10 state on or after January 1, 2025: 11 (1) Individual or group accident and sickness insurance 12 providing coverage on an expense-incurred basis. 13 (2) An individual or group hospital or medical service 14 contract issued pursuant to chapter 509, 514, or 514A. 15 (3) An individual or group health maintenance organization 16 contract regulated under chapter 514B. 17 (4) An individual or group Medicare supplement policy, 18 unless coverage under this section is preempted by federal law. 19 (5) A plan established for public employees pursuant to 20 chapter 509A. 21 b. This section shall not apply to accident-only, specified 22 disease, short-term hospital or medical, hospital confinement 23 indemnity, credit, dental, vision, long-term care, basic 24 hospital and medical-surgical expense coverage as defined 25 by the commissioner, disability income insurance coverage, 26 coverage issued as a supplement to liability insurance, 27 workers’ compensation or similar insurance, or automobile 28 medical payment insurance. 29 4. The commissioner of insurance shall adopt rules pursuant 30 to chapter 17A to administer this section. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to insurance coverage for health care 35 -2- LSB 5499SV (1) 90 nls/ko 2/ 3

S.F. 2363 services related to the prevention of ovarian cancer. 1 The bill requires a policy, contract, or plan providing for 2 third-party payment or prepayment of health or medical expenses 3 to provide coverage for an annual cervical smear test or pap 4 smear test, and for surveillance testing for ovarian cancer 5 for covered persons at risk for ovarian cancer. “Surveillance 6 testing for ovarian cancer” is defined in the bill as 7 annual screening using CA 125 blood testing, a transvaginal 8 ultrasound, and a pelvic examination. “At risk for ovarian 9 cancer” is defined as a family history that includes one or 10 more first degree relatives that have had ovarian cancer, 11 clusters of female relatives that have had breast cancer or 12 nonpolyposis colorectal cancer; or testing positive for either 13 the BRCA1 or BRCA2 mutation. 14 Coverage required under the bill shall not be less favorable 15 than coverage a health carrier offers for general physical 16 illness. Cost-sharing requirements imposed for coverage 17 required under the bill shall not be less favorable than 18 cost-sharing requirements imposed by a health carrier for 19 general physical illness. 20 The bill applies to third-party payment providers enumerated 21 in the bill. The bill specifies the types of specialized 22 health-related insurance which are not subject to the bill. 23 The commissioner of insurance is required to adopt rules to 24 administer the bill. 25 The bill applies to third-party payment provider contracts, 26 policies, or plans delivered, issued for delivery, continued, 27 or renewed in this state on or after January 1, 2025. 28 -3- LSB 5499SV (1) 90 nls/ko 3/ 3