SF 290 (LSB 2147XS (3) 90)

SENATE FILE 290

BY  SWEENEY

A BILL FOR

An Act relating to insurance coverage for health care services related to the prevention of ovarian cancer.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  SHORT TITLE.  This Act shall be known as “Barbara’s Bill”.
    Sec. 2.  NEW SECTION.  514C.36  Ovarian cancer prevention —— coverage.
   1.  As used in this section, unless the context otherwise requires:
   a.  “At risk for ovarian cancer” means any of the following:
   (1)  A family history that includes any of the following:
   (a)  One or more first degree relatives that have had ovarian cancer.
   (b)  Clusters of female relatives that have had breast cancer.
   (c)  Nonpolyposis colorectal cancer.
   (2)  Testing positive for either the BRCA1 or BRCA2 mutation.
   b.  “Cost-sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense obligation imposed on a covered person by a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses.
   c.  “Covered person” means a policyholder, subscriber, or other person participating in a policy, contract, or plan that provides for third-party payment or prepayment of health or medical expenses.
   d.  “Health carrier” means the same as defined in section 514J.102.
   e.  “Surveillance testing for ovarian cancer” means annual screening using CA 125 blood testing, a transvaginal ultrasound, and a pelvic examination.
   2.  a.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a health carrier that offers individual, group, or small group contracts, policies, or plans in this state that provide for third-party payment or prepayment of health or medical expenses shall offer coverage for all of the following:
   (1)  An annual cervical smear test or pap smear test.
   (2)  Surveillance testing for ovarian cancer for covered persons at risk for ovarian cancer.
   b.  Coverage required under this section shall not be less favorable than coverage a health carrier offers for general physical illness.
   c.  Cost-sharing requirements imposed for coverage required under this section shall not be less favorable than cost-sharing requirements imposed by a health carrier for general physical illness.
   3.  a.  This section shall apply to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2024:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  An individual or group Medicare supplement policy, unless coverage under this section is preempted by federal law.
   (5)  A plan established for public employees pursuant to chapter 509A.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   4.  The commissioner of insurance shall adopt rules pursuant to chapter 17A to administer this section.
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 insurance coverage for health care services related to the prevention of ovarian cancer, and shall be known as “Barbara’s Bill”.
   The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to provide coverage for an annual cervical smear test or pap smear test, and for surveillance testing for ovarian cancer for covered persons at risk for ovarian cancer. “Surveillance testing for ovarian cancer” is defined in the bill as annual screening using CA 125 blood testing, a transvaginal ultrasound, and a pelvic examination. “At risk for ovarian cancer” is defined as a family history that includes one or more first degree relatives that have had ovarian cancer, clusters of female relatives that have had breast cancer or nonpolyposis colorectal cancer; or testing positive for either the BRCA1 or BRCA2 mutation.
   Coverage required under the bill shall not be less favorable than coverage a health carrier offers for general physical illness. Cost-sharing requirements imposed for coverage required under the bill shall not be less favorable than cost-sharing requirements imposed by a health carrier for general physical illness.
   The bill applies to third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the bill.
   The commissioner of insurance is required to adopt rules to administer the bill.
   The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2024.