House File 4 - Introduced HOUSE FILE 4 BY BODEN A BILL FOR An Act relating to health benefit plans, claims for 1 reimbursement, and explanation of benefits. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 1536YH (2) 91 nls/ko

H.F. 4 Section 1. NEW SECTION . 147.165 Health benefit plans —— 1 claims. 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. “Health benefit plan” means a policy, contract, 7 certificate, or agreement offered or issued by a health carrier 8 to provide, deliver, arrange for, pay for, or reimburse any of 9 the costs of health care services. 10 c. “Health care professional” means a physician or other 11 health care practitioner licensed, accredited, registered, or 12 certified to perform specified health care services consistent 13 with state law. 14 d. “Health care services” means the same as defined in 15 section 514J.102. 16 e. “Personal representative” means the same as described in 17 45 C.F.R. §164.502(g). 18 2. A health care professional who provides health 19 care services to a covered person shall submit a claim for 20 reimbursement to the primary health benefit plan designated 21 by the covered person or the covered person’s personal 22 representative prior to submitting a claim for reimbursement to 23 any other health benefit plan designated by the covered person 24 or the covered person’s personal representative. 25 Sec. 2. NEW SECTION . 514A.16 Explanation of benefits —— 26 secondary health benefit plans. 27 1. As used in this section, unless the context otherwise 28 requires: 29 a. “Covered person” means the same as defined in section 30 514J.102. 31 b. “Explanation of benefits” means a statement provided to a 32 covered person by the covered person’s health benefit plan that 33 explains the costs that the health benefit plan will cover for 34 the health care services received by the covered person. 35 -1- LSB 1536YH (2) 91 nls/ko 1/ 2

H.F. 4 c. “Health benefit plan” means a policy, contract, 1 certificate, or agreement offered or issued by a health carrier 2 to provide, deliver, arrange for, pay for, or reimburse any of 3 the costs of health care services. 4 d. “Health care services” means the same as defined in 5 section 514J.102. 6 e. “Personal representative” means the same as described in 7 45 C.F.R. §164.502(g). 8 2. If a covered person, a covered person’s personal 9 representative, or a covered person’s secondary health benefit 10 plan request a copy of an explanation of benefits from a 11 covered person’s primary health benefit plan, the primary 12 health benefit plan shall provide a copy of the explanation of 13 benefits no later than thirty calendar days from the date of 14 the request. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanation’s substance by the members of the general assembly. 18 This bill relates to health benefit plans, claims for 19 reimbursement, and explanation of benefits (EOB). 20 Under the bill, a health care professional who provides 21 health care services to a covered person (person) shall 22 submit a claim for reimbursement (claim) to the primary 23 health benefit plan (plan) designated by the person or their 24 personal representative (representative) prior to submitting 25 a claim to any other plan designated by the person or their 26 representative. If the person, person’s representative, or 27 person’s secondary plan requests a copy of an EOB from a 28 person’s primary plan, the primary plan shall provide a copy 29 of the EOB no later than 30 calendar days from the date of the 30 request. 31 -2- LSB 1536YH (2) 91 nls/ko 2/ 2