HF 606 (LSB 1277YH (4) 91)

HOUSE FILE 606

BY  A. MEYER

A BILL FOR

An Act relating to certain health insurance policies, contracts, and plans and a special enrollment period for pregnant women.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.37  Special enrollment period —— pregnant women.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Health care professional” means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law.
   b.  “Special enrollment period” means a period other than the first period in which an eligible individual or the individual’s dependent is eligible to enroll under the terms of a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses, without regard to other enrollment periods defined under the terms of the policy, contract, or plan.
   2.  a.  Notwithstanding the uniformity of treatment requirements of section 514C.6, and notwithstanding any provision of law to the contrary, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide a special enrollment period for a pregnant woman that allows the pregnant woman to enroll at any time after a health care professional certifies that the woman is pregnant. The policy, contract, or plan shall not impose a fee or other penalty for special enrollment of the pregnant woman.
   b.  Upon enrollment of a pregnant woman in a policy, contract, or plan under paragraph “a”, coverage shall be effective as of the first day of the month in which the health care professional certifies that the woman is pregnant, unless the woman elects to have coverage effective on the first day of the month following the date that the woman received certification of the pregnancy.
   3.  a.  This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026:
   (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)  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, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner of insurance, 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 a special enrollment period for pregnant women.
   The bill requires a policy, contract, or plan (policy) providing for third-party payment or prepayment of health or medical expenses to provide a special enrollment period for a pregnant woman that allows the pregnant woman to enroll at any time after a health care professional (professional) certifies that the woman is pregnant. The policy shall not impose a fee or other penalty for special enrollment of the pregnant woman. Upon enrollment of a pregnant woman in a policy, coverage shall be effective as of the first day of the month in which the professional certifies that the woman is pregnant, unless the individual elects to have coverage effective on the first day of the month following the date that the woman received certification of the pregnancy.
   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 coverage requirements of the bill.
   The commissioner of insurance shall adopt rules to administer the bill.