SF 87 (LSB 2198SS (2) 91)

SENATE FILE 87

BY  DONAHUE

A BILL FOR

An Act relating to insurance coverage for acupuncture.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 148E.9, Code 2025, is amended to read as follows:
   148E.9  Accident and health insurance coverage.
   This chapter shall not be construed to require accident and health insurance coverage for acupuncture services under an existing or future contract or policy for insurance issued or issued for delivery in this state, unless otherwise provided by the contract or policy, or as required by section 514C.36.
    Sec. 2.  NEW SECTION.  514C.37  Acupuncture —— coverage.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Acupuncture” means the same as defined in section 148E.1.
   b.  “Acupuncturist” means a person who is engaged in the practice of acupuncture and who is licensed pursuant to section 148E.2.
   c.  “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.
   d.  “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.
   e.  “Health carrier” means the same as defined in section 514J.102.
   f.  “Practice of acupuncture” means the same as defined in section 148E.1.
   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 acupuncture performed by an acupuncturist.
   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, 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, 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 may 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 acupuncture.
   “Acupuncture” is defined in the bill as a form of health care developed from traditional and modern oriental medical concepts that employs oriental medical diagnosis and treatment, and adjunctive therapies and diagnostic techniques, for the promotion, maintenance, and restoration of health and the prevention of disease.
   The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to offer coverage for acupuncture performed by an acupuncturist. “Acupuncturist” is defined as a person who is engaged in the practice of acupuncture and who is licensed pursuant to Code section 148E.2. “Practice of acupuncture” is also defined in the bill. 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. “Cost-sharing” is defined in the bill.
   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 may 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, 2026.
   The bill makes conforming changes to Code section 148E.9.