SSB 1060 (LSB 2235XC (2) 91)

SENATE FILE _____ 

BY  (PROPOSED COMMITTEE ON COMMERCE BILL BY CHAIRPERSON BOUSSELOT)

A BILL FOR

An Act relating to cost-sharing requirements for supplemental and diagnostic breast examinations.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 514C.4A, subsection 1, Code 2025, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  0c.  “Cost-sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket cost obligation imposed by a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses on a covered person.
    Sec. 2.  Section 514C.4A, subsection 2, Code 2025, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  c.  Cost-sharing shall not be imposed for coverage required under this section.
    Sec. 3.  Section 514C.4A, subsection 3, Code 2025, is amended by adding the following new paragraph:
   NEW PARAGRAPH.  c.  If a covered person’s policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses qualifies as a high-deductible health plan under section 223 of the Internal Revenue Code, subsection 2, paragraph “c”, shall apply only after the covered person satisfies the covered person’s minimum deductible, except for items or services determined to be preventive care under section 223(c)(2)(C) of the Internal Revenue Code.
    Sec. 4.  APPLICABILITY.  This Act 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.
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 cost-sharing requirements for supplemental and diagnostic breast examinations.
   Under the bill, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not impose cost-sharing requirements for required coverage of supplemental and diagnostic breast examinations. “Cost-sharing” is defined in the bill. If a covered person’s policy, contract, or plan qualifies as a high-deductible health plan (HDHP) under section 223 of the Internal Revenue Code (IRC), the cost-sharing prohibition shall apply only to the covered person’s qualified HDHP after the covered person satisfies the covered person’s minimum deductible, except for items or services determined to be preventive care under section 223(c)(2)(C) of the IRC.
   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.