HF 467 (LSB 1565HV (2) 90)

HOUSE FILE 467

BY  COMMITTEE ON HEALTH AND HUMAN SERVICES

(SUCCESSOR TO HF 226)

(As Amended and Passed by the House 2023-03-21)

A BILL FOR

An Act relating to primary health benefit plans, claims for reimbursement, and explanation of benefits.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  147.164  Health benefit plans —— claims.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Covered person” means the same as defined in section 514J.102.
   b.  “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
   c.  “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.
   d.  “Health care services” means the same as defined in section 514J.102.
   e.  “Personal representative” means the same as described in 45 C.F.R. §164.502(g).
   2.  A health care professional who provides health care services to a covered person shall submit a claim for reimbursement to the primary health benefit plan designated by the covered person or the covered person’s personal representative prior to submitting a claim for reimbursement to any other health benefit plan designated by the covered person or the covered person’s personal representative.
    Sec. 2.  NEW SECTION.  514A.16  Explanation of benefits —— secondary health benefit plans.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Covered person” means the same as defined in section 514J.102.
   b.  “Explanation of benefits” means a statement provided to a covered person by the covered person’s health benefit plan that explains the costs that the health benefit plan will cover for the health care services received by the covered person.
   c.  “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
   d.  “Health care services” means the same as defined in section 514J.102.
   e.  “Personal representative” means the same as described in 45 C.F.R. §164.502(g).
   2.  If a covered person, a covered person’s personal representative, or a covered person’s secondary health benefit plan request a copy of an explanation of benefits from a covered person’s primary health benefit plan, the primary health benefit plan shall provide a copy of the explanation of benefits no later than thirty calendar days from the date of the request.