Bill Text: IA HF384 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to health insurance coverage for certain post-mastectomy-related issues.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2023-02-21 - Introduced, referred to Commerce. H.J. 377. [HF384 Detail]
Download: Iowa-2023-HF384-Introduced.html
House
File
384
-
Introduced
HOUSE
FILE
384
BY
BEST
A
BILL
FOR
An
Act
relating
to
health
insurance
coverage
for
certain
1
post-mastectomy-related
issues.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
NEW
SECTION
.
514C.36
Post-mastectomy-related
1
issues.
2
1.
As
used
in
this
section,
unless
the
context
otherwise
3
requires:
4
a.
“Cost-sharing”
means
any
coverage
limit,
copayment,
5
coinsurance,
deductible,
or
other
out-of-pocket
expense
6
obligation
imposed
on
a
covered
person
by
a
policy,
contract,
7
or
plan
providing
for
third-party
payment
or
prepayment
of
8
health
or
medical
expenses.
9
b.
“Covered
person”
means
a
policyholder,
subscriber,
or
10
other
person
participating
in
a
policy,
contract,
or
plan
that
11
provides
for
third-party
payment
or
prepayment
of
health
or
12
medical
expenses.
13
c.
“Health
care
professional”
means
the
same
as
defined
in
14
section
514J.102.
15
d.
“Mastectomy”
means
the
removal
of
all
or
part
of
a
breast
16
for
a
medically
necessary
reason
as
determined
by
a
covered
17
person’s
health
care
professional.
18
2.
a.
Notwithstanding
the
uniformity
of
treatment
19
requirements
of
section
514C.6,
a
policy,
contract,
or
plan
20
providing
for
third-party
payment
or
prepayment
of
health
or
21
medical
expenses,
and
that
provides
coverage
for
mastectomies,
22
shall
provide
coverage
for
all
of
the
following:
23
(1)
Physical
complications
caused
by
a
mastectomy,
24
including
lymphedema.
25
(2)
Prosthetic
devices.
26
(3)
A
custom
fabricated
breast
prothesis
for
each
breast
on
27
which
a
mastectomy
has
been
performed.
28
(4)
One
additional
breast
prothesis
for
each
breast
29
affected
by
a
mastectomy.
30
(5)
Reconstructive
surgery
incident
to
a
mastectomy,
in
31
the
manner
determined
by
the
covered
person
and
the
covered
32
person’s
health
care
professional
to
be
appropriate,
including
33
all
of
the
following:
34
(a)
All
stages
of
reconstruction
of
the
breast
on
which
the
35
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mastectomy
has
been
performed.
1
(b)
Surgery
and
reconstruction
of
the
breast
on
which
the
2
mastectomy
was
not
performed
to
produce
symmetry
with
the
3
breast
on
which
the
mastectomy
was
performed.
4
b.
Coverage
requirements
under
paragraph
“a”
shall
apply
5
regardless
of
whether
a
covered
person
was
covered
under
the
6
policy,
contract,
or
plan
at
the
time
of
the
covered
person’s
7
mastectomy.
8
c.
Coverage
required
under
this
section
shall
not
be
less
9
favorable
than
coverage
a
health
carrier
offers
for
general
10
physical
illness.
11
d.
Cost-sharing
imposed
for
coverage
required
under
this
12
section
shall
not
be
less
favorable
than
cost-sharing
a
health
13
carrier
imposes
for
general
physical
illness.
14
3.
a.
This
section
applies
to
the
following
classes
of
15
third-party
payment
provider
contracts,
policies,
or
plans
16
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
17
state
on
or
after
January
1,
2024:
18
(1)
Individual
or
group
accident
and
sickness
insurance
19
providing
coverage
on
an
expense-incurred
basis.
20
(2)
An
individual
or
group
hospital
or
medical
service
21
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
22
(3)
An
individual
or
group
health
maintenance
organization
23
contract
regulated
under
chapter
514B.
24
(4)
A
plan
established
for
public
employees
pursuant
to
25
chapter
509A.
26
b.
This
section
shall
not
apply
to
accident-only,
specified
27
disease,
short-term
hospital
or
medical,
hospital
confinement
28
indemnity,
credit,
dental,
vision,
Medicare
supplement,
29
long-term
care,
basic
hospital
and
medical-surgical
expense
30
coverage
as
defined
by
the
commissioner
of
insurance,
31
disability
income
insurance
coverage,
coverage
issued
as
a
32
supplement
to
liability
insurance,
workers’
compensation
or
33
similar
insurance,
or
automobile
medical
payment
insurance.
34
4.
The
commissioner
of
insurance
shall
adopt
rules
pursuant
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to
chapter
17A
to
administer
this
section.
1
EXPLANATION
2
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
3
the
explanation’s
substance
by
the
members
of
the
general
assembly.
4
This
bill
relates
to
health
insurance
coverage
for
certain
5
post-mastectomy-related
issues.
6
The
bill
defines
“mastectomy”
as
the
removal
of
all
or
part
7
of
a
breast
for
a
medically
necessary
reason
as
determined
by
a
8
covered
person’s
health
care
professional.
9
The
bill
requires
a
health
carrier
that
offers
individual,
10
group,
or
small
group
contracts,
policies,
or
plans
(plans)
in
11
this
state
that
provide
for
third-party
payment
or
prepayment
12
of
health
or
medical
expenses,
and
that
provide
coverage
for
13
mastectomies,
to
provide
coverage
for
physical
complications
14
caused
by
a
mastectomy,
including
lymphedema;
prosthetic
15
devices;
a
custom
fabricated
breast
prothesis
for
each
breast
16
on
which
a
mastectomy
has
been
performed;
one
additional
breast
17
prothesis
for
each
breast
affected
by
a
mastectomy;
all
stages
18
of
reconstruction
of
the
breast
on
which
the
mastectomy
has
19
been
performed;
and
surgery
and
reconstruction
of
the
breast
on
20
which
the
mastectomy
was
not
performed
to
produce
symmetry
with
21
the
other
breast.
22
The
coverage
cannot
be
subject
to
cost
sharing
that
is
23
greater
than
the
cost
sharing
that
a
plan
imposes
for
a
24
mastectomy
under
the
plan.
25
The
bill
applies
to
the
third-party
payment
providers
26
enumerated
in
the
bill.
The
bill
specifies
the
types
of
27
specialized
health-related
insurance
which
are
not
subject
28
to
the
coverage
requirements
of
the
bill.
The
bill
applies
29
to
third-party
payment
provider
plans
delivered,
issued
for
30
delivery,
continued,
or
renewed
in
this
state
on
or
after
31
January
1,
2024.
32
The
commissioner
of
insurance
must
adopt
rules
to
administer
33
the
bill.
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