Bill Text: IA SF2368 | 2017-2018 | 87th General Assembly | Introduced

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Bill Title: A bill for an act relating to health insurance coverage for mammograms and including effective date and applicability provisions. (Formerly SSB 3177.)

Spectrum: Committee Bill

Status: (Introduced - Dead) 2018-03-15 - Referred to Human Resources. S.J. 693. [SF2368 Detail]

Download: Iowa-2017-SF2368-Introduced.html

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Senate File 2368 - Introduced




                                 SENATE FILE       
                                 BY  COMMITTEE ON HUMAN
                                     RESOURCES

                                 (SUCCESSOR TO SSB
                                     3177)

                                      A BILL FOR

  1 An Act relating to health insurance coverage for mammograms and
  2    including effective date and applicability provisions.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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PAG LIN



  1  1    Section 1.  Section 514C.4, Code 2018, is amended to read as
  1  2 follows:
  1  3    514C.4  Mandated coverage for mammography.
  1  4    1.  As used in this section:
  1  5    a.  "Health care professional" means a health care
  1  6 practitioner licensed, accredited, registered, or certified
  1  7 consistent with state law to recommend the performance of a
  1  8 mammogram.
  1  9    b.  "Mammogram" means a radiographic image obtained using a
  1 10 procedure, including two=dimensional mammography or three=
  1 11 dimensional mammography, as recommended by a woman's health
  1 12 care professional.
  1 13    1.  2.  a.  A policy or contract providing for third=party
  1 14 payment or prepayment of health or medical expenses shall
  1 15 provide minimum mammography examination coverage, including,
  1 16 but not limited to, the following classes of third=party
  1 17 payment provider contracts or policies delivered, issued for
  1 18 delivery, continued, or renewed in this state.
  1 19    (1)  Individual or group accident and sickness insurance
  1 20 providing coverage on an expense=incurred basis.
  1 21    (2)  An individual or group hospital or medical service
  1 22 contract issued pursuant to chapter 509, 514, or 514A.
  1 23    (3)  An individual or group health maintenance organization
  1 24 contract regulated under chapter 514B.
  1 25    (4)  An individual or group Medicare supplemental policy,
  1 26 unless coverage pursuant to such policy is preempted by federal
  1 27 law.
  1 28    b.  A long=term care policy or contract is specifically
  1 29 excluded from regulation under this section.
  1 30    2.  3.  As used in this section, "minimum mammography
  1 31 examination coverage" means benefits which are better than or
  1 32 equal to the following minimum requirements:
  1 33    a.  One baseline mammogram for any woman who is thirty=five
  1 34 through thirty=nine years of age, or more frequent mammograms
  1 35 if recommended by the woman's physician health care
  2  1 professional.
  2  2    b.  A mammogram every two years for any woman who is
  2  3 forty through forty=nine years of age, or more frequently if
  2  4 recommended by the woman's physician.
  2  5    c.  b.  A mammogram every year for any woman who is fifty
  2  6  forty years of age or older, or more frequently if recommended
  2  7 by the woman's physician health care professional.
  2  8    3.  4.  Mammogram benefits may be subject to any policy or
  2  9 contract provisions which apply generally to other services
  2 10 covered by the policy or contract.
  2 11    4.  5.  The commissioner of insurance shall adopt rules under
  2 12 chapter 17A necessary to implement this section.
  2 13    Sec. 2.  EFFECTIVE DATE.  This Act, being deemed of immediate
  2 14 importance, takes effect upon enactment.
  2 15    Sec. 3.  APPLICABILITY.  This Act applies to the classes of
  2 16 third=party payment provider contracts or policies specified
  2 17 in section 514C.4, as amended by this Act, that are delivered,
  2 18 issued for delivery, continued, or renewed in this state on or
  2 19 after July 1, 2018.
  2 20                           EXPLANATION
  2 21 The inclusion of this explanation does not constitute agreement with
  2 22 the explanation's substance by the members of the general assembly.
  2 23    This bill relates to insurance coverage for a mammogram as
  2 24 recommended by a woman's health care professional.
  2 25    The bill defines "mammogram" as a radiographic image
  2 26 obtained using a procedure, including two=dimensional
  2 27 mammography or three=dimensional mammography, as recommended
  2 28 by a woman's health care professional. Currently, insurance
  2 29 coverage is required for one mammogram every two years for
  2 30 women age 40 through 49. The bill changes this to require
  2 31 insurance coverage for an annual mammogram for women age 40 and
  2 32 over. The bill requires that the insurance coverage apply to
  2 33 two=dimensional mammograms and three=dimensional mammograms.
  2 34 The bill also allows a woman's health care professional,
  2 35 defined to include licensed, accredited, registered, or
  3  1 certified health care practitioners, to recommend a mammogram.
  3  2 Currently, a woman's physician must recommend the performance
  3  3 of a mammogram.
  3  4    The bill applies to the classes of third=party payment
  3  5 provider contracts or policies specified in Code section 514C.4
  3  6 that are delivered, issued for delivery, continued, or renewed
  3  7 in this state on or after July 1, 2018.
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