Bill Text: IA HF2306 | 2017-2018 | 87th General Assembly | Introduced

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Bill Title: A bill for an act relating to insurance coverage for dispensing prescription contraceptives in certain quantities.

Spectrum: Moderate Partisan Bill (Democrat 15-2)

Status: (Introduced - Dead) 2018-02-12 - Sponsor added, Maxwell. H.J. 252. [HF2306 Detail]

Download: Iowa-2017-HF2306-Introduced.html

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House File 2306 - Introduced




                                 HOUSE FILE       
                                 BY  BENNETT, MEYER, KURTH,
                                     MASCHER, ANDERSON,
                                     T. TAYLOR, KEARNS,
                                     GASKILL, HUNTER,
                                     RUNNING=MARQUARDT,
                                     WINCKLER, LENSING,
                                     KRESSIG, KAUFMANN,
                                     STAED, M. SMITH, and
                                     HINSON

                                      A BILL FOR

  1 An Act relating to insurance coverage for dispensing
  2    prescription contraceptives in certain quantities.
  3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
    TLSB 5048YH (18) 87
    ko/rj

PAG LIN



  1  1    Section 1.  Section 514C.19, Code 2018, is amended to read
  1  2 as follows:
  1  3    514C.19  Prescription contraceptive coverage.
  1  4    1.  For purposes of this section:
  1  5    a.  "Dispense" means the same as defined in section 155A.3.
  1  6    b.  "Health care professional" means the same as defined in
  1  7 section 514J.102.
  1  8    c.  "Prescription contraceptive" means a medically acceptable
  1  9 oral drug or contraceptive patch or ring that is used to
  1 10 prevent pregnancy, and requires a prescription.
  1 11    1.  2.  Notwithstanding the uniformity of treatment
  1 12 requirements of section 514C.6, a group policy, or contract, or
  1 13 plan providing for third=party payment or prepayment of health
  1 14 or medical expenses shall not do either of the following:
  1 15    a.  Exclude or restrict benefits for a prescription
  1 16 contraceptive drugs or prescription contraceptive devices which
  1 17 prevent conception and which are contraceptive that is approved
  1 18 by the United States food and drug administration, or a generic
  1 19 equivalents equivalent approved as substitutable a substitute
  1 20  by the United States food and drug administration, if such
  1 21 policy, or contract, or plan provides benefits a benefit for
  1 22 any other outpatient prescription drugs drug or devices device.
  1 23 Such policy, contract, or plan shall provide for payment to a
  1 24 health care professional that dispenses any of the following to
  1 25 a covered person:
  1 26    (1)  A three=month supply of a prescription contraceptive
  1 27 the first time the prescription contraceptive is dispensed to
  1 28 the covered person.
  1 29    (2)  A twelve=month supply of a prescription contraceptive
  1 30 for any subsequent dispensing of the same prescription
  1 31 contraceptive to the covered person. 
  1 32    (3)  A three=month supply of a prescription vaginal
  1 33 contraceptive ring. 
  1 34    b.  Exclude or restrict benefits for an outpatient
  1 35 contraceptive services which are service that is provided
  2  1 for the purpose of preventing conception if such policy,
  2  2  or contract, or plan provides benefits a benefit for any
  2  3  other outpatient services service provided by a health care
  2  4 professional.
  2  5    2.  3.  A person who provides a group policy, or contract, or
  2  6 plan providing for third=party payment or prepayment of health
  2  7 or medical expenses which is subject to subsection 1 2 shall
  2  8 not do any of the following:
  2  9    a.  Deny to an individual eligibility, or continued
  2 10 eligibility, to enroll in or to renew coverage under the terms
  2 11 of the policy, or contract, or plan because of the individual's
  2 12 use or potential use of such a prescription contraceptive
  2 13 drugs drug or devices device, or use or potential use of an
  2 14  outpatient contraceptive services service.
  2 15    b.  Provide a monetary payment or rebate to a covered
  2 16 individual to encourage such individual to accept less than the
  2 17 minimum benefits provided for under subsection 1 2.
  2 18    c.  Penalize or otherwise reduce or limit the reimbursement
  2 19 of a health care professional because such professional
  2 20 prescribes a contraceptive drugs drug or devices device, or
  2 21 provides a contraceptive services service.
  2 22    d.  Provide incentives an incentive, monetary or otherwise,
  2 23 to a health care professional to induce such professional to
  2 24 withhold from a covered individual a contraceptive drugs drug
  2 25  or devices device, or a contraceptive services service from a
  2 26 covered individual.
  2 27    3.  4.  This section shall not be construed to prevent a
  2 28 third=party payor from including deductibles, coinsurance, or
  2 29 copayments under the policy, or contract, or plan as follows:
  2 30    a.  A deductible, coinsurance, or copayment for benefits a
  2 31 benefit for a prescription contraceptive drugs drug shall not
  2 32 be greater than such deductible, coinsurance, or copayment for
  2 33 any outpatient prescription drug for which coverage under the
  2 34 policy, or contract, or plan is provided.
  2 35    b.  A deductible, coinsurance, or copayment for benefits a
  3  1 benefit for a prescription contraceptive devices device shall
  3  2 not be greater than such deductible, coinsurance, or copayment
  3  3 for any outpatient prescription device for which coverage under
  3  4 the policy, or contract, or plan is provided.
  3  5    c.  A deductible, coinsurance, or copayment for benefits a
  3  6 benefit for an outpatient contraceptive services service shall
  3  7 not be greater than such deductible, coinsurance, or copayment
  3  8 for any outpatient health care services service for which
  3  9 coverage under the policy, or contract, or plan is provided.
  3 10    4.  5.  This section shall not be construed to require
  3 11 a third=party payor under a policy, or contract, or plan
  3 12  to provide benefits a benefit for an experimental or
  3 13 investigational contraceptive drugs drug or devices device, or
  3 14 experimental or investigational contraceptive services service,
  3 15 except to the extent that such policy, or contract, or plan
  3 16  provides coverage for any other experimental or investigational
  3 17 outpatient prescription drugs drug or devices device, or
  3 18 experimental or investigational outpatient health care services
  3 19  service.
  3 20    5.  6.  This section shall not be construed to limit or
  3 21 otherwise discourage the any of the following:
  3 22    a.  The use of a generic equivalent drugs drug approved
  3 23 by the United States food and drug administration, whenever
  3 24  if available and appropriate. This section, when a brand
  3 25 name drug is requested by a covered individual and a suitable
  3 26 generic equivalent is available and appropriate, shall not be
  3 27 construed to prohibit a
  3 28    b.  A third=party payor from requiring the a covered
  3 29 individual to pay a deductible, coinsurance, or copayment
  3 30 consistent with subsection 3 4, in addition to the difference
  3 31 of the cost of the brand name drug less the maximum covered
  3 32 amount for a generic equivalent.
  3 33    7.  This section shall not be construed to require a
  3 34 third=party payor to provide payment to a health care
  3 35 professional for dispensing a prescription contraceptive to
  4  1 replace a prescription contraceptive that has been dispensed
  4  2 to a covered person and that has been misplaced, stolen, or
  4  3 destroyed. This section shall not be construed to require a
  4  4 third=party payor to replace covered prescriptions that are
  4  5 misplaced, stolen, or destroyed.
  4  6    6.  8.  A person who provides an individual policy, or
  4  7  contract, or plan providing for third=party payment or
  4  8 prepayment of health or medical expenses shall make available
  4  9 a coverage provision that satisfies the requirements in
  4 10 subsections 1 2 through 5 7 in the same manner as such
  4 11 requirements are applicable to a group policy, or contract, or
  4 12 plan under those subsections. The policy, or contract, or plan
  4 13  shall provide that the individual policyholder may reject the
  4 14 coverage provision at the option of the policyholder.
  4 15    7.  9.  a.  This section applies shall apply to the following
  4 16 classes of third=party payment provider policies, contracts, or
  4 17 policies and plans delivered, issued for delivery, continued,
  4 18 or renewed in this state on or after July 1, 2000 2018:
  4 19    (1)  Individual or group accident and sickness insurance
  4 20 providing coverage on an expense=incurred basis.
  4 21    (2)  An individual or group hospital or medical service
  4 22 contract issued pursuant to chapter 509, 514, or 514A.
  4 23    (3)  An individual or group health maintenance organization
  4 24 contract regulated under chapter 514B.
  4 25    (4)  Any other entity engaged in the business of insurance,
  4 26 risk transfer, or risk retention, which is subject to the
  4 27 jurisdiction of the commissioner.
  4 28    (5)  A plan established pursuant to chapter 509A for public
  4 29 employees.
  4 30    b.  This section shall not apply to accident=only,
  4 31 specified disease, short=term hospital or medical, hospital
  4 32 confinement indemnity, credit, dental, vision, Medicare
  4 33 supplement, long=term care, basic hospital and medical=surgical
  4 34 expense coverage as defined by the commissioner, disability
  4 35 income insurance coverage, coverage issued as a supplement
  5  1 to liability insurance, workers' compensation or similar
  5  2 insurance, or automobile medical payment insurance.
  5  3                           EXPLANATION
  5  4 The inclusion of this explanation does not constitute agreement with
  5  5 the explanation's substance by the members of the general assembly.
  5  6    This bill relates to insurance coverage for a prescription
  5  7 contraceptive dispensed by a health care professional to a
  5  8 covered person in a three=month or 12=month quantity. The bill
  5  9 defines "health care professional" as a physician or other
  5 10 health care practitioner licensed, accredited, registered, or
  5 11 certified to perform specified health care services consistent
  5 12 with state law.
  5 13    The bill amends prescription contraceptive coverage
  5 14 provisions to specifically require that a policy, contract,
  5 15 or plan providing for third=party payment or prepayment of
  5 16 health or medical expenses provide for payment to a health
  5 17 care professional that dispenses a three=month supply of a
  5 18 prescription contraceptive the first time it is dispensed to a
  5 19 covered person, and payment when a 12=month supply of the same
  5 20 prescription contraceptive is subsequently dispensed to the
  5 21 same covered person. The bill also provides for payment to a
  5 22 health care professional for dispensing a three=month supply of
  5 23 a prescription vaginal contraceptive ring.
  5 24    The bill shall not be construed to require a third=party
  5 25 payor to provide payment to a health care professional
  5 26 for dispensing a prescription contraceptive to replace a
  5 27 prescription contraceptive that has been dispensed and has been
  5 28 misplaced, lost, or stolen.
       LSB 5048YH (18) 87
       ko/rj