Bill Text: IA SF2112 | 2013-2014 | 85th General Assembly | Introduced
Bill Title: A bill for an act providing for the establishment of the Iowa health insurance marketplace and including effective date provisions. (See SF 2253.)
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2014-02-11 - Subcommittee, Hatch, Bolkcom, and Schneider. S.J. 234. [SF2112 Detail]
Download: Iowa-2013-SF2112-Introduced.html
Senate
File
2112
-
Introduced
SENATE
FILE
2112
BY
HATCH
A
BILL
FOR
An
Act
providing
for
the
establishment
of
the
Iowa
health
1
insurance
marketplace
and
including
effective
date
2
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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DIVISION
I
1
IOWA
HEALTH
INSURANCE
MARKETPLACE
ACT
2
Section
1.
NEW
SECTION
.
514M.1
Title.
3
This
chapter
shall
be
known
and
may
be
cited
as
the
“Iowa
4
Health
Insurance
Marketplace
Act”
.
5
Sec.
2.
NEW
SECTION
.
514M.2
Purpose
and
intent.
6
The
purpose
of
this
chapter
is
to
provide
for
the
7
establishment
of
a
health
insurance
marketplace
in
this
8
state
to
facilitate
the
sale
and
purchase
of
qualified
health
9
insurance
plans
by
qualified
individuals
in
the
individual
10
market
in
this
state
and
by
qualified
small
employers
in
the
11
small
group
market
in
this
state.
The
intent
of
authorizing
12
the
establishment
of
a
health
insurance
marketplace
in
this
13
state
is
to
reduce
the
number
of
uninsured
individuals
in
14
this
state,
provide
a
transparent
marketplace
and
consumer
15
education,
and
assist
individuals
with
access
to
relevant
16
federal
and
state
programs,
premium
assistance
tax
credits,
and
17
cost-sharing
reductions.
18
Sec.
3.
NEW
SECTION
.
514M.3
Definitions.
19
As
used
in
this
chapter,
unless
the
context
otherwise
20
requires:
21
1.
“Board”
means
the
board
of
directors
of
the
Iowa
health
22
insurance
marketplace
as
provided
in
section
514M.5.
23
2.
“Commissioner”
means
the
commissioner
of
insurance.
24
3.
“Executive
director”
means
the
executive
director
of
the
25
Iowa
health
insurance
marketplace.
26
4.
“Federal
Act”
means
the
federal
Patient
Protection
and
27
Affordable
Care
Act,
Pub.
L.
No.
111-148,
as
amended
by
the
28
federal
Health
Care
and
Education
Reconciliation
Act
of
2010,
29
Pub.
L.
No.
111-152,
and
any
amendments
thereto,
or
regulations
30
or
guidance
issued
under,
those
Acts.
31
5.
“Health
carrier”
means
an
entity
subject
to
the
insurance
32
laws
and
rules
of
this
state,
or
subject
to
the
jurisdiction
33
of
the
commissioner,
that
contracts
or
offers
to
contract
to
34
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
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the
costs
of
health
care
services,
including
an
insurance
1
company
offering
sickness
and
accident
plans,
a
health
2
maintenance
organization,
a
nonprofit
hospital
or
health
3
service
corporation,
or
any
other
entity
providing
a
plan
of
4
health
insurance,
health
benefits,
or
health
services.
5
6.
a.
“Health
insurance
plan”
means
a
policy,
contract,
6
certificate,
or
agreement
offered
or
issued
by
a
health
carrier
7
to
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
8
the
costs
of
health
care
services.
9
b.
“Health
insurance
plan”
does
not
include
any
of
the
10
following:
11
(1)
Coverage
only
for
accident,
or
disability
income
12
insurance,
or
any
combination
thereof.
13
(2)
Coverage
issued
as
a
supplement
to
liability
insurance.
14
(3)
Liability
insurance,
including
general
liability
15
insurance
and
automobile
liability
insurance.
16
(4)
Workers’
compensation
or
similar
insurance.
17
(5)
Automobile
medical
payment
insurance.
18
(6)
Credit-only
insurance.
19
(7)
Coverage
for
on-site
medical
clinics.
20
(8)
Other
similar
insurance
coverage,
specified
in
federal
21
regulations
issued
pursuant
to
Tit.
XXVII
of
the
federal
Public
22
Health
Service
Act,
as
enacted
by
the
federal
Health
Insurance
23
Portability
and
Accountability
Act
of
1996,
Pub.
L.
No.
24
104-191,
and
amended
by
the
federal
Act,
under
which
benefits
25
for
health
care
services
are
secondary
or
incidental
to
other
26
insurance
benefits.
27
c.
“Health
insurance
plan”
does
not
include
any
of
the
28
following
benefits
if
they
are
provided
under
a
separate
29
policy,
certificate,
or
contract
of
insurance
or
are
otherwise
30
not
an
integral
part
of
the
plan:
31
(1)
Limited
scope
dental
or
vision
benefits.
32
(2)
Benefits
for
long-term
care,
nursing
home
care,
home
33
health
care,
community-based
care,
or
any
combination
thereof.
34
(3)
Other
similar,
limited
benefits
specified
in
federal
35
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regulations
issued
pursuant
to
the
federal
Health
Insurance
1
Portability
and
Accountability
Act
of
1996,
Pub.
L.
No.
2
104-191.
3
d.
“Health
insurance
plan”
does
not
include
any
of
the
4
following
benefits
if
the
benefits
are
provided
under
a
5
separate
policy,
certificate,
or
contract
of
insurance,
there
6
is
no
coordination
between
the
provision
of
the
benefits
7
and
any
exclusion
of
benefits
under
any
group
health
plan
8
maintained
by
the
same
plan
sponsor,
and
the
benefits
are
paid
9
with
respect
to
an
event
without
regard
to
whether
benefits
are
10
provided
with
respect
to
such
an
event
under
any
group
health
11
plan
maintained
by
the
same
plan
sponsor:
12
(1)
Coverage
only
for
a
specified
disease
or
illness.
13
(2)
Hospital
indemnity
or
other
fixed
indemnity
insurance.
14
e.
“Health
insurance
plan”
does
not
include
any
of
the
15
following
if
offered
as
a
separate
policy,
certificate,
or
16
contract
of
insurance:
17
(1)
Medicare
supplemental
health
insurance
as
defined
under
18
section
1882(g)(1)
of
the
federal
Social
Security
Act.
19
(2)
Coverage
supplemental
to
the
coverage
provided
under
10
20
U.S.C.
ch.
55,
by
the
civilian
health
and
medical
program
of
21
the
uniformed
services.
22
(3)
Supplemental
coverage
similar
to
that
provided
under
a
23
group
health
insurance
plan.
24
7.
“Insurance
producer”
means
a
person
required
to
be
25
licensed
under
chapter
522B.
26
8.
“Marketplace”
means
the
Iowa
health
insurance
marketplace
27
established
pursuant
to
section
514M.4.
28
9.
“Navigator”
means
a
person
selected,
licensed,
and
29
regulated
by
the
marketplace
in
accordance
with
section
1311(i)
30
of
the
federal
Act,
standards
developed
by
the
secretary,
and
31
chapter
522D.
32
10.
“Qualified
dental
plan”
means
a
limited
scope
dental
33
plan
that
has
been
certified
in
accordance
with
section
34
514M.10.
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11.
“Qualified
employer”
means
a
small
employer
that
elects
1
to
make
its
full-time
employees
eligible
for
one
or
more
2
qualified
health
insurance
plans
offered
through
the
small
3
business
health
options
program
of
the
marketplace,
and
at
4
the
option
of
the
employer,
make
some
or
all
of
its
part-time
5
employees
so
eligible,
provided
that
the
employer
does
either
6
of
the
following:
7
a.
Has
its
principal
place
of
business
in
this
state
and
8
elects
to
provide
coverage
through
the
marketplace
to
all
of
9
its
eligible
employees
wherever
employed.
10
b.
Elects
to
provide
coverage
through
the
marketplace
to
all
11
of
its
eligible
employees
who
are
principally
employed
in
this
12
state.
13
12.
“Qualified
health
plan”
means
a
health
plan
that
has
in
14
effect
a
certification
as
described
in
section
1311(c)
of
the
15
federal
Act
and
section
514M.10.
16
13.
“Qualified
individual”
means
an
individual,
including
a
17
minor,
who
is
all
of
the
following:
18
a.
Is
seeking
to
enroll
in
a
qualified
health
plan
offered
19
to
individuals
through
the
marketplace.
20
b.
Is
a
resident
of
this
state.
21
c.
At
the
time
of
enrollment,
is
not
incarcerated,
other
22
than
incarceration
pending
the
disposition
of
charges.
23
d.
Is,
and
is
reasonably
expected
to
be,
for
the
entire
24
period
for
which
enrollment
is
sought,
a
citizen
or
national
of
25
the
United
States
or
an
alien
lawfully
present
in
the
United
26
States.
27
14.
“Secretary”
means
the
secretary
of
the
United
States
28
department
of
health
and
human
services.
29
15.
“Secretary
of
the
board”
means
the
secretary
of
the
30
board
of
directors
of
the
Iowa
health
insurance
marketplace.
31
16.
“Small
business
health
options
program”
means
the
small
32
business
health
options
program
component
of
the
marketplace
33
established
under
section
514M.8.
34
17.
a.
“Small
employer”
means
an
employer
that
employed
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an
average
of
at
least
one
and
not
more
than
fifty
employees
1
during
the
preceding
calendar
year.
2
b.
For
the
purposes
of
this
subsection:
3
(1)
All
persons
treated
as
a
single
employer
under
4
subsection
(b),
(c),
(m),
or
(o)
of
section
414
of
the
Internal
5
Revenue
Code
of
1986
shall
be
treated
as
a
single
employer.
6
(2)
An
employer
and
any
predecessor
employer
shall
be
7
treated
as
a
single
employer.
8
(3)
All
employees
shall
be
counted,
including
part-time
9
employees
and
employees
who
are
not
eligible
for
coverage
10
through
the
employer.
11
(4)
If
an
employer
was
not
in
existence
throughout
the
12
preceding
calendar
year,
the
determination
of
whether
that
13
employer
is
a
small
employer
shall
be
based
on
the
average
14
number
of
employees
that
the
employer
is
reasonably
expected
to
15
employ
on
business
days
in
the
current
calendar
year.
16
(5)
An
employer
that
makes
enrollment
in
qualified
health
17
plans
available
to
its
employees
through
the
small
business
18
health
options
program
component
of
the
marketplace,
and
19
would
cease
to
be
a
small
employer
by
reason
of
an
increase
20
in
the
number
of
its
employees,
shall
continue
to
be
treated
21
as
a
small
employer
for
purposes
of
this
chapter
as
long
as
22
the
employer
continuously
makes
enrollment
through
the
small
23
business
health
options
program
component
of
the
marketplace
24
available
to
its
employees.
25
Sec.
4.
NEW
SECTION
.
514M.4
Establishment
of
Iowa
health
26
insurance
marketplace.
27
1.
The
Iowa
health
insurance
marketplace
is
established
28
as
a
nonprofit
corporation.
The
marketplace
shall
be
29
established
for
the
purpose
of
facilitating
the
sale
and
30
purchase
of
qualified
health
plans
by
qualified
individuals
31
in
the
individual
market
in
this
state
and
by
qualified
small
32
employers
in
the
small
group
market
in
this
state.
33
2.
The
powers
and
duties
of
the
marketplace
are
vested
in
34
and
shall
be
exercised
by
a
board
of
directors
established
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under
section
514M.5.
1
3.
The
marketplace
shall
operate
under
a
plan
of
operation
2
established
and
approved
by
the
board
of
directors,
in
3
consultation
with
the
commissioner.
The
plan
shall
effectuate
4
the
purposes
of
this
chapter
and
assure
the
fair,
reasonable,
5
and
equitable
administration
of
the
marketplace.
The
board
6
shall
do
all
of
the
following
pursuant
to
the
plan,
including
7
but
not
limited
to:
8
a.
Plan,
direct,
coordinate,
and
execute
the
administrative
9
functions
of
the
marketplace.
10
b.
Employ
professional
and
clerical
staff
as
necessary.
11
c.
Keep
an
accurate
account
of
all
activities,
receipts,
12
and
expenditures
of
the
marketplace
and
annually
submit
a
13
report
to
the
commissioner,
governor,
general
assembly,
and
14
the
auditor
of
state
concerning
such
accountings
pursuant
to
15
section
514M.14.
16
4.
The
marketplace
shall
be
operated
on
a
statewide
basis.
17
5.
The
marketplace
shall
include
separate
marketplace
18
components
which
facilitate
the
sale
and
purchase
of
qualified
19
health
plans
to
eligible
individuals
and
to
small
employers
as
20
described
in
this
chapter
and
in
the
federal
Act.
21
6.
The
marketplace
may
establish
a
reimbursement
system
for
22
health
insurance
plans
issued
in
this
state
that
all
health
23
carriers
and
health
care
providers
may
join
to
facilitate
fair
24
and
reasonable
payments
for
the
cost
of
health
care
services
25
provided
pursuant
to
a
health
insurance
plan.
26
7.
The
marketplace
shall
do
all
of
the
following:
27
a.
Facilitate
the
purchase
and
sale
of
qualified
health
28
plans
to
qualified
individuals
and
qualified
employers
as
29
described
in
this
chapter
and
in
the
federal
Act.
30
b.
Establish
rate
schedules
for
commissions
paid
to
31
insurance
producers
by
qualified
health
plans
offered
through
32
the
marketplace.
33
c.
Meet
the
requirements
of
this
chapter
and
any
rules
34
adopted
pursuant
to
this
chapter.
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8.
a.
A
person
who
selects,
purchases,
or
enrolls
in
a
1
qualified
health
plan
offered
through
the
marketplace
shall
be
2
enrolled
in
the
plan
by
an
insurance
producer
or
may
enroll
in
3
the
plan
directly
through
the
marketplace
internet
site.
The
4
commission
paid
to
an
insurance
producer
who
enrolls
a
person
5
in
a
plan
offered
through
the
marketplace
shall
be
established
6
by
the
marketplace.
7
b.
On
the
anniversary
date
of
coverage
obtained
through
8
the
marketplace,
an
enrollee
may
renew
or
enroll
in
coverage
9
offered
through
the
marketplace
through
any
insurance
producer
10
of
the
enrollee’s
choice
or
may
enroll
directly
through
the
11
marketplace
internet
site.
A
commission
shall
be
paid
to
an
12
insurance
producer
who
renews
or
enrolls
a
person
in
coverage
13
under
this
paragraph
in
the
same
manner
as
is
provided
in
14
paragraph
“a”
.
15
9.
The
marketplace
may
contract
with
an
experienced
and
16
reputable
entity
to
develop
and
maintain
the
marketplace’s
17
internet
site.
The
entity
shall
preferably
have
relevant
18
experience
in
developing
and
maintaining
similar
state
health
19
insurance
plan
internet
sites.
20
10.
The
marketplace
may
employ
staff
to
carry
out
21
the
functions
of
the
marketplace,
but
no
employee
of
the
22
marketplace
shall
sell,
solicit,
or
negotiate
enrollment
in
a
23
health
insurance
plan
or
otherwise
offer
services
for
which
24
a
license
as
an
insurance
producer
is
required
pursuant
to
25
chapter
522B.
26
11.
The
marketplace
may
contract
with
an
eligible
entity
to
27
fulfill
any
of
its
specialized
duties
or
responsibilities
as
28
described
in
this
chapter.
An
eligible
entity
includes
but
is
29
not
limited
to
an
entity
that
has
experience
in
individual
and
30
small
group
health
insurance
plans,
benefit
administration,
or
31
other
experience
relevant
to
the
responsibilities
to
be
assumed
32
by
the
entity.
However,
a
health
carrier
or
an
affiliate
of
a
33
health
carrier
is
not
an
eligible
entity
for
the
purposes
of
34
this
subsection.
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12.
The
marketplace
may
enter
into
information-sharing
1
agreements
with
federal
and
state
agencies
to
carry
out
2
its
responsibilities
under
this
chapter
provided
such
3
agreements
include
adequate
protections
with
respect
to
the
4
confidentiality
of
the
information
to
be
shared
and
comply
with
5
all
state
laws
and
rules
and
federal
laws
and
regulations.
6
13.
Each
qualified
health
plan
offered
through
the
7
marketplace
shall
be
assigned
a
rating
by
the
marketplace
in
8
accordance
with
criteria
developed
by
the
secretary
under
9
section
1311(c)(3)
of
the
federal
Act,
and
the
marketplace
10
shall
determine
the
level
of
coverage
of
each
qualified
health
11
plan
in
accordance
with
regulations
issued
by
the
secretary
12
under
section
1302(d)(2)(A)
of
the
federal
Act
and
applicable
13
state
law.
14
14.
If
a
qualified
health
plan
offered
through
the
15
marketplace
meets
or
exceeds
the
criteria
for
a
qualified
16
health
plan
set
forth
by
the
secretary,
the
plan
shall
be
17
reviewed
and
assigned
a
rating
by
the
marketplace.
18
Sec.
5.
NEW
SECTION
.
514M.5
Board
of
directors
——
executive
19
director
——
secretary.
20
1.
The
board
of
directors
of
the
Iowa
health
insurance
21
marketplace
shall
effectuate
the
powers
and
duties
of
the
22
marketplace
as
set
forth
in
this
chapter.
23
2.
a.
The
board
shall
consist
of
seven
members.
The
24
members
shall
be
appointed
by
the
governor,
subject
to
25
confirmation
by
the
senate.
The
members
of
the
board
shall
26
annually
elect
one
member
as
chairperson
and
one
member
as
vice
27
chairperson.
28
b.
The
members
shall
be
appointed
by
the
governor
as
29
follows:
30
(1)
Two
persons
who
represent
the
interests
of
small
31
business
from
nominations
made
to
the
governor
by
nationally
32
recognized
groups
that
represent
the
interests
of
small
33
business.
34
(2)
Three
persons
who
represent
the
interests
of
consumers
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from
nominations
made
to
the
governor
by
nationally
recognized
1
groups
that
represent
the
interests
of
consumers.
2
(3)
One
person
who
is
an
insurance
producer
licensed
under
3
chapter
522B.
4
(4)
One
person
who
is
a
health
care
provider.
5
3.
The
governor
shall
not
appoint
to
the
board
any
person
6
who
is
either
the
spouse
or
a
relative
within
the
first
degree
7
of
consanguinity
of
a
serving
member
of
the
board.
8
4.
Each
member
of
the
board
appointed
by
the
governor
shall
9
be
a
resident
of
this
state
and
the
composition
of
members
of
10
the
board
shall
be
in
compliance
with
sections
69.16,
69.16A,
11
and
69.16C.
12
5.
The
members
of
the
board
shall
be
appointed
for
staggered
13
terms
of
three
years
as
provided
in
section
69.19.
The
initial
14
terms
of
the
members
of
the
board
shall
be
staggered
at
the
15
discretion
of
the
governor.
A
member
of
the
board
is
eligible
16
for
reappointment.
The
governor
shall
fill
a
vacancy
on
the
17
board
in
the
same
manner
as
the
original
appointment
for
the
18
remainder
of
the
term.
A
member
of
the
board
may
be
removed
19
by
the
governor
for
misfeasance,
malfeasance,
willful
neglect
20
of
duty,
failure
to
actively
participate
in
the
affairs
of
the
21
board,
or
other
cause
after
notice
and
a
public
hearing
unless
22
the
notice
and
hearing
are
waived
by
the
member
in
writing.
23
6.
A
member
of
the
board
shall
not
be
an
employee
of,
24
a
consultant
to,
a
member
of
the
board
of
directors
of,
25
affiliated
with,
have
an
ownership
interest
in,
or
otherwise
26
be
a
representative
of
any
health
carrier,
insurance
producer
27
agency,
insurance
consultant
organization,
trade
association
of
28
insurers,
or
association
offering
health
insurance
plans
to
its
29
members,
while
serving
on
the
board.
30
7.
Members
of
the
board
shall
be
reimbursed
from
the
moneys
31
of
the
marketplace
for
all
actual
and
necessary
expenses
32
incurred
in
the
performance
of
their
duties
as
members,
and
33
shall
receive
per
diem
at
the
rate
of
fifty
dollars
per
day
for
34
their
services.
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8.
A
majority
of
the
members
of
the
board
constitutes
a
1
quorum.
The
affirmative
vote
of
a
majority
of
the
members
is
2
necessary
for
any
action
taken
by
the
board.
The
majority
3
shall
not
include
a
member
who
has
a
conflict
of
interest
and
a
4
statement
by
a
member
of
a
conflict
of
interest
is
conclusive
5
for
this
purpose.
A
vacancy
in
the
membership
of
the
board
6
does
not
impair
the
right
of
a
quorum
to
exercise
the
rights
7
and
perform
the
duties
of
the
board.
An
action
taken
by
the
8
board
under
this
chapter
may
be
authorized
by
resolution
at
9
a
regular
or
special
meeting
and
each
resolution
shall
take
10
effect
immediately
and
need
not
be
published
or
posted.
11
9.
The
members
of
the
board
shall
give
bond
as
required
for
12
public
officers
by
chapter
64.
13
10.
The
members
of
the
board
are
subject
to
and
are
14
officials
within
the
meaning
of
chapter
68B.
15
11.
The
board
shall
meet
at
the
call
of
the
chairperson,
16
or
in
the
absence
of
the
chairperson,
at
the
call
of
the
vice
17
chairperson,
or
when
any
four
members
of
the
board
file
a
18
written
request
with
the
chairperson
for
a
meeting.
Written
19
notice
of
the
time
and
place
of
each
meeting
shall
be
given
to
20
each
member
of
the
board.
21
12.
a.
The
members
of
the
board
shall
appoint
an
executive
22
director,
subject
to
confirmation
by
the
senate,
to
supervise
23
the
administrative
affairs
and
general
management
and
24
operations
of
the
marketplace.
25
b.
The
members
of
the
board
may
appoint
other
officers
as
26
the
members
of
the
board
determine.
The
officers
shall
not
be
27
members
of
the
board
and
shall
serve
at
the
pleasure
of
the
28
members
of
the
board,
and
shall
receive
compensation
as
fixed
29
by
the
board.
30
c.
The
board
may
employ
other
staff
to
carry
out
the
31
functions
of
the
marketplace,
but
no
employee
of
the
32
marketplace
shall
sell,
solicit,
or
negotiate
enrollment
in
a
33
health
insurance
plan
or
otherwise
offer
services
for
which
34
a
license
as
an
insurance
producer
is
required
pursuant
to
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chapter
522B.
All
employees
of
the
marketplace
are
exempt
from
1
chapter
8A,
subchapter
IV,
and
chapter
97B.
2
13.
a.
The
members
of
the
board
shall
appoint
a
secretary
3
of
the
board
who
shall
keep
a
record
of
the
proceedings
of
the
4
board,
and
shall
be
the
custodian
of
all
books,
documents,
and
5
papers
filed
with
the
board,
including
information
filed
in
an
6
electronic
format,
and
the
minute
book
or
journal
of
the
board.
7
b.
The
secretary
of
the
board
shall
serve
at
the
pleasure
8
of
the
board,
and
shall
receive
compensation
as
fixed
by
the
9
board.
10
14.
Members
of
the
board,
or
persons
acting
on
behalf
of
11
the
marketplace,
while
acting
in
the
scope
of
their
agency
or
12
employment,
are
not
subject
to
personal
liability
resulting
13
from
carrying
out
the
powers
and
duties
in
this
chapter.
14
Sec.
6.
NEW
SECTION
.
514M.6
General
powers.
15
1.
The
marketplace
has
any
and
all
powers
necessary
and
16
convenient
to
carry
out
its
purposes
and
duties
and
exercise
17
its
specific
powers,
including
but
not
limited
to
the
power
to:
18
a.
Sue
and
be
sued
in
its
own
name.
19
b.
Have
and
alter
a
corporate
seal.
20
c.
Make
and
alter
bylaws
for
its
management
consistent
with
21
the
provisions
of
this
chapter.
22
d.
Make
and
execute
agreements,
contracts,
and
other
23
instruments
of
any
and
all
types
on
such
terms
and
conditions
24
as
the
marketplace
may
find
necessary
or
convenient
to
the
25
purpose
of
the
marketplace,
with
any
public
or
private
entity,
26
including
but
not
limited
to
contracts
for
goods
and
services.
27
All
political
subdivisions,
other
public
agencies,
and
state
28
departments
and
agencies
may
enter
into
contracts
and
otherwise
29
cooperate
with
the
marketplace.
30
e.
Adopt
procedures
relating
to
competitive
bidding,
31
including
the
identification
of
those
circumstances
under
32
which
competitive
bidding
by
the
marketplace,
either
33
formally
or
informally,
shall
be
required.
In
any
bidding
34
process,
the
marketplace
may
administer
its
own
bidding
and
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procurement
or
may
utilize
the
services
of
the
department
of
1
administrative
services
or
any
other
agency.
Except
when
such
2
rules
apply,
the
marketplace
and
all
contracts
entered
into
3
by
the
marketplace
in
carrying
out
its
public
and
essential
4
governmental
functions
with
respect
to
any
of
its
purposes
5
shall
be
exempt
from
the
provisions
and
requirements
of
all
6
laws
or
rules
of
the
state
which
require
competitive
bids
in
7
connection
with
the
letting
of
such
contracts.
8
f.
Acquire,
hold,
improve,
mortgage,
lease,
and
dispose
of
9
real
and
personal
property,
including
but
not
limited
to
the
10
power
to
sell
at
public
or
private
sale,
with
or
without
public
11
bidding,
any
such
property,
or
other
obligation
held
by
it.
12
g.
Procure
insurance
against
any
loss
in
connection
with
its
13
operations
and
property
interests.
14
h.
Accept
appropriations,
gifts,
grants,
loans,
or
other
15
aid
from
public
or
private
entities.
A
record
of
all
gifts
or
16
grants,
stating
the
type,
amount,
and
donor,
shall
be
clearly
17
set
out
in
the
marketplace’s
annual
report
along
with
the
18
record
of
other
receipts.
19
i.
Provide
to
public
and
private
entities
technical
20
assistance
and
counseling
related
to
the
marketplace’s
21
purposes.
22
j.
In
cooperation
with
other
local,
state,
or
federal
23
governmental
agencies,
conduct
research
studies,
develop
24
estimates
of
unmet
health
insurance
needs,
gather
and
compile
25
data
useful
to
facilitating
decision
making,
and
enter
into
26
agreements
to
carry
out
programs
within
or
without
the
state
27
which
the
marketplace
finds
to
be
consistent
with
the
goals
of
28
the
marketplace.
29
k.
Enter
into
agreements
with
the
federal
government,
30
tribes,
and
other
states
to
facilitate
the
sale
or
purchase
of
31
qualified
health
plans
by
qualified
individuals
and
qualified
32
small
employers
in
this
state.
33
l.
Own
or
acquire
intellectual
property
rights
including
34
but
not
limited
to
copyrights,
trademarks,
service
marks,
and
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patents,
and
enforce
the
rights
of
the
marketplace
with
respect
1
to
such
intellectual
property
rights.
2
m.
Form
committees
or
panels
as
necessary
to
facilitate
the
3
marketplace’s
duties.
Committees
or
panels
formed
pursuant
to
4
this
paragraph
shall
be
subject
to
the
provisions
of
chapters
5
21
and
22.
6
n.
Establish
one
or
more
funds
within
the
state
treasury
7
under
the
control
of
the
marketplace.
Notwithstanding
section
8
8.33
or
12C.7,
or
any
other
provision
to
the
contrary,
moneys
9
invested
by
the
treasurer
of
state
pursuant
to
this
paragraph
10
shall
not
revert
to
the
general
fund
of
the
state
and
interest
11
accrued
on
the
moneys
shall
be
moneys
of
the
marketplace
and
12
shall
not
be
credited
to
the
general
fund
of
the
state.
The
13
nonreversion
of
moneys
allowed
under
this
paragraph
does
not
14
apply
to
moneys
appropriated
to
the
marketplace
by
the
general
15
assembly.
16
o.
Exercise
generally
all
powers
typically
exercised
by
17
private
enterprises
engaged
in
business
pursuits
unless
the
18
exercise
of
such
a
power
would
violate
the
terms
of
this
19
chapter
or
the
Constitution
of
the
State
of
Iowa.
20
2.
Notwithstanding
any
other
provision
of
law,
any
purchase
21
or
lease
of
real
property,
other
than
on
a
temporary
basis,
22
when
necessary
in
order
to
implement
the
purposes
of
the
23
marketplace
or
protect
the
investments
of
the
marketplace,
24
shall
require
written
notice
from
the
marketplace
to
the
25
government
oversight
committees
of
the
general
assembly
or
26
their
successor
committees
and
the
prior
approval
of
the
27
executive
council.
28
3.
The
powers
enumerated
in
this
section
are
cumulative
of
29
and
in
addition
to
those
powers
enumerated
elsewhere
in
this
30
chapter
and
such
powers
do
not
limit
or
restrict
any
other
31
powers
of
the
marketplace.
32
Sec.
7.
NEW
SECTION
.
514M.7
Specific
powers.
33
1.
In
addition
to
the
general
powers
described
in
section
34
514M.6,
the
marketplace
shall
have
all
powers
convenient
and
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necessary
to
carry
out
the
purpose
and
intent
of
this
chapter.
1
2.
The
marketplace
established
pursuant
to
section
514M.4
2
shall
make
qualified
health
plans
that
are
effective
on
January
3
1,
2016,
available
to
qualified
individuals
and
qualified
4
employers
in
this
state.
5
3.
At
such
time
as
applications
for
waivers
from
the
6
requirements
of
the
federal
Act
are
accepted
by
the
secretary,
7
the
marketplace
may
request
such
waivers
from
the
secretary.
8
4.
The
marketplace
shall
allow
a
health
carrier
to
offer
a
9
plan
that
provides
limited
scope
dental
benefits
meeting
the
10
requirements
of
section
9832(c)(2)(A)
of
the
Internal
Revenue
11
Code
of
1986
through
the
marketplace,
either
separately
or
in
12
conjunction
with
a
qualified
health
plan,
if
the
plan
provides
13
pediatric
dental
benefits
meeting
the
requirements
of
section
14
1302(b)(1)(J)
of
the
federal
Act.
15
5.
The
marketplace
or
a
health
carrier
offering
qualified
16
health
plans
through
the
marketplace
shall
not
charge
an
17
individual
a
fee
or
penalty
for
termination
of
coverage
if
18
the
individual
enrolls
in
another
type
of
minimum
essential
19
coverage
because
the
individual
has
become
newly
eligible
for
20
that
coverage
or
because
the
individual’s
employer-sponsored
21
coverage
has
become
affordable
using
the
standards
of
the
22
federal
Act,
as
codified
at
section
36B(c)(2)(C)
of
the
23
Internal
Revenue
Code
of
1986.
24
Sec.
8.
NEW
SECTION
.
514M.8
Duties
of
the
marketplace.
25
The
marketplace
shall
do
all
of
the
following:
26
1.
Implement
procedures
for
the
certification,
27
recertification,
and
decertification
of
health
insurance
plans
28
as
qualified
health
plans,
consistent
with
guidelines
developed
29
by
the
secretary
under
section
1311(c)
of
the
federal
Act
and
30
applicable
state
law.
31
2.
Provide
for
the
operation
of
an
internet
site,
a
32
toll-free
telephone
hotline,
and
in-person
support
staff
33
available
in
selected
locations
in
the
state
to
respond
to
34
requests
for
assistance.
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3.
Provide
for
enrollment
periods,
as
determined
by
the
1
secretary
under
section
1311(c)(6)
of
the
federal
Act
and
2
applicable
state
law.
3
4.
Utilize
a
standardized
format
for
presenting
health
4
insurance
plan
options
in
the
marketplace,
including
the
use
of
5
the
uniform
outline
of
coverage
established
under
section
2715
6
of
the
Public
Health
Service
Act
and
applicable
state
law.
7
5.
In
accordance
with
section
1413
of
the
federal
Act
8
and
applicable
state
law,
inform
individuals
of
eligibility
9
requirements
for
the
Medicaid
program
under
Tit.
XIX
of
the
10
federal
Social
Security
Act,
the
children’s
health
insurance
11
program
under
Tit.
XXI
of
the
federal
Social
Security
Act,
or
12
any
applicable
state
or
local
public
program
and,
if
through
13
screening
of
an
application
by
the
marketplace,
the
marketplace
14
determines
that
any
individual
is
eligible
for
any
such
15
program,
enroll
that
individual
in
that
program.
16
6.
Establish
and
make
available
by
electronic
means
a
17
calculator
to
determine
the
actual
cost
of
coverage
after
18
application
of
any
premium
tax
credit
for
which
an
individual
19
is
eligible
using
the
standards
of
the
federal
Act
as
codified
20
at
section
36B(c)(2)(C)
of
the
Internal
Revenue
Code
of
1986
21
and
any
cost-sharing
reductions
under
section
1402
of
the
22
federal
Act.
23
7.
Establish
a
small
business
health
options
program
24
component
of
the
marketplace
through
which
individuals
25
employed
by
a
qualified
employer
may
enroll
in
any
qualified
26
health
plan
offered
through
the
small
business
health
options
27
program
at
the
level
of
coverage
specified
by
the
employer.
28
In
establishing
a
small
business
health
options
program
29
marketplace
component,
the
marketplace
shall
do
all
of
the
30
following:
31
a.
Provide
consolidated
billing
and
premium
payment
32
by
qualified
employers
including
detailed
information
to
33
those
employers
about
health
insurance
plans
chosen
by
their
34
employees
and
the
cost
of
those
plans.
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b.
Establish
an
electronic
interface
and
facilitate
the
flow
1
of
funds
between
health
carriers,
employers,
and
employees,
2
including
subsidiaries.
3
c.
Provide
for
the
dissemination
of
health
insurance
plan
4
enrollment
information
to
employers.
5
8.
Establish
an
individual
health
options
marketplace
6
component
through
which
individuals
may
enroll
in
any
qualified
7
health
plan
for
individuals.
8
9.
Select
entities
qualified
and
licensed
to
serve
as
9
navigators
in
accordance
with
section
1311(i)
of
the
federal
10
Act,
standards
developed
by
the
secretary,
section
514M.9,
and
11
chapter
522D,
and
award
grants
to
facilitate
the
function
of
12
navigators
as
provided
in
section
514M.9.
13
10.
Encourage
and
review
the
development
of
cafeteria
plans
14
pursuant
to
section
125
of
the
Internal
Revenue
Code
of
1986,
15
for
use
by
employers
participating
in
the
marketplace.
16
11.
Maintain
an
internet
site
through
which
enrollees,
17
employers,
and
prospective
enrollees
of
qualified
health
18
plans,
at
a
minimum,
may
obtain
standardized
comparative
19
information
on
qualified
health
plans
and
health
plans
that
20
are
not
offered
through
the
marketplace.
In
developing
the
21
electronic
clearinghouse,
the
marketplace
may
require
health
22
carriers
participating
in
the
marketplace
to
make
available
23
and
regularly
update
an
electronic
directory
of
contracting
24
health
care
providers
so
individuals
seeking
coverage
through
25
the
marketplace
can
search
by
health
care
provider
name
to
26
determine
which
qualified
health
plans
in
the
marketplace
27
include
that
health
care
provider
in
their
network,
and
whether
28
that
health
care
provider
is
accepting
new
patients
for
that
29
particular
health
plan.
30
12.
Consult
with
stakeholders
who
are
relevant
to
carrying
31
out
the
activities
required
under
this
chapter.
32
13.
Assist
in
the
implementation
of
reinsurance
and
risk
33
adjustment
mechanisms,
as
required
by
state
and
federal
law.
34
14.
Establish
guidelines
for
determining
qualifications
for
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marketplace
employees
and
entities
or
persons
who
are
licensed
1
and
selected
as
navigators.
2
15.
Subject
to
section
1411
of
the
federal
Act
and
3
applicable
state
law,
grant
a
certification
attesting
that,
for
4
purposes
of
the
individual
responsibility
penalty
under
the
5
standards
of
the
federal
Act,
as
codified
at
section
5000A
of
6
the
Internal
Revenue
Code
of
1986,
an
individual
is
exempt
from
7
the
individual
responsibility
requirement
or
from
the
penalty
8
imposed
by
that
section
because
of
any
of
the
following:
9
a.
There
is
no
affordable
qualified
health
plan
available
10
through
the
marketplace,
or
the
individual’s
employer,
covering
11
the
individual.
12
b.
The
individual
meets
the
requirements
for
any
other
such
13
exemption
from
the
individual
responsibility
requirement
or
14
penalty.
15
16.
Transfer
to
the
United
States
secretary
of
the
treasury
16
all
of
the
following:
17
a.
A
list
of
the
individuals
who
are
issued
a
certification
18
under
subsection
15,
paragraph
“a”
,
including
the
name
and
19
taxpayer
identification
number
of
each
individual.
20
b.
The
name
and
taxpayer
identification
number
of
each
21
individual
who
was
an
employee
of
an
employer
but
who
was
22
determined
to
be
eligible
for
the
premium
tax
credit
using
23
the
standards
of
the
federal
Act
as
codified
at
section
24
36B(c)(2)(C)
of
the
Internal
Revenue
Code
of
1986,
because
of
25
either
of
the
following:
26
(1)
The
employer
did
not
provide
minimum
essential
health
27
benefits
coverage.
28
(2)
The
employer
provided
minimum
essential
health
benefits
29
coverage,
but
it
was
determined
using
the
standards
of
the
30
federal
Act,
as
codified
at
section
36B(c)(2)(C)
of
the
31
Internal
Revenue
Code
of
1986,
to
either
be
unaffordable
to
32
the
employee
or
not
to
provide
the
required
minimum
actuarial
33
value.
34
c.
The
name
and
taxpayer
identification
number
of
all
of
the
35
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following:
1
(1)
Each
individual
who
notifies
the
marketplace
under
2
section
1411(b)(4)
of
the
federal
Act
that
the
individual
has
3
changed
employers.
4
(2)
Each
individual
who
ceases
coverage
under
a
qualified
5
health
plan
during
a
plan
year
and
the
effective
date
of
that
6
cessation.
7
17.
Provide
to
each
employer
the
name
of
each
employee
of
8
the
employer
described
in
subsection
16,
paragraph
“b”
,
who
9
ceases
coverage
under
a
qualified
health
plan
during
a
plan
10
year
and
the
effective
date
of
the
cessation.
11
18.
Perform
duties
required
of,
or
delegated
to,
the
12
marketplace
by
the
secretary,
the
United
States
secretary
13
of
the
treasury,
or
the
commissioner
related
to
determining
14
eligibility
for
premium
tax
credits,
reduced
cost-sharing,
or
15
individual
responsibility
requirement
exemptions.
16
19.
In
consultation
with
the
commissioner,
review
the
17
rate
of
premium
growth
of
health
insurance
plans
within
the
18
marketplace
and
outside
the
marketplace,
and
consider
the
19
information
obtained
in
developing
recommendations
on
whether
20
to
continue
limiting
qualified
employer
status
to
small
21
employers.
22
Sec.
9.
NEW
SECTION
.
514M.9
Navigators.
23
1.
The
marketplace
may
select
entities
qualified
and
24
licensed
to
serve
as
navigators
in
accordance
with
section
25
1311(i)
of
the
federal
Act,
standards
developed
by
the
26
secretary,
and
applicable
state
law
including
chapter
522D,
and
27
award
grants
to
enable
navigators
to
do
all
of
the
following:
28
a.
Conduct
public
education
activities
to
raise
awareness
29
of
the
availability
of
qualified
health
plans
through
the
30
marketplace.
31
b.
Distribute
fair
and
impartial
information
concerning
32
enrollment
in
qualified
health
plans,
and
the
availability
of
33
premium
tax
credits
for
which
an
individual
may
be
eligible
34
using
the
standards
of
the
federal
Act,
as
codified
at
section
35
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2112
36B(c)(2)(C)
of
the
Internal
Revenue
Code
of
1986,
and
any
1
cost-sharing
reductions
under
section
1402
of
the
federal
Act.
2
c.
Facilitate
enrollment
in
qualified
health
plans
offered
3
through
the
marketplace
or
in
health
insurance
plans
offered
4
outside
the
marketplace
by
referring
consumers
to
insurance
5
producers
and
to
the
marketplace
internet
site
for
enrollment.
6
d.
Provide
referrals
to
the
office
of
health
insurance
7
consumer
assistance
established
under
the
federal
Act
pursuant
8
to
section
2793
of
the
federal
Public
Health
Service
Act
9
and
the
office
of
the
commissioner
or
any
other
appropriate
10
state
agency,
for
any
enrollee
with
a
grievance,
complaint,
11
or
question
regarding
the
enrollee’s
health
insurance
plan
or
12
coverage,
or
a
determination
under
that
plan
or
coverage.
13
e.
Provide
information
in
a
manner
that
is
culturally
and
14
linguistically
appropriate
to
the
needs
of
the
population
being
15
served
by
the
marketplace.
16
2.
An
entity
selected
and
licensed
as
a
navigator
shall
not
17
engage
in
any
activities
that
require
licensure
as
an
insurance
18
producer
under
chapter
522B
unless
the
entity
is
also
licensed
19
as
an
insurance
producer.
20
Sec.
10.
NEW
SECTION
.
514M.10
Health
insurance
plan
21
certification.
22
1.
The
marketplace
may
certify
a
health
insurance
plan
as
a
23
qualified
health
plan
if
the
plan
meets
all
of
the
following
24
criteria:
25
a.
The
plan
provides
the
essential
health
benefit
package
26
described
in
section
1302(a)
of
the
federal
Act,
except
that
27
the
plan
is
not
required
to
provide
essential
benefits
that
28
duplicate
the
minimum
benefits
of
qualified
dental
plans
as
29
provided
in
subsection
6
if
all
of
the
following
occur:
30
(1)
The
marketplace
determines
that
at
least
one
qualified
31
dental
plan
is
available
to
supplement
the
plan’s
coverage.
32
(2)
The
health
carrier
makes
a
prominent
disclosure
at
the
33
time
it
offers
the
plan,
in
a
form
approved
by
the
marketplace,
34
that
the
plan
does
not
provide
the
full
range
of
essential
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pediatric
benefits
and
that
qualified
dental
plans
providing
1
those
benefits
and
other
dental
benefits
not
covered
by
the
2
plan
are
offered
through
the
marketplace.
3
b.
The
premium
rates
and
contract
language
have
been
4
approved
by
the
commissioner.
5
c.
The
plan
provides
at
least
a
bronze
level
of
coverage,
6
as
that
level
is
defined
by
the
federal
Act,
unless
the
plan
7
is
certified
as
a
qualified
catastrophic
plan,
meets
the
8
requirements
of
the
federal
Act
for
catastrophic
plans,
and
9
will
only
be
offered
to
individuals
eligible
for
catastrophic
10
coverage.
11
d.
The
plan’s
cost-sharing
requirements
do
not
exceed
the
12
limits
established
under
section
1302(c)(1)
of
the
federal
Act,
13
and
if
the
plan
is
offered
through
the
small
business
health
14
options
program
component
of
the
marketplace
that
offers
plans
15
to
small
employers,
the
plan’s
deductible
does
not
exceed
the
16
limits
established
under
section
1302(c)(2)
of
the
federal
Act.
17
e.
The
plan
offers
wellness
programs.
18
f.
The
health
carrier
offering
the
plan
provides
greater
19
transparency
and
disclosure
of
information
about
the
plan
20
benefits,
provider
networks,
claim
payment
practices,
and
21
solvency
ratings,
and
establishes
a
process
for
consumers
to
22
compare
features
of
health
insurance
plans
offered
through
the
23
marketplace.
24
g.
The
health
carrier
offering
the
plan
meets
all
of
the
25
following
criteria:
26
(1)
Is
licensed
and
in
good
standing
to
offer
health
27
insurance
coverage
in
this
state.
28
(2)
Offers
at
least
one
qualified
health
plan
in
the
silver
29
level
and
at
least
one
qualified
health
plan
in
the
gold
level,
30
as
those
levels
are
defined
in
the
federal
Act,
through
each
31
component
of
the
marketplace
in
which
the
health
carrier
32
participates,
where
component
refers
to
the
components
of
the
33
marketplace
which
offer
individual
coverage
and
coverage
for
34
small
employers.
35
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(3)
Charges
the
same
premium
rate
for
each
qualified
health
1
plan
without
regard
to
whether
the
plan
is
offered
through
the
2
marketplace.
3
(4)
Does
not
charge
any
termination
of
coverage
fees
or
4
penalties
in
violation
of
section
514M.7.
5
(5)
Complies
with
the
regulations
developed
by
the
6
secretary
under
section
1311(d)
of
the
federal
Act,
applicable
7
state
laws,
and
such
other
requirements
as
the
marketplace
may
8
establish.
9
h.
The
plan
meets
the
requirements
of
certification
as
10
adopted
by
rule
pursuant
to
this
section
and
by
the
secretary
11
under
section
1311(c)
of
the
federal
Act,
which
include
but
12
are
not
limited
to
minimum
standards
in
the
areas
of
marketing
13
practices,
network
adequacy,
essential
community
providers
in
14
underserved
areas,
accreditation,
quality
improvement,
uniform
15
enrollment
forms
and
descriptions
of
coverage,
and
information
16
on
quality
measures
for
plan
performance.
17
i.
The
marketplace
determines
that
making
the
plan
available
18
through
the
marketplace
is
in
the
interest
of
qualified
19
individuals
and
qualified
employers
in
this
state.
20
2.
The
marketplace
shall
not
exclude
a
health
insurance
plan
21
from
certification
for
any
of
the
following
reasons:
22
a.
On
the
basis
that
the
plan
is
a
fee-for-service
plan.
23
b.
Through
the
imposition
of
premium
price
controls.
24
c.
On
the
basis
that
the
plan
provides
treatments
necessary
25
to
prevent
patients’
deaths
in
circumstances
the
marketplace
26
determines
are
inappropriate
or
too
costly.
27
3.
The
marketplace
shall
require
each
health
carrier
28
seeking
certification
of
a
health
insurance
plan
as
a
qualified
29
health
plan
to
do
all
of
the
following:
30
a.
Provide
notice
of
any
proposed
premium
increase
and
31
a
justification
for
the
increase
to
the
marketplace
and
to
32
affected
policyholders
before
implementation
of
that
increase.
33
The
health
carrier
shall
prominently
post
the
information
34
on
its
internet
site.
The
marketplace
shall
take
this
35
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information,
along
with
the
information
and
the
recommendations
1
provided
to
the
marketplace
by
the
commissioner
under
the
2
federal
Act
pursuant
to
section
2794(b)
of
the
federal
Public
3
Health
Service
Act
and
applicable
state
law,
into
consideration
4
when
determining
whether
to
allow
the
health
carrier
to
make
5
plans
available
through
the
marketplace.
6
b.
Make
available
to
the
public,
in
the
format
described
in
7
paragraph
“c”
,
and
submit
to
the
marketplace,
the
secretary,
and
8
the
commissioner,
accurate
and
timely
disclosure
of
all
of
the
9
following:
10
(1)
Claims
payment
policies
and
practices.
11
(2)
Periodic
financial
disclosures.
12
(3)
Data
on
enrollment.
13
(4)
Data
on
disenrollment.
14
(5)
Data
on
the
number
of
claims
that
are
denied.
15
(6)
Data
on
rating
practices.
16
(7)
Information
on
cost-sharing
and
payments
with
respect
17
to
any
out-of-network
coverage.
18
(8)
Information
on
enrollee
and
participant
rights
under
19
Tit.
I
of
the
federal
Act
and
applicable
state
law.
20
(9)
Other
information
as
determined
appropriate
by
the
21
secretary,
the
marketplace,
or
the
commissioner.
22
c.
The
information
required
in
paragraph
“b”
shall
be
23
provided
in
plain
language,
as
that
term
is
defined
in
section
24
1311(e)
of
the
federal
Act,
as
amended
by
section
10104
of
the
25
federal
Act,
and
applicable
state
law.
26
4.
The
marketplace
shall
permit
individuals
to
learn,
27
in
a
timely
manner
upon
the
request
of
an
individual,
the
28
amount
of
cost-sharing,
including
deductibles,
copayments,
29
and
coinsurance,
under
the
individual’s
health
insurance
plan
30
or
coverage
for
which
the
individual
would
be
responsible
31
for
paying
with
respect
to
the
furnishing
of
a
specific
item
32
or
service
by
a
participating
health
care
provider.
At
a
33
minimum,
this
information
shall
be
made
available
to
the
34
individual
through
an
internet
site
and
through
other
means
for
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individuals
without
access
to
the
internet.
1
5.
The
marketplace
shall
not
exempt
any
health
carrier
2
seeking
certification
of
a
health
insurance
plan,
regardless
3
of
the
type
or
size
of
the
health
carrier,
from
applicable
4
state
licensure
or
solvency
requirements
and
shall
apply
the
5
criteria
of
this
section
in
a
manner
that
assures
a
level
6
playing
field
between
or
among
health
carriers
participating
7
in
the
marketplace.
8
6.
a.
The
provisions
of
this
chapter
that
are
applicable
to
9
qualified
health
plans
shall
also
apply
to
the
extent
relevant
10
to
qualified
dental
plans
except
as
modified
in
accordance
with
11
the
provisions
of
paragraphs
“b”
,
“c”
,
and
“d”
,
or
by
rules
12
adopted
by
the
marketplace.
13
b.
A
health
carrier
to
offer
dental
coverage
shall
be
14
licensed,
but
is
not
required
to
be
licensed
to
offer
other
15
health
benefits.
16
c.
A
qualified
dental
plan
shall
be
limited
to
dental
and
17
oral
health
benefits,
without
substantially
duplicating
the
18
benefits
typically
offered
by
health
insurance
plans
without
19
dental
coverage
and
shall
include,
at
a
minimum,
the
essential
20
pediatric
dental
benefits
prescribed
by
the
secretary
pursuant
21
to
section
1302(b)(1)(J)
of
the
federal
Act,
and
such
other
22
dental
benefits
as
the
marketplace
or
the
secretary
may
specify
23
by
rule
or
regulation.
24
d.
A
comprehensive
plan
may
be
offered
through
the
25
marketplace
in
which
dental
benefits
are
included
either
as
26
part
of
a
qualified
health
plan,
or
by
a
qualified
dental
27
plan
offered
in
conjunction
with
a
qualified
health
plan,
28
provided
that
the
medical
and
dental
benefits
offered
by
the
29
comprehensive
plan
are
priced
separately
and
are
offered
for
30
purchase
separately
at
the
same
price.
31
Sec.
11.
NEW
SECTION
.
514M.11
Funding
——
publication
of
32
costs.
33
1.
The
marketplace
may
charge
assessments
or
user
fees
to
34
health
carriers
that
offer
health
insurance
plans
through
the
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marketplace
or
may
otherwise
generate
the
funding
necessary
to
1
support
the
operation
of
the
marketplace,
as
provided
pursuant
2
to
the
plan
of
operation
of
the
marketplace.
3
2.
The
marketplace
may
charge
user
fees
in
the
form
of
a
4
transaction
fee
set
at
a
percentage
of
the
premium
paid
for
a
5
health
insurance
plan
sold
through
the
marketplace.
6
3.
The
marketplace
may
accept
donations
consistent
with
the
7
purpose
and
intent
of
this
chapter
as
stated
in
section
514M.2.
8
4.
The
marketplace
shall
publish
the
average
costs
of
9
licensing,
regulatory
fees,
and
any
other
payments
required
10
by
the
marketplace,
and
the
administrative
costs
of
the
11
marketplace,
on
an
internet
site
for
the
purpose
of
educating
12
consumers
about
the
costs
of
operating
the
marketplace.
The
13
information
provided
shall
include
information
on
moneys
lost
14
due
to
waste,
fraud,
and
abuse
of
the
health
care
system.
15
5.
State
funding
shall
not
be
appropriated
or
allocated
16
for
the
operation
or
administration
of
the
marketplace.
Any
17
assessments
or
user
fees
charged
pursuant
to
this
section
18
shall
provide
for
the
sharing
of
losses
and
expenses
of
the
19
marketplace
on
an
equitable
and
proportionate
basis
among
20
health
carriers
in
this
state
as
provided
in
the
plan
of
21
operation
of
the
marketplace.
22
6.
The
marketplace
may
accept
for
the
benefit
of
the
23
marketplace
funds
from
the
federal
government
and
funds
held
24
by
the
Iowa
comprehensive
health
insurance
association
as
25
established
in
chapter
514E
in
the
form
of
member
assessments
26
or
other
moneys
not
necessary
for
the
payment
of
the
27
association’s
obligations
under
chapter
514E.
28
Sec.
12.
NEW
SECTION
.
514M.12
Rules.
29
In
consultation
with
and
subject
to
the
approval
of
the
30
board,
the
commissioner
shall
adopt
rules
pursuant
to
chapter
31
17A
to
effectuate
and
administer
the
provisions
of
this
32
chapter.
Rules
adopted
under
this
section
shall
not
conflict
33
with
or
prevent
the
application
of
regulations
promulgated
by
34
the
secretary
under
the
federal
Act.
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Sec.
13.
NEW
SECTION
.
514M.13
Advisory
committee.
1
1.
The
board
shall
be
advised
by
a
legislative
health
2
insurance
marketplace
implementation
review
committee
3
consisting
of
members
of
the
general
assembly
appointed
by
the
4
legislative
council.
5
2.
The
advisory
committee
shall
offer
input
to
the
board
6
regarding
rules
proposed
by
the
commissioner,
the
plan
of
7
operation
for
the
marketplace,
and
any
other
topics
relevant
8
to
the
marketplace.
9
Sec.
14.
NEW
SECTION
.
514M.14
Annual
report.
10
1.
The
marketplace
shall
submit
an
annual
report
to
the
11
commissioner,
governor,
general
assembly,
and
the
auditor
of
12
state
by
January
15.
The
report
shall
include
an
accurate
13
accounting
of
all
the
activities
of
the
marketplace
and
of
all
14
its
receipts
and
expenditures
during
the
prior
fiscal
year.
15
2.
The
report
shall
describe
how
the
operations
and
16
activities
of
the
marketplace
serve
the
interests
of
the
state
17
and
further
the
purposes
set
forth
in
this
chapter.
18
Sec.
15.
NEW
SECTION
.
514M.15
Relation
to
other
laws.
19
This
chapter,
and
action
taken
by
the
marketplace
pursuant
20
to
this
chapter,
shall
not
be
construed
to
preempt
or
supersede
21
the
authority
of
the
commissioner
to
regulate
the
business
22
of
insurance
in
this
state.
Except
as
expressly
provided
to
23
the
contrary
in
this
chapter,
all
health
carriers
offering
24
qualified
health
plans
in
this
state
shall
comply
fully
with
25
all
applicable
health
insurance
laws
of
this
state
and
rules
26
adopted
and
orders
issued
by
the
commissioner.
27
Sec.
16.
NEW
SECTION
.
514M.16
Transition
provisions.
28
1.
a.
Beginning
on
or
before
March
1,
2015,
upon
their
29
appointment,
the
board
of
directors
of
the
marketplace
30
shall
meet,
and
in
consultation
with
the
commissioner,
shall
31
begin
plans
to
implement
the
transition
of
the
functions
and
32
administration
of
the
federal-state
partnership
exchange
in
33
full
operation
in
this
state
as
of
January
1,
2014,
pursuant
34
to
the
federal
Act,
to
the
marketplace
established
pursuant
to
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this
chapter,
in
accordance
with
the
federal
Act
and
standards
1
developed
by
the
secretary,
and
applicable
state
law.
2
b.
The
marketplace
established
pursuant
to
this
chapter
3
shall
be
operational
and
shall
offer
enrollment
in
qualified
4
health
plans
to
qualified
individuals
and
qualified
employers
5
in
this
state
on
or
before
October
1,
2015.
The
qualified
6
health
plans
that
are
offered
through
the
marketplace
shall
be
7
effective
on
January
1,
2016.
8
2.
The
commissioner
shall
transfer
the
functions
and
9
administration
of
the
Iowa
insurance
information
exchange
10
established
in
section
505.32
to
the
marketplace
established
11
pursuant
to
this
chapter
on
or
before
January
1,
2016.
12
DIVISION
II
13
CORRESPONDING
PROVISIONS
14
Sec.
17.
Section
249N.5,
Code
2014,
is
amended
by
adding
the
15
following
new
subsection:
16
NEW
SUBSECTION
.
3.
Beginning
January
1,
2016,
the
Iowa
17
health
and
wellness
plan
shall
be
administered
through
the
Iowa
18
health
insurance
marketplace
established
in
chapter
514M.
19
Sec.
18.
Section
505.32,
Code
2013,
is
amended
by
adding
the
20
following
new
subsection:
21
NEW
SUBSECTION
.
6.
This
section
is
repealed
on
July
1,
22
2016.
23
DIVISION
III
24
EFFECTIVE
DATE
25
Sec.
19.
EFFECTIVE
DATE.
This
Act
takes
effect
January
1,
26
2015.
27
EXPLANATION
28
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
29
the
explanation’s
substance
by
the
members
of
the
general
assembly.
30
This
bill
provides
for
the
establishment
of
the
Iowa
health
31
insurance
marketplace.
32
The
bill
creates
new
Code
chapter
514M,
which
provides
for
33
the
establishment
of
an
Iowa
health
insurance
marketplace,
in
34
place
of
the
federal-state
partnership
exchange
created
and
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fully
operational
as
of
January
1,
2014,
to
facilitate
the
1
sale
and
purchase
of
qualified
health
plans
in
this
state
by
2
qualified
individuals
in
the
individual
market
and
by
qualified
3
small
employers
in
the
small
group
market.
The
intent
of
4
establishing
such
a
marketplace
is
to
reduce
the
number
of
5
uninsured
individuals
in
this
state,
provide
a
transparent
6
marketplace
and
consumer
education,
and
assist
individuals
7
with
access
to
relevant
federal
and
state
programs,
premium
8
assistance
tax
credits,
and
cost-sharing
reductions.
9
For
purposes
of
the
bill,
a
qualified
employer
that
can
10
participate
in
the
small
business
health
options
program
11
component
of
the
marketplace
is
an
employer
that
employs
an
12
average
of
at
least
one
and
not
more
than
50
employees
during
13
the
preceding
calendar
year
and
elects
to
make
its
full-time
14
employees,
and
at
the
employer’s
option,
some
or
all
of
its
15
part-time
employees,
eligible
for
one
or
more
qualified
health
16
plans
offered
through
the
small
business
health
options
program
17
component
of
the
marketplace.
A
qualified
employer
must
18
either
have
its
principal
place
of
business
in
this
state
and
19
elect
to
provide
health
coverage
through
the
marketplace
to
20
all
of
its
eligible
employees
wherever
employed,
or
elect
to
21
provide
coverage
through
the
marketplace
to
all
of
its
eligible
22
employees
who
are
principally
employed
in
this
state.
23
The
Iowa
health
insurance
marketplace
is
established
as
a
24
nonprofit
corporation.
The
marketplace
shall
be
operated
on
25
a
statewide
basis
pursuant
to
a
plan
of
operation
established
26
and
approved
by
its
board
of
directors
in
consultation
27
with
the
commissioner
of
insurance.
The
marketplace
shall
28
include
separate
components
which
facilitate
the
purchase
29
of
qualified
health
plans
by
eligible
individuals
and
small
30
employers
as
described
in
new
Code
chapter
514M
and
the
federal
31
Patient
Protection
and
Affordable
Care
Act,
as
amended.
The
32
marketplace
may
contract
with
an
experienced
and
reputable
33
entity
to
develop
and
maintain
the
marketplace’s
internet
site.
34
The
marketplace
may
employ
staff
to
carry
out
its
duties
but
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no
employees
of
the
marketplace
may
offer
services
for
which
1
a
license
as
an
insurance
producer
is
required
pursuant
to
2
Code
chapter
522B.
The
marketplace
is
also
authorized
to
3
contract
with
an
eligible
entity
to
fulfill
any
of
its
duties
4
or
responsibilities
as
described
in
new
Code
chapter
514M.
5
The
board
of
directors
of
the
marketplace
is
comprised
6
of
seven
members
appointed
by
the
governor
for
three-year
7
staggered
terms
with
two
representing
the
interests
of
small
8
business;
three
representing
the
interests
of
consumers;
one
9
who
is
a
licensed
insurance
producer;
and
one
who
is
a
health
10
care
provider.
The
members
must
be
appointed
on
or
before
11
March
1,
2015.
12
The
members
of
the
board
are
required
to
appoint
an
13
executive
director,
subject
to
confirmation
by
the
senate,
to
14
supervise
the
administrative
affairs
and
general
management
15
and
operations
of
the
marketplace.
The
board
may
appoint
16
other
officers
as
the
board
deems
necessary.
The
board
is
17
also
required
to
appoint
a
secretary
of
the
board
who
keeps
18
a
record
of
the
board
proceedings,
is
the
custodian
of
all
19
books,
documents,
and
papers
filed
with
the
board,
including
20
information
filed
in
an
electronic
format,
and
of
the
minute
21
book
or
journal
of
the
board.
22
The
marketplace
has
all
the
general
powers
of
a
nonprofit
23
corporation
that
are
necessary
and
convenient
to
carry
out
its
24
purposes
and
duties
and
to
exercise
its
specific
powers
as
25
provided
in
new
Code
chapter
514M.
26
The
marketplace
is
required
to
make
qualified
health
plans
27
that
are
effective
on
or
before
January
1,
2016,
available
to
28
qualified
individuals
and
qualified
employers
in
the
state.
29
The
specific
duties
and
powers
of
the
marketplace
are
set
30
forth
in
new
Code
chapter
514M.
The
specific
duties
include
31
responding
to
requests
for
assistance
through
an
internet
site,
32
a
toll-free
telephone
hotline,
and
in-person
support
staff
33
available
in
selected
locations
in
the
state.
34
The
marketplace
is
authorized
to
select
entities
licensed
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and
qualified
to
act
as
navigators
in
accordance
with
the
1
requirements
of
state
and
federal
law
for
the
purpose
of
2
conducting
public
education
activities,
distributing
fair
and
3
impartial
information
concerning
enrollment
in
qualified
health
4
plans,
facilitating
such
enrollment,
providing
referrals
to
the
5
appropriate
federal
or
state
entity
for
grievances,
complaints,
6
or
questions
regarding
an
enrollee’s
health
plan,
and
providing
7
culturally
and
linguistically
appropriate
information
to
8
persons
served
by
the
marketplace.
An
entity
licensed
as
a
9
navigator
under
Code
chapter
522D
shall
not
engage
in
any
10
activities
that
require
licensure
as
an
insurance
producer
11
unless
the
entity
is
also
licensed
as
an
insurance
producer
12
under
Code
chapter
522B.
The
marketplace
is
authorized
to
13
certify
a
health
insurance
plan
as
a
qualified
health
plan
if
14
the
plan
meets
specified
criteria.
15
The
marketplace
may
charge
assessments
or
user
fees,
16
including
transaction
fees
set
at
a
percentage
of
premiums
17
paid,
on
health
insurance
plans
sold
through
the
marketplace,
18
or
otherwise
generate
the
funding
necessary
to
support
the
19
operation
of
the
marketplace,
including
through
donations,
20
as
provided
in
the
marketplace’s
plan
of
operation.
The
21
marketplace
is
required
to
publish
the
average
costs
of
22
licensing,
regulatory
fees,
and
any
other
payments
required
23
by
the
marketplace,
as
well
as
the
administrative
costs
24
of
the
marketplace
on
an
internet
site
for
the
purpose
25
of
educating
consumers
about
the
costs
of
operating
the
26
marketplace.
No
state
funding
can
be
appropriated
or
allocated
27
for
the
operation
or
administration
of
the
marketplace.
Any
28
assessments
or
user
fees
charged
must
provide
for
sharing
29
the
losses
and
expenses
of
the
marketplace
on
an
equitable
30
and
proportionate
basis
among
health
carriers
in
the
state.
31
The
marketplace
may
accept
federal
funds
as
well
as
moneys
32
available
from
the
Iowa
comprehensive
health
insurance
33
association
established
in
Code
chapter
514E.
34
In
consultation
with
and
subject
to
the
approval
of
the
35
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2112
board,
the
commissioner
of
insurance
is
required
to
adopt
rules
1
pursuant
to
Code
chapter
17A
to
effectuate
and
administer
2
the
provisions
of
new
Code
chapter
514M.
The
board
is
to
3
be
advised
regarding
implementation
of
the
marketplace
by
4
a
committee
consisting
of
members
of
the
general
assembly
5
appointed
by
the
legislative
council.
6
The
marketplace
is
required
to
submit
an
annual
report
to
the
7
commissioner,
governor,
general
assembly,
and
the
auditor
of
8
state
by
January
15,
which
includes
an
accurate
accounting
of
9
all
the
activities
of
the
marketplace
and
of
all
its
receipts
10
and
expenditures
during
the
prior
fiscal
year.
The
report
11
shall
also
describe
how
the
operations
and
activities
of
the
12
marketplace
serve
the
interests
of
the
state
and
further
the
13
purposes
of
new
Code
chapter
514M.
14
The
enactment
of
the
Code
chapter
and
actions
taken
by
15
the
marketplace
are
not
to
be
construed
as
preempting
or
16
superseding
the
authority
of
the
commissioner
to
regulate
17
insurance
in
this
state.
18
The
new
Code
chapter
contains
transition
provisions
19
that
require
the
new
marketplace
board
to
be
appointed
and
20
meet
on
or
before
March
1,
2015,
and
in
consultation
with
21
the
commissioner
of
insurance,
begin
plans
to
implement
22
the
transition
of
the
functions
and
administration
of
the
23
federal-state
partnership
exchange
in
full
operation
in
this
24
state
as
of
January
1,
2014,
pursuant
to
the
federal
Act,
to
25
the
marketplace
established
pursuant
to
new
Code
chapter
514M.
26
The
marketplace
must
be
operational
and
offer
enrollment
in
27
qualified
health
plans
to
qualified
individuals
and
qualified
28
employers
in
this
state
on
or
before
October
1,
2015.
The
29
qualified
health
plans
that
are
offered
through
the
marketplace
30
must
be
effective
on
January
1,
2016.
The
Iowa
health
and
31
wellness
plan
will
be
administered
through
the
marketplace
32
beginning
January
1,
2016.
33
The
commissioner
of
insurance
is
also
directed
to
transfer
34
the
functions
and
administration
of
the
Iowa
insurance
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