Bill Text: IA SF375 | 2013-2014 | 85th General Assembly | Introduced
Bill Title: A bill for an act providing for the establishment of the Iowa health benefit marketplace and including effective date provisions. (Formerly SF 72.)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2013-12-31 - END OF 2013 ACTIONS [SF375 Detail]
Download: Iowa-2013-SF375-Introduced.html
Senate
File
375
-
Introduced
SENATE
FILE
375
BY
COMMITTEE
ON
COMMERCE
(SUCCESSOR
TO
SF
72)
A
BILL
FOR
An
Act
providing
for
the
establishment
of
the
Iowa
health
1
benefit
marketplace
and
including
effective
date
provisions.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
1060SV
(1)
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S.F.
375
DIVISION
I
1
IOWA
HEALTH
BENEFIT
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
Benefit
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
benefit
marketplace
in
this
state
to
8
facilitate
the
sale
and
purchase
of
qualified
health
benefit
9
plans
by
qualified
individuals
in
the
individual
market
in
10
this
state
and
by
qualified
small
employers
in
the
small
11
group
market
in
this
state.
The
intent
of
authorizing
the
12
establishment
of
a
health
benefit
marketplace
in
this
state
is
13
to
reduce
the
number
of
uninsured
individuals
in
this
state,
14
provide
a
transparent
marketplace
and
consumer
education,
and
15
assist
individuals
with
access
to
relevant
federal
and
state
16
programs,
premium
assistance
tax
credits,
and
cost-sharing
17
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
benefit
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
benefit
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.
a.
“Health
benefit
plan”
means
a
policy,
contract,
32
certificate,
or
agreement
offered
or
issued
by
a
health
carrier
33
to
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
34
the
costs
of
health
care
services.
35
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b.
“Health
benefit
plan”
does
not
include
any
of
the
1
following:
2
(1)
Coverage
only
for
accident,
or
disability
income
3
insurance,
or
any
combination
thereof.
4
(2)
Coverage
issued
as
a
supplement
to
liability
insurance.
5
(3)
Liability
insurance,
including
general
liability
6
insurance
and
automobile
liability
insurance.
7
(4)
Workers’
compensation
or
similar
insurance.
8
(5)
Automobile
medical
payment
insurance.
9
(6)
Credit-only
insurance.
10
(7)
Coverage
for
on-site
medical
clinics.
11
(8)
Other
similar
insurance
coverage,
specified
in
federal
12
regulations
issued
pursuant
to
Tit.
XXVII
of
the
federal
Public
13
Health
Service
Act,
as
enacted
by
the
federal
Health
Insurance
14
Portability
and
Accountability
Act
of
1996,
Pub.
L.
No.
15
104-191,
and
amended
by
the
federal
Act,
under
which
benefits
16
for
health
care
services
are
secondary
or
incidental
to
other
17
insurance
benefits.
18
c.
“Health
benefit
plan”
does
not
include
any
of
the
19
following
benefits
if
they
are
provided
under
a
separate
20
policy,
certificate,
or
contract
of
insurance
or
are
otherwise
21
not
an
integral
part
of
the
plan:
22
(1)
Limited
scope
dental
or
vision
benefits.
23
(2)
Benefits
for
long-term
care,
nursing
home
care,
home
24
health
care,
community-based
care,
or
any
combination
thereof.
25
(3)
Other
similar,
limited
benefits
specified
in
federal
26
regulations
issued
pursuant
to
the
federal
Health
Insurance
27
Portability
and
Accountability
Act
of
1996,
Pub.
L.
No.
28
104-191.
29
d.
“Health
benefit
plan”
does
not
include
any
of
the
30
following
benefits
if
the
benefits
are
provided
under
a
31
separate
policy,
certificate,
or
contract
of
insurance,
there
32
is
no
coordination
between
the
provision
of
the
benefits
and
33
any
exclusion
of
benefits
under
any
group
health
benefit
plan
34
maintained
by
the
same
plan
sponsor,
and
the
benefits
are
paid
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with
respect
to
an
event
without
regard
to
whether
benefits
are
1
provided
with
respect
to
such
an
event
under
any
group
health
2
benefit
plan
maintained
by
the
same
plan
sponsor:
3
(1)
Coverage
only
for
a
specified
disease
or
illness.
4
(2)
Hospital
indemnity
or
other
fixed
indemnity
insurance.
5
e.
“Health
benefit
plan”
does
not
include
any
of
the
6
following
if
offered
as
a
separate
policy,
certificate,
or
7
contract
of
insurance:
8
(1)
Medicare
supplemental
health
insurance
as
defined
under
9
section
1882(g)(1)
of
the
federal
Social
Security
Act.
10
(2)
Coverage
supplemental
to
the
coverage
provided
under
10
11
U.S.C.
ch.
55,
by
the
civilian
health
and
medical
program
of
12
the
uniformed
services.
13
(3)
Supplemental
coverage
similar
to
that
provided
under
a
14
group
health
benefit
plan.
15
6.
“Health
carrier”
means
an
entity
subject
to
the
insurance
16
laws
and
rules
of
this
state,
or
subject
to
the
jurisdiction
17
of
the
commissioner,
that
contracts
or
offers
to
contract
to
18
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
19
the
costs
of
health
care
services,
including
an
insurance
20
company
offering
sickness
and
accident
plans,
a
health
21
maintenance
organization,
a
nonprofit
hospital
or
health
22
service
corporation,
or
any
other
entity
providing
a
plan
of
23
health
insurance,
health
benefits,
or
health
services.
24
7.
“Insurance
producer”
means
a
person
required
to
be
25
licensed
under
chapter
522B.
26
8.
“Marketplace”
means
the
Iowa
health
benefit
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
1
elects
to
make
its
full-time
employees
eligible
for
one
or
2
more
qualified
health
benefit
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
benefit
plan”
means
a
health
benefit
14
plan
that
has
in
effect
a
certification
as
described
in
section
15
1311(c)
of
the
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
benefit
plan
19
offered
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
benefit
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
benefit
plans
available
to
its
employees
through
the
small
18
business
health
options
program
component
of
the
marketplace,
19
and
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
benefit
marketplace.
27
1.
The
Iowa
health
benefit
marketplace
is
established
as
a
28
nonprofit
corporation.
The
marketplace
shall
be
established
29
for
the
purpose
of
facilitating
the
sale
and
purchase
of
30
qualified
health
benefit
plans
by
qualified
individuals
in
31
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
benefit
plans
to
eligible
individuals
and
to
small
20
employers
as
described
in
this
chapter
and
in
the
federal
Act.
21
6.
The
marketplace
may
establish
a
reimbursement
system
22
for
health
benefit
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
benefit
plan.
26
7.
The
marketplace
shall
do
all
of
the
following:
27
a.
Facilitate
the
purchase
and
sale
of
qualified
health
28
benefit
plans
to
qualified
individuals
and
qualified
employers
29
as
described
in
this
chapter
and
in
the
federal
Act.
30
b.
Establish
rate
schedules
for
commissions
paid
to
31
insurance
producers
by
qualified
health
benefit
plans
offered
32
through
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
benefit
plan
offered
through
the
marketplace
2
shall
be
enrolled
in
the
plan
by
an
insurance
producer
or
may
3
enroll
in
the
plan
directly
through
the
marketplace
internet
4
site.
The
commission
paid
to
an
insurance
producer
who
enrolls
5
a
person
in
a
plan
offered
through
the
marketplace
shall
be
6
established
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
employ
staff
to
carry
out
the
16
functions
of
the
marketplace,
but
no
employee
of
the
17
marketplace
shall
sell,
solicit,
or
negotiate
enrollment
in
18
a
health
benefit
plan
or
otherwise
offer
services
for
which
19
a
license
as
an
insurance
producer
is
required
pursuant
to
20
chapter
522B.
21
10.
The
marketplace
may
contract
with
an
eligible
entity
to
22
fulfill
any
of
its
specialized
duties
or
responsibilities
as
23
described
in
this
chapter.
An
eligible
entity
includes
but
is
24
not
limited
to
an
entity
that
has
experience
in
individual
and
25
small
group
health
benefit
plans,
benefit
administration,
or
26
other
experience
relevant
to
the
responsibilities
to
be
assumed
27
by
the
entity.
However,
a
health
carrier
or
an
affiliate
of
a
28
health
carrier
is
not
an
eligible
entity
for
the
purposes
of
29
this
subsection.
30
11.
The
marketplace
may
enter
into
information-sharing
31
agreements
with
federal
and
state
agencies
to
carry
out
32
its
responsibilities
under
this
chapter
provided
such
33
agreements
include
adequate
protections
with
respect
to
the
34
confidentiality
of
the
information
to
be
shared
and
comply
with
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all
state
laws
and
rules
and
federal
laws
and
regulations.
1
12.
Each
qualified
health
benefit
plan
offered
through
2
the
marketplace
shall
be
assigned
a
rating
by
the
marketplace
3
in
accordance
with
criteria
developed
by
the
secretary
under
4
section
1311(c)(3)
of
the
federal
Act,
and
the
marketplace
5
shall
determine
the
level
of
coverage
of
each
qualified
health
6
benefit
plan
in
accordance
with
regulations
issued
by
the
7
secretary
under
section
1302(d)(2)(A)
of
the
federal
Act
and
8
applicable
state
law.
9
13.
If
a
qualified
health
benefit
plan
offered
through
10
the
marketplace
meets
or
exceeds
the
criteria
for
a
qualified
11
health
benefit
plan
set
forth
by
the
secretary,
the
plan
shall
12
be
reviewed
and
assigned
a
rating
by
the
marketplace.
13
Sec.
5.
NEW
SECTION
.
514M.5
Board
of
directors
——
executive
14
director
——
secretary.
15
1.
The
board
of
directors
of
the
Iowa
health
benefit
16
marketplace
shall
effectuate
the
powers
and
duties
of
the
17
marketplace
as
set
forth
in
this
chapter.
18
2.
The
board
shall
consist
of
seven
voting
members
and
19
five
ex
officio,
nonvoting
members.
The
voting
members
shall
20
be
appointed
by
the
governor,
subject
to
confirmation
by
the
21
senate.
The
voting
members
of
the
board
shall
annually
elect
22
one
voting
member
as
chairperson
and
one
voting
member
as
vice
23
chairperson.
24
a.
The
voting
members
shall
be
appointed
by
the
governor
as
25
follows:
26
(1)
Two
persons
who
represent
the
interests
of
small
27
business
from
nominations
made
to
the
governor
by
nationally
28
recognized
groups
that
represent
the
interests
of
small
29
business.
30
(2)
Three
persons
who
represent
the
interests
of
consumers
31
from
nominations
made
to
the
governor
by
nationally
recognized
32
groups
that
represent
the
interests
of
consumers.
33
(3)
One
person
who
is
an
insurance
producer
licensed
under
34
chapter
522B.
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(4)
One
person
who
is
a
health
care
provider.
1
b.
The
ex
officio,
nonvoting
members
of
the
board
are
as
2
follows:
3
(1)
Four
members
of
the
general
assembly,
one
appointed
4
by
the
speaker
of
the
house
of
representatives,
one
appointed
5
by
the
minority
leader
of
the
house
of
representatives,
6
one
appointed
by
the
majority
leader
of
the
senate,
and
one
7
appointed
by
the
minority
leader
of
the
senate.
8
(2)
A
person
who
shall
serve
as
the
secretary
of
the
board,
9
appointed
by
the
board.
10
3.
The
governor
shall
not
appoint
to
the
board
any
person
11
who
is
either
the
spouse
or
a
relative
within
the
first
degree
12
of
consanguinity
of
a
serving
member
of
the
board.
13
4.
Each
member
of
the
board
appointed
by
the
governor
shall
14
be
a
resident
of
this
state
and
the
composition
of
voting
15
members
of
the
board
shall
be
in
compliance
with
sections
16
69.16,
69.16A,
and
69.16C.
17
5.
The
voting
members
of
the
board
shall
be
appointed
for
18
staggered
terms
of
three
years
on
or
before
March
1,
2014,
and
19
by
December
15
of
each
year
thereafter.
The
initial
terms
20
of
the
voting
members
of
the
board
shall
be
staggered
at
the
21
discretion
of
the
governor.
A
voting
member
of
the
board
is
22
eligible
for
reappointment.
The
governor
shall
fill
a
vacancy
23
on
the
board
in
the
same
manner
as
the
original
appointment
24
for
the
remainder
of
the
term.
A
voting
member
of
the
board
25
may
be
removed
by
the
governor
for
misfeasance,
malfeasance,
26
willful
neglect
of
duty,
failure
to
actively
participate
in
the
27
affairs
of
the
board,
or
other
cause
after
notice
and
a
public
28
hearing
unless
the
notice
and
hearing
are
waived
by
the
member
29
in
writing.
30
6.
A
voting
member
of
the
board
shall
not
be
an
employee
31
of,
a
consultant
to,
a
member
of
the
board
of
directors
of,
32
affiliated
with,
have
an
ownership
interest
in,
or
otherwise
33
be
a
representative
of
any
health
carrier,
insurance
producer
34
agency,
insurance
consultant
organization,
trade
association
of
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insurers,
or
association
offering
health
benefit
plans
to
its
1
members,
while
serving
on
the
board.
2
7.
Voting
members
of
the
board
shall
be
reimbursed
from
the
3
moneys
of
the
marketplace
for
all
actual
and
necessary
expenses
4
incurred
in
the
performance
of
their
duties
as
members,
and
5
shall
receive
per
diem
at
the
rate
of
fifty
dollars
per
day
for
6
their
services.
7
8.
A
majority
of
the
voting
members
of
the
board
constitutes
8
a
quorum.
The
affirmative
vote
of
a
majority
of
the
voting
9
members
is
necessary
for
any
action
taken
by
the
board.
The
10
majority
shall
not
include
a
member
who
has
a
conflict
of
11
interest
and
a
statement
by
a
member
of
a
conflict
of
interest
12
is
conclusive
for
this
purpose.
A
vacancy
in
the
membership
of
13
the
board
does
not
impair
the
right
of
a
quorum
to
exercise
the
14
rights
and
perform
the
duties
of
the
board.
An
action
taken
by
15
the
board
under
this
chapter
may
be
authorized
by
resolution
16
at
a
regular
or
special
meeting
and
each
resolution
shall
take
17
effect
immediately
and
need
not
be
published
or
posted.
18
9.
The
voting
members
of
the
board
shall
give
bond
as
19
required
for
public
officers
by
chapter
64.
20
10.
The
voting
members
of
the
board
are
subject
to
and
are
21
officials
within
the
meaning
of
chapter
68B.
22
11.
The
board
shall
meet
at
the
call
of
the
chairperson,
23
or
in
the
absence
of
the
chairperson,
at
the
call
of
the
vice
24
chairperson,
or
when
any
four
voting
members
of
the
board
file
25
a
written
request
with
the
chairperson
for
a
meeting.
Written
26
notice
of
the
time
and
place
of
each
meeting
shall
be
given
to
27
each
member
of
the
board.
28
12.
a.
The
voting
members
of
the
board
shall
appoint
an
29
executive
director,
subject
to
confirmation
by
the
senate,
to
30
supervise
the
administrative
affairs
and
general
management
and
31
operations
of
the
marketplace.
32
b.
The
voting
members
of
the
board
may
appoint
other
33
officers
as
the
members
of
the
board
determine.
The
officers
34
shall
not
be
members
of
the
board,
with
the
exception
of
the
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secretary
of
the
board,
and
shall
serve
at
the
pleasure
of
the
1
voting
members
of
the
board,
and
shall
receive
compensation
as
2
fixed
by
the
board.
3
c.
The
board
may
employ
other
staff
to
carry
out
the
4
functions
of
the
marketplace,
but
no
employee
of
the
5
marketplace
shall
sell,
solicit,
or
negotiate
enrollment
in
6
a
health
benefit
plan
or
otherwise
offer
services
for
which
7
a
license
as
an
insurance
producer
is
required
pursuant
to
8
chapter
522B.
All
employees
of
the
marketplace
are
exempt
from
9
chapter
8A,
subchapter
IV,
and
chapter
97B.
10
13.
a.
The
voting
members
of
the
board
shall
appoint
a
11
secretary
of
the
board
who
shall
be
an
ex
officio
member
of
the
12
board
as
provided
in
subsection
2,
shall
keep
a
record
of
the
13
proceedings
of
the
board,
and
shall
be
the
custodian
of
all
14
books,
documents,
and
papers
filed
with
the
board,
including
15
information
filed
in
an
electronic
format,
and
the
minute
book
16
or
journal
of
the
board.
17
b.
The
secretary
of
the
board
shall
serve
at
the
pleasure
18
of
the
board,
and
shall
receive
compensation
as
fixed
by
the
19
board.
20
14.
Members
of
the
board,
or
persons
acting
on
behalf
of
21
the
marketplace,
while
acting
in
the
scope
of
their
agency
or
22
employment,
are
not
subject
to
personal
liability
resulting
23
from
carrying
out
the
powers
and
duties
in
this
chapter.
24
Sec.
6.
NEW
SECTION
.
514M.6
General
powers.
25
1.
The
marketplace
has
any
and
all
powers
necessary
and
26
convenient
to
carry
out
its
purposes
and
duties
and
exercise
27
its
specific
powers,
including
but
not
limited
to
the
power
to:
28
a.
Sue
and
be
sued
in
its
own
name.
29
b.
Have
and
alter
a
corporate
seal.
30
c.
Make
and
alter
bylaws
for
its
management
consistent
with
31
the
provisions
of
this
chapter.
32
d.
Make
and
execute
agreements,
contracts,
and
other
33
instruments
of
any
and
all
types
on
such
terms
and
conditions
34
as
the
marketplace
may
find
necessary
or
convenient
to
the
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purpose
of
the
marketplace,
with
any
public
or
private
entity,
1
including
but
not
limited
to
contracts
for
goods
and
services.
2
All
political
subdivisions,
other
public
agencies,
and
state
3
departments
and
agencies
may
enter
into
contracts
and
otherwise
4
cooperate
with
the
marketplace.
5
e.
Adopt
procedures
relating
to
competitive
bidding,
6
including
the
identification
of
those
circumstances
under
which
7
competitive
bidding
by
the
marketplace,
either
formally
or
8
informally,
shall
be
required.
In
any
bidding
process,
the
9
marketplace
may
administer
its
own
bidding
and
procurement
or
10
may
utilize
the
services
of
the
department
of
administrative
11
services
or
any
other
agency.
Except
when
such
rules
apply,
12
the
marketplace
and
all
contracts
made
by
it
in
carrying
out
13
its
public
and
essential
governmental
functions
with
respect
14
to
any
of
its
purposes
shall
be
exempt
from
the
provisions
15
and
requirements
of
all
laws
or
rules
of
the
state
which
16
require
competitive
bids
in
connection
with
the
letting
of
such
17
contracts.
18
f.
Acquire,
hold,
improve,
mortgage,
lease,
and
dispose
of
19
real
and
personal
property,
including
but
not
limited
to
the
20
power
to
sell
at
public
or
private
sale,
with
or
without
public
21
bidding,
any
such
property,
or
other
obligation
held
by
it.
22
g.
Procure
insurance
against
any
loss
in
connection
with
its
23
operations
and
property
interests.
24
h.
Accept
appropriations,
gifts,
grants,
loans,
or
other
25
aid
from
public
or
private
entities.
A
record
of
all
gifts
or
26
grants,
stating
the
type,
amount,
and
donor,
shall
be
clearly
27
set
out
in
the
marketplace’s
annual
report
along
with
the
28
record
of
other
receipts.
29
i.
Provide
to
public
and
private
entities
technical
30
assistance
and
counseling
related
to
the
marketplace’s
31
purposes.
32
j.
In
cooperation
with
other
local,
state,
or
federal
33
governmental
agencies,
conduct
research
studies,
develop
34
estimates
of
unmet
health
insurance
needs,
gather
and
compile
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data
useful
to
facilitating
decision
making,
and
enter
into
1
agreements
to
carry
out
programs
within
or
without
the
state
2
which
the
marketplace
finds
to
be
consistent
with
the
goals
of
3
the
marketplace.
4
k.
Enter
into
agreements
with
the
federal
government,
5
tribes,
and
other
states
to
facilitate
the
sale
or
purchase
of
6
qualified
health
benefit
plans
by
qualified
individuals
and
7
qualified
small
employers
in
this
state.
8
l.
Own
or
acquire
intellectual
property
rights
including
9
but
not
limited
to
copyrights,
trademarks,
service
marks,
and
10
patents,
and
enforce
the
rights
of
the
marketplace
with
respect
11
to
such
intellectual
property
rights.
12
m.
Form
committees
or
panels
as
necessary
to
facilitate
the
13
marketplace’s
duties.
Committees
or
panels
formed
pursuant
to
14
this
paragraph
shall
be
subject
to
the
provisions
of
chapters
15
21
and
22.
16
n.
Establish
one
or
more
funds
within
the
state
treasury
17
under
the
control
of
the
marketplace.
Notwithstanding
section
18
8.33
or
12C.7,
or
any
other
provision
to
the
contrary,
moneys
19
invested
by
the
treasurer
of
state
pursuant
to
this
paragraph
20
shall
not
revert
to
the
general
fund
of
the
state
and
interest
21
accrued
on
the
moneys
shall
be
moneys
of
the
marketplace
and
22
shall
not
be
credited
to
the
general
fund
of
the
state.
The
23
nonreversion
of
moneys
allowed
under
this
paragraph
does
not
24
apply
to
moneys
appropriated
to
the
marketplace
by
the
general
25
assembly.
26
o.
Exercise
generally
all
powers
typically
exercised
by
27
private
enterprises
engaged
in
business
pursuits
unless
the
28
exercise
of
such
a
power
would
violate
the
terms
of
this
29
chapter
or
the
Constitution
of
the
State
of
Iowa.
30
2.
Notwithstanding
any
other
provision
of
law,
any
purchase
31
or
lease
of
real
property,
other
than
on
a
temporary
basis,
32
when
necessary
in
order
to
implement
the
purposes
of
the
33
marketplace
or
protect
the
investments
of
the
marketplace,
34
shall
require
written
notice
from
the
marketplace
to
the
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government
oversight
committees
of
the
general
assembly
or
1
their
successor
committees
and
the
prior
approval
of
the
2
executive
council.
3
3.
The
powers
enumerated
in
this
section
are
cumulative
of
4
and
in
addition
to
those
powers
enumerated
elsewhere
in
this
5
chapter
and
such
powers
do
not
limit
or
restrict
any
other
6
powers
of
the
marketplace.
7
Sec.
7.
NEW
SECTION
.
514M.7
Specific
powers.
8
1.
In
addition
to
the
general
powers
described
in
section
9
514M.6,
the
marketplace
shall
have
all
powers
convenient
and
10
necessary
to
carry
out
the
purpose
and
intent
of
this
chapter.
11
2.
The
marketplace
established
pursuant
to
section
514M.4
12
shall
make
qualified
health
benefit
plans
that
are
effective
13
on
January
1,
2015,
available
to
qualified
individuals
and
14
qualified
employers
in
this
state.
15
3.
At
such
time
as
applications
for
waivers
from
the
16
requirements
of
the
federal
Act
are
accepted
by
the
secretary,
17
the
marketplace
may
request
such
waivers
from
the
secretary.
18
4.
The
marketplace
shall
allow
a
health
carrier
to
offer
a
19
plan
that
provides
limited
scope
dental
benefits
meeting
the
20
requirements
of
section
9832(c)(2)(A)
of
the
Internal
Revenue
21
Code
of
1986
through
the
marketplace,
either
separately
or
in
22
conjunction
with
a
qualified
health
benefit
plan,
if
the
plan
23
provides
pediatric
dental
benefits
meeting
the
requirements
of
24
section
1302(b)(1)(J)
of
the
federal
Act.
25
5.
The
marketplace
or
a
health
carrier
offering
qualified
26
health
benefit
plans
through
the
marketplace
shall
not
charge
27
an
individual
a
fee
or
penalty
for
termination
of
coverage
if
28
the
individual
enrolls
in
another
type
of
minimum
essential
29
coverage
because
the
individual
has
become
newly
eligible
for
30
that
coverage
or
because
the
individual’s
employer-sponsored
31
coverage
has
become
affordable
using
the
standards
of
the
32
federal
Act,
as
codified
at
section
36B(c)(2)(C)
of
the
33
Internal
Revenue
Code
of
1986.
34
Sec.
8.
NEW
SECTION
.
514M.8
Duties
of
the
marketplace.
35
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The
marketplace
shall
do
all
of
the
following:
1
1.
Implement
procedures
for
the
certification,
2
recertification,
and
decertification
of
health
benefit
plans
3
as
qualified
health
benefit
plans,
consistent
with
guidelines
4
developed
by
the
secretary
under
section
1311(c)
of
the
federal
5
Act
and
applicable
state
law.
6
2.
Provide
for
the
operation
of
a
toll-free
telephone
7
hotline
to
respond
to
requests
for
assistance.
8
3.
Provide
for
enrollment
periods,
as
determined
by
the
9
secretary
under
section
1311(c)(6)
of
the
federal
Act
and
10
applicable
state
law.
11
4.
Utilize
a
standardized
format
for
presenting
health
12
benefit
plan
options
in
the
marketplace,
including
the
use
of
13
the
uniform
outline
of
coverage
established
under
section
2715
14
of
the
Public
Health
Service
Act
and
applicable
state
law.
15
5.
In
accordance
with
section
1413
of
the
federal
Act
16
and
applicable
state
law,
inform
individuals
of
eligibility
17
requirements
for
the
Medicaid
program
under
Tit.
XIX
of
the
18
federal
Social
Security
Act,
the
children’s
health
insurance
19
program
under
Tit.
XXI
of
the
federal
Social
Security
Act,
or
20
any
applicable
state
or
local
public
program
and,
if
through
21
screening
of
an
application
by
the
marketplace,
the
marketplace
22
determines
that
any
individual
is
eligible
for
any
such
23
program,
enroll
that
individual
in
that
program.
24
6.
Establish
and
make
available
by
electronic
means
a
25
calculator
to
determine
the
actual
cost
of
coverage
after
26
application
of
any
premium
tax
credit
for
which
an
individual
27
is
eligible
using
the
standards
of
the
federal
Act
as
codified
28
at
section
36B(c)(2)(C)
of
the
Internal
Revenue
Code
of
1986
29
and
any
cost-sharing
reductions
under
section
1402
of
the
30
federal
Act.
31
7.
Establish
a
small
business
health
options
program
32
component
of
the
marketplace
through
which
individuals
employed
33
by
a
qualified
employer
may
enroll
in
any
qualified
health
34
benefit
plan
offered
through
the
small
business
health
options
35
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375
program
at
the
level
of
coverage
specified
by
the
employer.
1
In
establishing
a
small
business
health
options
program
2
marketplace
component,
the
marketplace
shall
do
all
of
the
3
following:
4
a.
Provide
consolidated
billing
and
premium
payment
by
5
qualified
employers
including
detailed
information
to
those
6
employers
about
health
benefit
plans
chosen
by
their
employees
7
and
the
cost
of
those
plans.
8
b.
Establish
an
electronic
interface
and
facilitate
the
flow
9
of
funds
between
health
carriers,
employers,
and
employees,
10
including
subsidiaries.
11
c.
Provide
for
the
dissemination
of
health
benefit
plan
12
enrollment
information
to
employers.
13
8.
Establish
an
individual
health
options
marketplace
14
component
through
which
individuals
may
enroll
in
any
qualified
15
health
benefit
plan
for
individuals.
16
9.
Select
entities
qualified
and
licensed
to
serve
as
17
navigators
in
accordance
with
section
1311(i)
of
the
federal
18
Act,
standards
developed
by
the
secretary,
section
514M.9,
and
19
chapter
522D,
and
award
grants
to
facilitate
the
function
of
20
navigators
as
provided
in
section
514M.9.
21
10.
Encourage
and
review
the
development
of
cafeteria
plans
22
pursuant
to
section
125
of
the
Internal
Revenue
Code
of
1986,
23
for
use
by
employers
participating
in
the
marketplace.
24
11.
Maintain
an
internet
site
through
which
enrollees,
25
employers,
and
prospective
enrollees
of
qualified
health
26
benefit
plans,
at
a
minimum,
may
obtain
standardized
27
comparative
information
on
qualified
health
benefit
plans
28
and
health
benefit
plans
that
are
not
offered
through
the
29
marketplace.
In
developing
the
electronic
clearinghouse,
30
the
marketplace
may
require
health
carriers
participating
in
31
the
marketplace
to
make
available
and
regularly
update
an
32
electronic
directory
of
contracting
health
care
providers
so
33
individuals
seeking
coverage
through
the
marketplace
can
search
34
by
health
care
provider
name
to
determine
which
qualified
35
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31
S.F.
375
health
benefit
plans
in
the
marketplace
include
that
health
1
care
provider
in
their
network,
and
whether
that
health
care
2
provider
is
accepting
new
patients
for
that
particular
health
3
benefit
plan.
4
12.
Consult
with
stakeholders
who
are
relevant
to
carrying
5
out
the
activities
required
under
this
chapter.
6
13.
Assist
in
the
implementation
of
reinsurance
and
risk
7
adjustment
mechanisms,
as
required
by
state
and
federal
law.
8
14.
Establish
guidelines
for
determining
qualifications
for
9
marketplace
employees
and
entities
or
persons
who
are
licensed
10
and
selected
as
navigators.
11
15.
Subject
to
section
1411
of
the
federal
Act
and
12
applicable
state
law,
grant
a
certification
attesting
that,
for
13
purposes
of
the
individual
responsibility
penalty
under
the
14
standards
of
the
federal
Act,
as
codified
at
section
5000A
of
15
the
Internal
Revenue
Code
of
1986,
an
individual
is
exempt
from
16
the
individual
responsibility
requirement
or
from
the
penalty
17
imposed
by
that
section
because
of
any
of
the
following:
18
a.
There
is
no
affordable
qualified
health
benefit
plan
19
available
through
the
marketplace,
or
the
individual’s
20
employer,
covering
the
individual.
21
b.
The
individual
meets
the
requirements
for
any
other
such
22
exemption
from
the
individual
responsibility
requirement
or
23
penalty.
24
16.
Transfer
to
the
United
States
secretary
of
the
treasury
25
all
of
the
following:
26
a.
A
list
of
the
individuals
who
are
issued
a
certification
27
under
subsection
15,
paragraph
“a”
,
including
the
name
and
28
taxpayer
identification
number
of
each
individual.
29
b.
The
name
and
taxpayer
identification
number
of
each
30
individual
who
was
an
employee
of
an
employer
but
who
was
31
determined
to
be
eligible
for
the
premium
tax
credit
using
32
the
standards
of
the
federal
Act
as
codified
at
section
33
36B(c)(2)(C)
of
the
Internal
Revenue
Code
of
1986,
because
of
34
either
of
the
following:
35
-17-
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31
S.F.
375
(1)
The
employer
did
not
provide
minimum
essential
health
1
benefits
coverage.
2
(2)
The
employer
provided
minimum
essential
health
benefits
3
coverage,
but
it
was
determined
using
the
standards
of
the
4
federal
Act,
as
codified
at
section
36B(c)(2)(C)
of
the
5
Internal
Revenue
Code
of
1986,
to
either
be
unaffordable
to
6
the
employee
or
not
to
provide
the
required
minimum
actuarial
7
value.
8
c.
The
name
and
taxpayer
identification
number
of
all
of
the
9
following:
10
(1)
Each
individual
who
notifies
the
marketplace
under
11
section
1411(b)(4)
of
the
federal
Act
that
the
individual
has
12
changed
employers.
13
(2)
Each
individual
who
ceases
coverage
under
a
qualified
14
health
benefit
plan
during
a
plan
year
and
the
effective
date
15
of
that
cessation.
16
17.
Provide
to
each
employer
the
name
of
each
employee
of
17
the
employer
described
in
subsection
16,
paragraph
“b”
,
who
18
ceases
coverage
under
a
qualified
health
benefit
plan
during
a
19
plan
year
and
the
effective
date
of
the
cessation.
20
18.
Perform
duties
required
of,
or
delegated
to,
the
21
marketplace
by
the
secretary,
the
United
States
secretary
22
of
the
treasury,
or
the
commissioner
related
to
determining
23
eligibility
for
premium
tax
credits,
reduced
cost-sharing,
or
24
individual
responsibility
requirement
exemptions.
25
19.
In
consultation
with
the
commissioner,
review
the
26
rate
of
premium
growth
of
health
benefit
plans
within
the
27
marketplace
and
outside
the
marketplace,
and
consider
the
28
information
obtained
in
developing
recommendations
on
whether
29
to
continue
limiting
qualified
employer
status
to
small
30
employers.
31
Sec.
9.
NEW
SECTION
.
514M.9
Navigators.
32
1.
The
marketplace
may
select
entities
qualified
and
33
licensed
to
serve
as
navigators
in
accordance
with
section
34
1311(i)
of
the
federal
Act,
standards
developed
by
the
35
-18-
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31
S.F.
375
secretary,
and
applicable
state
law
including
chapter
522D,
and
1
award
grants
to
enable
navigators
to
do
all
of
the
following:
2
a.
Conduct
public
education
activities
to
raise
awareness
of
3
the
availability
of
qualified
health
benefit
plans
through
the
4
marketplace.
5
b.
Distribute
fair
and
impartial
information
concerning
6
enrollment
in
qualified
health
benefit
plans,
and
the
7
availability
of
premium
tax
credits
for
which
an
individual
8
may
be
eligible
using
the
standards
of
the
federal
Act,
as
9
codified
at
section
36B(c)(2)(C)
of
the
Internal
Revenue
Code
10
of
1986,
and
any
cost-sharing
reductions
under
section
1402
of
11
the
federal
Act.
12
c.
Facilitate
enrollment
in
qualified
health
benefit
plans
13
offered
through
the
marketplace
or
in
health
benefit
plans
14
offered
outside
the
marketplace
by
referring
consumers
to
15
insurance
producers
and
to
the
marketplace
internet
site
for
16
enrollment.
17
d.
Provide
referrals
to
the
office
of
health
insurance
18
consumer
assistance
established
under
the
federal
Act
pursuant
19
to
section
2793
of
the
federal
Public
Health
Service
Act
20
and
the
office
of
the
commissioner
or
any
other
appropriate
21
state
agency,
for
any
enrollee
with
a
grievance,
complaint,
22
or
question
regarding
the
enrollee’s
health
benefit
plan
or
23
coverage,
or
a
determination
under
that
plan
or
coverage.
24
e.
Provide
information
in
a
manner
that
is
culturally
and
25
linguistically
appropriate
to
the
needs
of
the
population
being
26
served
by
the
marketplace.
27
2.
An
entity
selected
and
licensed
as
a
navigator
shall
not
28
engage
in
any
activities
that
require
licensure
as
an
insurance
29
producer
under
chapter
522B
unless
the
entity
is
also
licensed
30
as
an
insurance
producer.
31
Sec.
10.
NEW
SECTION
.
514M.10
Health
benefit
plan
32
certification.
33
1.
The
marketplace
may
certify
a
health
benefit
plan
as
34
a
qualified
health
benefit
plan
if
the
plan
meets
all
of
the
35
-19-
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375
following
criteria:
1
a.
The
plan
provides
the
essential
health
benefit
package
2
described
in
section
1302(a)
of
the
federal
Act,
except
that
3
the
plan
is
not
required
to
provide
essential
benefits
that
4
duplicate
the
minimum
benefits
of
qualified
dental
plans
as
5
provided
in
subsection
6
if
all
of
the
following
occur:
6
(1)
The
marketplace
determines
that
at
least
one
qualified
7
dental
plan
is
available
to
supplement
the
plan’s
coverage.
8
(2)
The
health
carrier
makes
a
prominent
disclosure
at
the
9
time
it
offers
the
plan,
in
a
form
approved
by
the
marketplace,
10
that
the
plan
does
not
provide
the
full
range
of
essential
11
pediatric
benefits
and
that
qualified
dental
plans
providing
12
those
benefits
and
other
dental
benefits
not
covered
by
the
13
plan
are
offered
through
the
marketplace.
14
b.
The
premium
rates
and
contract
language
have
been
15
approved
by
the
commissioner.
16
c.
The
plan
provides
at
least
a
bronze
level
of
coverage,
17
as
that
level
is
defined
by
the
federal
Act,
unless
the
plan
18
is
certified
as
a
qualified
catastrophic
plan,
meets
the
19
requirements
of
the
federal
Act
for
catastrophic
plans,
and
20
will
only
be
offered
to
individuals
eligible
for
catastrophic
21
coverage.
22
d.
The
plan’s
cost-sharing
requirements
do
not
exceed
the
23
limits
established
under
section
1302(c)(1)
of
the
federal
Act,
24
and
if
the
plan
is
offered
through
the
small
business
health
25
options
program
component
of
the
marketplace
that
offers
plans
26
to
small
employers,
the
plan’s
deductible
does
not
exceed
the
27
limits
established
under
section
1302(c)(2)
of
the
federal
Act.
28
e.
The
plan
offers
wellness
programs.
29
f.
The
health
carrier
offering
the
plan
provides
greater
30
transparency
and
disclosure
of
information
about
the
plan
31
benefits,
provider
networks,
claim
payment
practices,
and
32
solvency
ratings,
and
establishes
a
process
for
consumers
to
33
compare
features
of
health
benefit
plans
offered
through
the
34
marketplace.
35
-20-
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1060SV
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85
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31
S.F.
375
g.
The
health
carrier
offering
the
plan
meets
all
of
the
1
following
criteria:
2
(1)
Is
licensed
and
in
good
standing
to
offer
health
3
insurance
coverage
in
this
state.
4
(2)
Offers
at
least
one
qualified
health
benefit
plan
in
the
5
silver
level
and
at
least
one
qualified
health
benefit
plan
in
6
the
gold
level,
as
those
levels
are
defined
in
the
federal
Act,
7
through
each
component
of
the
marketplace
in
which
the
health
8
carrier
participates,
where
component
refers
to
the
components
9
of
the
marketplace
which
offer
individual
coverage
and
coverage
10
for
small
employers.
11
(3)
Charges
the
same
premium
rate
for
each
qualified
health
12
benefit
plan
without
regard
to
whether
the
plan
is
offered
13
through
the
marketplace.
14
(4)
Does
not
charge
any
termination
of
coverage
fees
or
15
penalties
in
violation
of
section
514M.7.
16
(5)
Complies
with
the
regulations
developed
by
the
17
secretary
under
section
1311(d)
of
the
federal
Act,
applicable
18
state
laws,
and
such
other
requirements
as
the
marketplace
may
19
establish.
20
h.
The
plan
meets
the
requirements
of
certification
as
21
adopted
by
rule
pursuant
to
this
section
and
by
the
secretary
22
under
section
1311(c)
of
the
federal
Act,
which
include
but
23
are
not
limited
to
minimum
standards
in
the
areas
of
marketing
24
practices,
network
adequacy,
essential
community
providers
in
25
underserved
areas,
accreditation,
quality
improvement,
uniform
26
enrollment
forms
and
descriptions
of
coverage,
and
information
27
on
quality
measures
for
plan
performance.
28
i.
The
marketplace
determines
that
making
the
plan
available
29
through
the
marketplace
is
in
the
interest
of
qualified
30
individuals
and
qualified
employers
in
this
state.
31
2.
The
marketplace
shall
not
exclude
a
health
benefit
plan
32
from
certification
for
any
of
the
following
reasons:
33
a.
On
the
basis
that
the
plan
is
a
fee-for-service
plan.
34
b.
Through
the
imposition
of
premium
price
controls.
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c.
On
the
basis
that
the
plan
provides
treatments
necessary
1
to
prevent
patients’
deaths
in
circumstances
the
marketplace
2
determines
are
inappropriate
or
too
costly.
3
3.
The
marketplace
shall
require
each
health
carrier
4
seeking
certification
of
a
health
benefit
plan
as
a
qualified
5
health
benefit
plan
to
do
all
of
the
following:
6
a.
Provide
notice
of
any
proposed
premium
increase
and
7
a
justification
for
the
increase
to
the
marketplace
and
to
8
affected
policyholders
before
implementation
of
that
increase.
9
The
health
carrier
shall
prominently
post
the
information
10
on
its
internet
site.
The
marketplace
shall
take
this
11
information,
along
with
the
information
and
the
recommendations
12
provided
to
the
marketplace
by
the
commissioner
under
the
13
federal
Act
pursuant
to
section
2794(b)
of
the
federal
Public
14
Health
Service
Act
and
applicable
state
law,
into
consideration
15
when
determining
whether
to
allow
the
health
carrier
to
make
16
plans
available
through
the
marketplace.
17
b.
Make
available
to
the
public,
in
the
format
described
in
18
paragraph
“c”
,
and
submit
to
the
marketplace,
the
secretary,
and
19
the
commissioner,
accurate
and
timely
disclosure
of
all
of
the
20
following:
21
(1)
Claims
payment
policies
and
practices.
22
(2)
Periodic
financial
disclosures.
23
(3)
Data
on
enrollment.
24
(4)
Data
on
disenrollment.
25
(5)
Data
on
the
number
of
claims
that
are
denied.
26
(6)
Data
on
rating
practices.
27
(7)
Information
on
cost-sharing
and
payments
with
respect
28
to
any
out-of-network
coverage.
29
(8)
Information
on
enrollee
and
participant
rights
under
30
Tit.
I
of
the
federal
Act
and
applicable
state
law.
31
(9)
Other
information
as
determined
appropriate
by
the
32
secretary,
the
marketplace,
or
the
commissioner.
33
c.
The
information
required
in
paragraph
“b”
shall
be
34
provided
in
plain
language,
as
that
term
is
defined
in
section
35
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1311(e)
of
the
federal
Act,
as
amended
by
section
10104
of
the
1
federal
Act,
and
applicable
state
law.
2
4.
The
marketplace
shall
permit
individuals
to
learn,
3
in
a
timely
manner
upon
the
request
of
an
individual,
the
4
amount
of
cost-sharing,
including
deductibles,
copayments,
5
and
coinsurance,
under
the
individual’s
health
benefit
plan
6
or
coverage
for
which
the
individual
would
be
responsible
7
for
paying
with
respect
to
the
furnishing
of
a
specific
item
8
or
service
by
a
participating
health
care
provider.
At
a
9
minimum,
this
information
shall
be
made
available
to
the
10
individual
through
an
internet
site
and
through
other
means
for
11
individuals
without
access
to
the
internet.
12
5.
The
marketplace
shall
not
exempt
any
health
carrier
13
seeking
certification
of
a
health
benefit
plan,
regardless
of
14
the
type
or
size
of
the
health
carrier,
from
applicable
state
15
licensure
or
solvency
requirements
and
shall
apply
the
criteria
16
of
this
section
in
a
manner
that
assures
a
level
playing
17
field
between
or
among
health
carriers
participating
in
the
18
marketplace.
19
6.
a.
The
provisions
of
this
chapter
that
are
applicable
20
to
qualified
health
benefit
plans
shall
also
apply
to
the
21
extent
relevant
to
qualified
dental
plans
except
as
modified
in
22
accordance
with
the
provisions
of
paragraphs
“b”
,
“c”
,
and
“d”
,
23
or
by
rules
adopted
by
the
marketplace.
24
b.
A
health
carrier
to
offer
dental
coverage
shall
be
25
licensed,
but
is
not
required
to
be
licensed
to
offer
other
26
health
benefits.
27
c.
A
qualified
dental
plan
shall
be
limited
to
dental
and
28
oral
health
benefits,
without
substantially
duplicating
the
29
benefits
typically
offered
by
health
benefit
plans
without
30
dental
coverage
and
shall
include,
at
a
minimum,
the
essential
31
pediatric
dental
benefits
prescribed
by
the
secretary
pursuant
32
to
section
1302(b)(1)(J)
of
the
federal
Act,
and
such
other
33
dental
benefits
as
the
marketplace
or
the
secretary
may
specify
34
by
rule
or
regulation.
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d.
A
comprehensive
plan
may
be
offered
through
the
1
marketplace
in
which
dental
benefits
are
included
either
as
2
part
of
a
qualified
health
benefit
plan,
or
by
a
qualified
3
dental
plan
offered
in
conjunction
with
a
qualified
health
4
benefit
plan,
provided
that
the
medical
and
dental
benefits
5
offered
by
the
comprehensive
plan
are
priced
separately
and
are
6
offered
for
purchase
separately
at
the
same
price.
7
Sec.
11.
NEW
SECTION
.
514M.11
Funding
——
publication
of
8
costs.
9
1.
The
marketplace
may
charge
assessments
or
user
fees
to
10
health
carriers
that
offer
health
benefit
plans
through
the
11
marketplace
or
may
otherwise
generate
the
funding
necessary
to
12
support
the
operation
of
the
marketplace,
as
provided
pursuant
13
to
the
plan
of
operation
of
the
marketplace.
14
2.
The
marketplace
shall
publish
the
average
costs
of
15
licensing,
regulatory
fees,
and
any
other
payments
required
16
by
the
marketplace,
and
the
administrative
costs
of
the
17
marketplace,
on
an
internet
site
for
the
purpose
of
educating
18
consumers
about
the
costs
of
operating
the
marketplace.
The
19
information
provided
shall
include
information
on
moneys
lost
20
due
to
waste,
fraud,
and
abuse
of
the
health
care
system.
21
3.
State
funding
shall
not
be
appropriated
or
allocated
22
for
the
operation
or
administration
of
the
marketplace.
Any
23
assessments
or
user
fees
charged
pursuant
to
this
section
24
shall
provide
for
the
sharing
of
losses
and
expenses
of
the
25
marketplace
on
an
equitable
and
proportionate
basis
among
26
health
carriers
in
this
state
as
provided
in
the
plan
of
27
operation
of
the
marketplace.
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
council.
1
1.
The
board
shall
establish
an
advisory
council
consisting
2
of
various
stakeholders
including
representatives
from
3
the
insurance
industry,
insurance
producer
organizations,
4
consumer
advocacy
groups,
labor
unions,
employers,
health
care
5
providers,
farmers,
and
other
interested
parties.
The
advisory
6
council
shall
meet
when
requested
by
the
board.
7
2.
The
advisory
council
shall
offer
input
to
the
board
8
regarding
rules
proposed
by
the
commissioner,
the
plan
of
9
operation
for
the
marketplace,
and
any
other
topics
relevant
10
to
the
marketplace.
11
3.
The
board
may
alter
the
composition
of
the
advisory
12
council
at
any
time
to
reflect
changes
in
the
interests
of
the
13
various
stakeholders.
14
Sec.
14.
NEW
SECTION
.
514M.14
Annual
report.
15
1.
The
marketplace
shall
submit
an
annual
report
to
the
16
commissioner,
governor,
general
assembly,
and
the
auditor
of
17
state
by
January
15.
The
report
shall
include
an
accurate
18
accounting
of
all
the
activities
of
the
marketplace
and
of
all
19
its
receipts
and
expenditures
during
the
prior
fiscal
year.
20
2.
The
report
shall
describe
how
the
operations
and
21
activities
of
the
marketplace
serve
the
interests
of
the
state
22
and
further
the
purposes
set
forth
in
this
chapter.
23
Sec.
15.
NEW
SECTION
.
514M.15
Relation
to
other
laws.
24
This
chapter,
and
action
taken
by
the
marketplace
pursuant
25
to
this
chapter,
shall
not
be
construed
to
preempt
or
supersede
26
the
authority
of
the
commissioner
to
regulate
the
business
27
of
insurance
in
this
state.
Except
as
expressly
provided
to
28
the
contrary
in
this
chapter,
all
health
carriers
offering
29
qualified
health
benefit
plans
in
this
state
shall
comply
fully
30
with
all
applicable
health
insurance
laws
of
this
state
and
31
rules
adopted
and
orders
issued
by
the
commissioner.
32
Sec.
16.
NEW
SECTION
.
514M.16
Transition
provisions.
33
1.
a.
Beginning
on
or
before
March
1,
2014,
upon
their
34
appointment,
the
board
of
directors
of
the
marketplace
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shall
meet,
and
in
consultation
with
the
commissioner,
shall
1
begin
plans
to
implement
the
transition
of
the
functions
and
2
administration
of
the
federally
facilitated
exchanges
or
state
3
partnership
exchanges
in
operation
in
the
state
as
of
January
4
1,
2014,
pursuant
to
the
federal
Act,
to
the
marketplace
5
established
pursuant
to
this
chapter,
in
accordance
with
the
6
federal
Act
and
standards
developed
by
the
secretary,
and
7
applicable
state
law.
8
b.
The
marketplace
established
pursuant
to
this
chapter
9
shall
be
operational
and
shall
offer
enrollment
in
qualified
10
health
benefit
plans
to
qualified
individuals
and
qualified
11
employers
in
this
state
on
or
before
October
1,
2014.
The
12
qualified
health
benefit
plans
that
are
offered
through
the
13
marketplace
shall
be
effective
on
January
1,
2015.
14
2.
The
commissioner
shall
transfer
the
functions
and
15
administration
of
the
Iowa
insurance
information
exchange
16
established
in
section
505.32
to
the
marketplace
established
17
pursuant
to
this
chapter
on
or
before
January
1,
2015.
18
DIVISION
II
19
CORRESPONDING
PROVISION
20
Sec.
17.
Section
505.32,
Code
2013,
is
amended
by
adding
the
21
following
new
subsection:
22
NEW
SUBSECTION
.
6.
This
section
is
repealed
on
July
1,
23
2015.
24
DIVISION
III
25
EFFECTIVE
DATE
26
Sec.
18.
EFFECTIVE
DATE.
This
Act
takes
effect
January
1,
27
2014.
28
EXPLANATION
29
This
bill
provides
for
the
establishment
of
the
Iowa
health
30
benefit
marketplace.
31
The
bill
creates
new
Code
chapter
514M,
which
provides
for
32
the
establishment
of
a
health
benefit
marketplace
to
facilitate
33
the
sale
and
purchase
of
qualified
health
benefit
plans
in
34
this
state
by
qualified
individuals
in
the
individual
market
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and
by
qualified
small
employers
in
the
small
group
market.
1
The
intent
of
establishing
such
a
marketplace
is
to
reduce
2
the
number
of
uninsured
individuals
in
this
state,
provide
a
3
transparent
marketplace
and
consumer
education,
and
assist
4
individuals
with
access
to
relevant
federal
and
state
programs,
5
premium
assistance
tax
credits,
and
cost-sharing
reductions.
6
For
purposes
of
the
bill,
a
qualified
employer
that
can
7
participate
in
the
small
business
health
options
program
8
component
of
the
marketplace
is
an
employer
that
employs
an
9
average
of
at
least
one
and
not
more
than
50
employees
during
10
the
preceding
calendar
year
and
elects
to
make
its
full-time
11
employees,
and
at
the
employer’s
option,
some
or
all
of
its
12
part-time
employees,
eligible
for
one
or
more
qualified
health
13
benefit
plans
offered
through
the
small
business
health
options
14
program
component
of
the
marketplace.
A
qualified
employer
15
must
either
have
its
principal
place
of
business
in
this
state
16
and
elect
to
provide
health
coverage
through
the
marketplace
to
17
all
of
its
eligible
employees
wherever
employed,
or
elect
to
18
provide
coverage
through
the
marketplace
to
all
of
its
eligible
19
employees
who
are
principally
employed
in
this
state.
20
The
Iowa
health
benefit
marketplace
is
established
as
a
21
nonprofit
corporation.
The
marketplace
shall
be
operated
on
22
a
statewide
basis
pursuant
to
a
plan
of
operation
established
23
and
approved
by
its
board
of
directors
in
consultation
24
with
the
commissioner
of
insurance.
The
marketplace
shall
25
include
separate
components
which
facilitate
the
purchase
of
26
qualified
health
benefit
plans
by
eligible
individuals
and
27
small
employers
as
described
in
new
Code
chapter
514M
and
the
28
federal
Patient
Protection
and
Affordable
Care
Act,
as
amended.
29
The
marketplace
may
employ
staff
to
carry
out
its
duties
but
30
no
employees
of
the
marketplace
may
offer
services
for
which
31
a
license
as
an
insurance
producer
is
required
pursuant
to
32
Code
chapter
522B.
The
marketplace
is
also
authorized
to
33
contract
with
an
eligible
entity
to
fulfill
any
of
its
duties
34
or
responsibilities
as
described
in
new
Code
chapter
514M.
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The
board
of
directors
of
the
marketplace
is
comprised
of
1
seven
voting
members
appointed
by
the
governor
for
three-year
2
staggered
terms
with
two
representing
the
interests
of
small
3
business;
three
representing
the
interests
of
consumers;
4
one
who
is
a
licensed
insurance
producer;
and
one
who
is
a
5
health
care
provider.
The
voting
members
must
be
appointed
6
on
or
before
March
1,
2014.
There
are
also
five
ex
officio,
7
nonvoting
members
of
the
board
including
four
members
of
the
8
general
assembly
with
one
each
appointed
by
the
speaker
and
the
9
minority
leader
of
the
house
of
representatives,
and
by
the
10
majority
and
minority
leaders
of
the
senate,
and
including
the
11
secretary
of
the
board.
12
The
voting
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
27
benefit
plans
that
are
effective
on
or
before
January
1,
2015,
28
available
to
qualified
individuals
and
qualified
employers
in
29
the
state.
The
specific
duties
and
powers
of
the
marketplace
30
are
set
forth
in
new
Code
chapter
514M.
31
The
marketplace
is
authorized
to
select
entities
licensed
32
and
qualified
to
act
as
navigators
in
accordance
with
33
the
requirements
of
state
and
federal
law
for
the
purpose
34
of
conducting
public
education
activities,
distributing
35
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fair
and
impartial
information
concerning
enrollment
in
1
qualified
health
benefit
plans,
facilitating
such
enrollment,
2
providing
referrals
to
the
appropriate
federal
or
state
3
entity
for
grievances,
complaints,
or
questions
regarding
an
4
enrollee’s
health
benefit
plan,
and
providing
culturally
and
5
linguistically
appropriate
information
to
persons
served
by
6
the
marketplace.
An
entity
licensed
as
a
navigator
under
Code
7
chapter
522D
shall
not
engage
in
any
activities
that
require
8
licensure
as
an
insurance
producer
unless
the
entity
is
also
9
licensed
as
an
insurance
producer
under
Code
chapter
522B.
The
10
marketplace
is
authorized
to
certify
a
health
benefit
plan
as
11
a
qualified
health
benefit
plan
if
the
plan
meets
specified
12
criteria.
13
The
marketplace
may
charge
assessments
or
user
fees
to
14
health
carriers
that
offer
health
benefit
plans
through
the
15
marketplace
or
otherwise
generate
the
funding
necessary
to
16
support
the
operation
of
the
marketplace
as
provided
in
the
17
marketplace’s
plan
of
operation.
The
marketplace
is
required
18
to
publish
the
average
costs
of
licensing,
regulatory
fees,
19
and
any
other
payments
required
by
the
marketplace,
as
well
20
as
the
administrative
costs
of
the
marketplace
on
an
internet
21
site
for
the
purpose
of
educating
consumers
about
the
costs
22
of
operating
the
marketplace.
No
state
funding
can
be
23
appropriated
or
allocated
for
the
operation
or
administration
24
of
the
marketplace.
Any
assessments
or
user
fees
charged
must
25
provide
for
sharing
the
losses
and
expenses
of
the
marketplace
26
on
an
equitable
and
proportionate
basis
among
health
carriers
27
in
the
state.
28
In
consultation
with
and
subject
to
the
approval
of
the
29
board,
the
commissioner
of
insurance
is
required
to
adopt
rules
30
pursuant
to
Code
chapter
17A
to
effectuate
and
administer
the
31
provisions
of
new
Code
chapter
514M.
The
board
is
required
32
to
establish
an
advisory
council
consisting
of
various
33
stakeholders
including
representatives
from
the
insurance
34
industry,
insurance
producer
organizations,
consumer
advocacy
35
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groups,
labor
unions,
employers,
health
care
providers,
1
farmers,
and
other
interested
parties.
The
council
shall
2
offer
input
to
the
board
regarding
rules
proposed
by
the
3
commissioner,
the
plan
of
operation
for
the
marketplace,
and
4
any
other
relevant
topics.
5
The
marketplace
is
required
to
submit
an
annual
report
to
the
6
commissioner,
governor,
general
assembly,
and
the
auditor
of
7
state
by
January
15,
which
includes
an
accurate
accounting
of
8
all
the
activities
of
the
marketplace
and
of
all
its
receipts
9
and
expenditures
during
the
prior
fiscal
year.
The
report
10
shall
also
describe
how
the
operations
and
activities
of
the
11
marketplace
serve
the
interests
of
the
state
and
further
the
12
purposes
of
new
Code
chapter
514M.
13
The
enactment
of
the
Code
chapter
and
actions
taken
by
14
the
marketplace
are
not
to
be
construed
as
preempting
or
15
superseding
the
authority
of
the
commissioner
to
regulate
16
insurance
in
this
state.
17
The
new
Code
chapter
contains
transition
provisions
that
18
require
the
new
marketplace
board
to
be
appointed
and
meet
19
on
or
before
March
1,
2014,
and
in
consultation
with
the
20
commissioner
of
insurance,
begin
plans
to
implement
the
21
transition
of
the
functions
and
administration
of
the
federally
22
facilitated
exchanges
or
state
partnership
exchanges
in
23
operation
in
the
state
as
of
January
1,
2014,
pursuant
to
the
24
federal
Act,
to
the
marketplace
established
pursuant
to
new
25
Code
chapter
514M.
26
The
marketplace
must
be
operational
and
offer
enrollment
in
27
qualified
health
benefit
plans
to
qualified
individuals
and
28
qualified
employers
in
this
state
on
or
before
October
1,
2014.
29
The
qualified
health
benefit
plans
that
are
offered
through
the
30
marketplace
must
be
effective
on
January
1,
2015.
31
The
commissioner
of
insurance
is
also
directed
to
transfer
32
the
functions
and
administration
of
the
Iowa
insurance
33
information
exchange
established
in
Code
section
505.32
to
the
34
marketplace
on
or
before
January
1,
2015,
and
Code
section
35
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