House File 384 - Introduced HOUSE FILE 384 BY BEST A BILL FOR An Act relating to health insurance coverage for certain 1 post-mastectomy-related issues. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2298YH (3) 90 ko/rn
H.F. 384 Section 1. NEW SECTION . 514C.36 Post-mastectomy-related 1 issues. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. Cost-sharing means any coverage limit, copayment, 5 coinsurance, deductible, or other out-of-pocket expense 6 obligation imposed on a covered person by a policy, contract, 7 or plan providing for third-party payment or prepayment of 8 health or medical expenses. 9 b. Covered person means a policyholder, subscriber, or 10 other person participating in a policy, contract, or plan that 11 provides for third-party payment or prepayment of health or 12 medical expenses. 13 c. Health care professional means the same as defined in 14 section 514J.102. 15 d. Mastectomy means the removal of all or part of a breast 16 for a medically necessary reason as determined by a covered 17 persons health care professional. 18 2. a. Notwithstanding the uniformity of treatment 19 requirements of section 514C.6, a policy, contract, or plan 20 providing for third-party payment or prepayment of health or 21 medical expenses, and that provides coverage for mastectomies, 22 shall provide coverage for all of the following: 23 (1) Physical complications caused by a mastectomy, 24 including lymphedema. 25 (2) Prosthetic devices. 26 (3) A custom fabricated breast prothesis for each breast on 27 which a mastectomy has been performed. 28 (4) One additional breast prothesis for each breast 29 affected by a mastectomy. 30 (5) Reconstructive surgery incident to a mastectomy, in 31 the manner determined by the covered person and the covered 32 persons health care professional to be appropriate, including 33 all of the following: 34 (a) All stages of reconstruction of the breast on which the 35 -1- LSB 2298YH (3) 90 ko/rn 1/ 3
H.F. 384 mastectomy has been performed. 1 (b) Surgery and reconstruction of the breast on which the 2 mastectomy was not performed to produce symmetry with the 3 breast on which the mastectomy was performed. 4 b. Coverage requirements under paragraph a shall apply 5 regardless of whether a covered person was covered under the 6 policy, contract, or plan at the time of the covered persons 7 mastectomy. 8 c. Coverage required under this section shall not be less 9 favorable than coverage a health carrier offers for general 10 physical illness. 11 d. Cost-sharing imposed for coverage required under this 12 section shall not be less favorable than cost-sharing a health 13 carrier imposes for general physical illness. 14 3. a. This section applies to the following classes of 15 third-party payment provider contracts, policies, or plans 16 delivered, issued for delivery, continued, or renewed in this 17 state on or after January 1, 2024: 18 (1) Individual or group accident and sickness insurance 19 providing coverage on an expense-incurred basis. 20 (2) An individual or group hospital or medical service 21 contract issued pursuant to chapter 509, 514, or 514A. 22 (3) An individual or group health maintenance organization 23 contract regulated under chapter 514B. 24 (4) A plan established for public employees pursuant to 25 chapter 509A. 26 b. This section shall not apply to accident-only, specified 27 disease, short-term hospital or medical, hospital confinement 28 indemnity, credit, dental, vision, Medicare supplement, 29 long-term care, basic hospital and medical-surgical expense 30 coverage as defined by the commissioner of insurance, 31 disability income insurance coverage, coverage issued as a 32 supplement to liability insurance, workers compensation or 33 similar insurance, or automobile medical payment insurance. 34 4. The commissioner of insurance shall adopt rules pursuant 35 -2- LSB 2298YH (3) 90 ko/rn 2/ 3
H.F. 384 to chapter 17A to administer this section. 1 EXPLANATION 2 The inclusion of this explanation does not constitute agreement with 3 the explanations substance by the members of the general assembly. 4 This bill relates to health insurance coverage for certain 5 post-mastectomy-related issues. 6 The bill defines mastectomy as the removal of all or part 7 of a breast for a medically necessary reason as determined by a 8 covered persons health care professional. 9 The bill requires a health carrier that offers individual, 10 group, or small group contracts, policies, or plans (plans) in 11 this state that provide for third-party payment or prepayment 12 of health or medical expenses, and that provide coverage for 13 mastectomies, to provide coverage for physical complications 14 caused by a mastectomy, including lymphedema; prosthetic 15 devices; a custom fabricated breast prothesis for each breast 16 on which a mastectomy has been performed; one additional breast 17 prothesis for each breast affected by a mastectomy; all stages 18 of reconstruction of the breast on which the mastectomy has 19 been performed; and surgery and reconstruction of the breast on 20 which the mastectomy was not performed to produce symmetry with 21 the other breast. 22 The coverage cannot be subject to cost sharing that is 23 greater than the cost sharing that a plan imposes for a 24 mastectomy under the plan. 25 The bill applies to the third-party payment providers 26 enumerated in the bill. The bill specifies the types of 27 specialized health-related insurance which are not subject 28 to the coverage requirements of the bill. The bill applies 29 to third-party payment provider plans delivered, issued for 30 delivery, continued, or renewed in this state on or after 31 January 1, 2024. 32 The commissioner of insurance must adopt rules to administer 33 the bill. 34 -3- LSB 2298YH (3) 90 ko/rn 3/ 3