House File 735 - Introduced HOUSE FILE 735 BY MOORE A BILL FOR An Act relating to health carriers, pharmacy benefits managers, 1 and the calculation of cost-sharing contributions by covered 2 persons. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1307YH (3) 91 nls/ko
H.F. 735 Section 1. NEW SECTION . 514F.10 Cost-sharing contribution 1 calculation. 2 1. For purposes of this section, unless the context 3 otherwise requires: 4 a. Cost-sharing means any coverage limit, copayment, 5 coinsurance, deductible, or other out-of-pocket cost obligation 6 imposed by a health benefit plan on a covered person. 7 b. Covered person means a policyholder, subscriber, 8 enrollee, or other individual participating in a health benefit 9 plan. 10 c. Health benefit plan means the same as defined in 11 section 510B.1. 12 d. Health carrier means the same as defined in section 13 514J.102. 14 e. Pharmacy benefits manager means the same as defined in 15 section 510B.1. 16 2. a. Notwithstanding the uniformity of treatment 17 requirements of section 514C.6, for purposes of calculating 18 a covered persons overall contribution to any cost-sharing 19 requirement under a health benefit plan, a health carrier or 20 a pharmacy benefits manager shall include any amount paid by 21 the covered person or paid by any other person on behalf of the 22 covered person. 23 b. If the contribution calculation under paragraph a will 24 result in the ineligibility of a health savings account under 25 section 223 of the Internal Revenue Code, the contribution 26 calculation for the health savings account shall apply only 27 after the covered person has satisfied the minimum deductible 28 under section 233 of the Internal Revenue Code, except that for 29 items or services that are preventive care pursuant to section 30 223(c)(2)(C) of the Internal Revenue Code, the contribution 31 calculation under paragraph a shall apply regardless of 32 whether the minimum deductible under section 233 of the 33 Internal Revenue Code has been satisfied. 34 3. a. This section applies to the following classes of 35 -1- LSB 1307YH (3) 91 nls/ko 1/ 3
H.F. 735 health benefit plans delivered, issued for delivery, continued, 1 or renewed in this state on or after January 1, 2026: 2 (1) Individual or group accident A and sickness insurance 3 providing coverage on an expense-incurred basis. 4 (2) An individual or group hospital or medical service 5 contract issued pursuant to chapter 509, 514, or 514A. 6 (3) An individual or group health maintenance organization 7 contract regulated under chapter 514B. 8 (4) A plan established for public employees pursuant to 9 chapter 509A. 10 b. This section shall not apply to accident-only, specified 11 disease, short-term hospital or medical, hospital confinement 12 indemnity, credit, dental, vision, Medicare supplement, 13 long-term care, basic hospital and medical-surgical expense 14 coverage as defined by the commissioner of insurance, 15 disability income insurance coverage, coverage issued as a 16 supplement to liability insurance, workers compensation or 17 similar insurance, or automobile medical payment insurance. 18 4. The commissioner of insurance may adopt rules pursuant to 19 chapter 17A to administer this section. 20 EXPLANATION 21 The inclusion of this explanation does not constitute agreement with 22 the explanations substance by the members of the general assembly. 23 This bill relates to health carriers, pharmacy benefits 24 managers, and the calculation of cost-sharing covered persons. 25 Cost-sharing and health carrier are defined in the bill. 26 Under the bill, when a health carrier calculates a covered 27 persons overall contribution to any cost-sharing requirement 28 under a health benefit plan, the health carrier and pharmacy 29 benefits manager shall include any amount paid by the covered 30 person, or paid by another person on behalf of the covered 31 person. Where the contribution calculation would result in the 32 ineligibility of a health savings account (HSA) under section 33 223 of the Internal Revenue Code (IRC), the contribution 34 calculation for the HSA shall apply only after the covered 35 -2- LSB 1307YH (3) 91 nls/ko 2/ 3
H.F. 735 person has satisfied the minimum deductible, except that for 1 items or services that are preventive care pursuant to section 2 223(c)(2)(C) of the IRC, the contribution calculation shall 3 apply regardless of whether the minimum deductible has been 4 satisfied. 5 The bill applies to health benefit plans delivered, issued 6 for delivery, continued, or renewed in this state on or after 7 January 1, 2026, as enumerated in the bill. The bill specifies 8 the types of specialized health-related insurance not subject 9 to the bill. 10 The commissioner of insurance may adopt rules to administer 11 the bill. 12 -3- LSB 1307YH (3) 91 nls/ko 3/ 3