Fiscal Note
Fiscal Services Division
SF 2358 – Insurance Coverage, Diagnostic Breast Examinations (LSB5676SV)
Staff Contact: Xavier Leonard (515.725.0509) xavier.leonard@legis.iowa.gov
Fiscal Note Version – New
Description
Senate File 2358 relates to insurance coverage for supplemental and diagnostic breast
examinations and does the following:
• Requires a policy, contract, or plan providing for third-party payment or prepayment of
health or medical expenses to provide coverage for diagnostic and supplemental breast
examinations.
• Prohibits the coverage required by the Bill from being less favorable than coverage a health
carrier offers for screening mammograms.
• Prohibits cost-sharing requirements from being imposed by a health carrier for coverage
required by the Bill.
• Permits the Iowa Insurance Division (IID) of the Department of Insurance and Financial
Services (DIFS) to adopt administrative rules.
The provisions of SF 2358 are applicable to third-party payment provider contracts, policies, or
plans delivered, issued for delivery, continued, or renewed in Iowa on or after January 1, 2025.
Background
Under the current State of Iowa Plan designs, cost-sharing for preventative and screening
mammograms, ultrasounds, and magnetic resonance imaging (MRIs) is cost-free to the
policyholder in nearly all cases, with mammograms making up the majority of the preventative
imaging services covered by the Bill. The same services for diagnostic purposes apply plan-
specific cost-sharing, and the shifting of these cost-shares from Plan members to the Plan may
result in an increase in claim spending.
Senate File 2358 is estimated to impact approximately 25.2% of the population of Iowa
(807,000). This includes individual coverage, fully insured small and large employer groups,
self-insured public employees, and the State of Iowa Plan.
Of the individuals not covered by the mandate, approximately 47.9% are covered by
government-sponsored health insurance, 23.0% are covered by employer coverage that is
governed by the federal Employee Retirement Income Security Act of 1974 (ERISA), and the
remaining 3.9% are uninsured. Additional details are presented in Figure 1.
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 Figure 1 — Population Covered by Insurance Plans Regulated by Iowa Law
Iowa Percent of
Type of Coverage Population Population
Total Population 2022 3,200,517 100.0%
Included in Mandate
Individual Coverage 102,399 3.2%
Fully Insured Small Employer Group 140,349 4.4%
Fully Insured Large Employer Group 294,013 9.2%
Self-Insured Public Employees 215,000 6.7%
State of Iowa Plan 55,000 1.7%
Total 806,761 25.2%
Not Included in Mandate
Employer (self-insured + other types not listed) 736,868 23.0%
Uninsured 126,000 3.9%
Other Public (Military, Tricare, Veterans Affairs) 21,600 0.7%
Medicare 658,382 20.6%
Medicaid + Children’s Health Insurance Plan 850,906 26.6%
Total 2,393,756 74.8%
Source: Iow a Insurance Division, Department of Insurance and Financial Services, and Wellmark
Assumptions
• The utilization of imaging may increase due to the removal of the requirement of an
abnormality for further imaging.
• State of Iowa Plan costs may increase between 0.03% and 0.15%. The lower end of this
range is more likely to occur.
• The costs to the Board of Regents Insurance Plans may increase minimally.
Fiscal Impact
Senate File 2358 is estimated to increase annual costs to the State of Iowa Insurance Plan by
an amount ranging from approximately $100,000 to $500,000 beginning in FY 2025. It is
anticipated that the lower end of this range is more likely to occur; however, the estimated cost
cannot be determined. Senate File 2358 is also estimated to minimally increase annual costs to
the Board of Regents Insurance Plans.
Sources
Iowa Insurance Division, Department of Insurance and Financial Services
Board of Regents
Wellmark
/s/ Jennifer Acton
March 13, 2024
Doc ID 1447437
The fiscal note for this Bill was prepared pursuant to Joint Rule 17 and the Iowa Code. Data used in developing this
fiscal note is available from the Fiscal Services Division of the Legislative Services Agency upon request.
www.legis.iowa.gov
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