House File 2651 - Introduced
HOUSE FILE 2651
BY BEST
A BILL FOR
1 An Act relating to certain health care plan’s cost-sharing for
2 essential health benefits.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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1 Section 1. NEW SECTION. 514K.3 Health care plans ——
2 cost-sharing for essential health benefits.
3 For purposes of calculating an enrollee’s contribution to
4 the annual limitation on cost-sharing under 42 U.S.C. §18022(c)
5 and 42 U.S.C. §300gg-6(b), a health care plan, or the health
6 care plan’s subcontractors, that provides small group health
7 coverage pursuant to chapter 513B, individual health coverage
8 pursuant to chapter 513C, or group health insurance coverage
9 pursuant to chapter 509, shall include expenditures for any
10 item or service covered under the health care plan if the
11 item or service is included within a category of essential
12 health benefits, as described in 42 U.S.C. §18022(b)(1), and
13 regardless of whether the health care plan, or the health
14 care plan’s subcontractors, classifies the item or service as
15 an essential health benefit. For purposes of this section,
16 “cost-sharing” means any coverage limit, copayment, coinsurance,
17 deductible, or other out-of-pocket cost obligation imposed by a
18 health care plan, or the health care plan’s subcontractors, on
19 an enrollee.
20 EXPLANATION
21 The inclusion of this explanation does not constitute agreement with
22 the explanation’s substance by the members of the general assembly.
23 This bill relates to certain health care plan’s cost-sharing
24 for essential health benefits. Under the bill, when
25 calculating an enrollee’s contribution to the annual limitation
26 on cost-sharing under federal law, a health care plan, or its
27 subcontractors, that provides small group health coverage,
28 individual health coverage, or group health insurance coverage
29 shall include expenditures for any item or service covered
30 under the health care plan if the item or service is included
31 within a category of essential health benefits regardless
32 of whether the health care plan, or its subcontractors,
33 classifies the item or service as an essential health benefit.
34 “Cost-sharing” is defined in the bill as any coverage limit,
35 copayment, coinsurance, deductible, or other out-of-pocket cost
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 H.F. 2651
1 obligation imposed by a health care plan, or the health care
2 plan’s subcontractors, on an enrollee.
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