This bill establishes new requirements for insurance coverage related to emergency services and reimbursements for out-of-network providers in Iowa. It mandates that health benefit plans must cover services provided by out-of-network providers in emergency situations or when services are rendered at a participating facility where the covered person could not access a participating provider. The bill defines key terms such as "emergency services," "out-of-network provider," and "complicating factor," which refers to additional elements that may justify higher reimbursement amounts.

Out-of-network providers are required to submit claims to health carriers within 60 days of providing services, and carriers must reimburse them within 60 days at a rate that is either the median amount paid to a participating provider or 150% of the federal Medicare fee schedule, excluding cost sharing. If a complicating factor is involved, providers can request additional reimbursement, which carriers must respond to within 30 days. If denied, providers can seek binding arbitration through the commissioner of insurance. The bill applies to various health insurance contracts effective January 1, 2027, while excluding certain types of insurance from its coverage requirements. The commissioner is also authorized to adopt rules for the administration of this section.