House File 467 - Reprinted
HOUSE FILE 467
BY COMMITTEE ON HEALTH AND
HUMAN SERVICES
(SUCCESSOR TO HF 226)
(As Amended and Passed by the House March 21, 2023)
A BILL FOR
1 An Act relating to primary health benefit plans, claims for
2 reimbursement, and explanation of benefits.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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1 Section 1. NEW SECTION. 147.164 Health benefit plans ——
2 claims.
3 1. As used in this section, unless the context otherwise
4 requires:
5 a. “Covered person” means the same as defined in section
6 514J.102.
7 b. “Health benefit plan” means a policy, contract,
8 certificate, or agreement offered or issued by a health carrier
9 to provide, deliver, arrange for, pay for, or reimburse any of
10 the costs of health care services.
11 c. “Health care professional” means a physician or other
12 health care practitioner licensed, accredited, registered, or
13 certified to perform specified health care services consistent
14 with state law.
15 d. “Health care services” means the same as defined in
16 section 514J.102.
17 e. “Personal representative” means the same as described in
18 45 C.F.R. §164.502(g).
19 2. A health care professional who provides health
20 care services to a covered person shall submit a claim for
21 reimbursement to the primary health benefit plan designated
22 by the covered person or the covered person’s personal
23 representative prior to submitting a claim for reimbursement to
24 any other health benefit plan designated by the covered person
25 or the covered person’s personal representative.
26 Sec. 2. NEW SECTION. 514A.16 Explanation of benefits ——
27 secondary health benefit plans.
28 1. As used in this section, unless the context otherwise
29 requires:
30 a. “Covered person” means the same as defined in section
31 514J.102.
32 b. “Explanation of benefits” means a statement provided to a
33 covered person by the covered person’s health benefit plan that
34 explains the costs that the health benefit plan will cover for
35 the health care services received by the covered person.
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1 c. “Health benefit plan” means a policy, contract,
2 certificate, or agreement offered or issued by a health carrier
3 to provide, deliver, arrange for, pay for, or reimburse any of
4 the costs of health care services.
5 d. “Health care services” means the same as defined in
6 section 514J.102.
7 e. “Personal representative” means the same as described in
8 45 C.F.R. §164.502(g).
9 2. If a covered person, a covered person’s personal
10 representative, or a covered person’s secondary health benefit
11 plan request a copy of an explanation of benefits from a
12 covered person’s primary health benefit plan, the primary
13 health benefit plan shall provide a copy of the explanation of
14 benefits no later than thirty calendar days from the date of
15 the request.
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