Read the full stored bill text
House
File
4
-
Introduced
HOUSE
FILE
4
BY
BODEN
A
BILL
FOR
An
Act
relating
to
health
benefit
plans,
claims
for
1
reimbursement,
and
explanation
of
benefits.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
1536YH
(2)
91
nls/ko
H.F.
4
Section
1.
NEW
SECTION
.
147.165
Health
benefit
plans
——
1
claims.
2
1.
As
used
in
this
section,
unless
the
context
otherwise
3
requires:
4
a.
“Covered
person”
means
the
same
as
defined
in
section
5
514J.102.
6
b.
“Health
benefit
plan”
means
a
policy,
contract,
7
certificate,
or
agreement
offered
or
issued
by
a
health
carrier
8
to
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
9
the
costs
of
health
care
services.
10
c.
“Health
care
professional”
means
a
physician
or
other
11
health
care
practitioner
licensed,
accredited,
registered,
or
12
certified
to
perform
specified
health
care
services
consistent
13
with
state
law.
14
d.
“Health
care
services”
means
the
same
as
defined
in
15
section
514J.102.
16
e.
“Personal
representative”
means
the
same
as
described
in
17
45
C.F.R.
§164.502(g).
18
2.
A
health
care
professional
who
provides
health
19
care
services
to
a
covered
person
shall
submit
a
claim
for
20
reimbursement
to
the
primary
health
benefit
plan
designated
21
by
the
covered
person
or
the
covered
person’s
personal
22
representative
prior
to
submitting
a
claim
for
reimbursement
to
23
any
other
health
benefit
plan
designated
by
the
covered
person
24
or
the
covered
person’s
personal
representative.
25
Sec.
2.
NEW
SECTION
.
514A.16
Explanation
of
benefits
——
26
secondary
health
benefit
plans.
27
1.
As
used
in
this
section,
unless
the
context
otherwise
28
requires:
29
a.
“Covered
person”
means
the
same
as
defined
in
section
30
514J.102.
31
b.
“Explanation
of
benefits”
means
a
statement
provided
to
a
32
covered
person
by
the
covered
person’s
health
benefit
plan
that
33
explains
the
costs
that
the
health
benefit
plan
will
cover
for
34
the
health
care
services
received
by
the
covered
person.
35
-1-
LSB
1536YH
(2)
91
nls/ko
1/
2
H.F.
4
c.
“Health
benefit
plan”
means
a
policy,
contract,
1
certificate,
or
agreement
offered
or
issued
by
a
health
carrier
2
to
provide,
deliver,
arrange
for,
pay
for,
or
reimburse
any
of
3
the
costs
of
health
care
services.
4
d.
“Health
care
services”
means
the
same
as
defined
in
5
section
514J.102.
6
e.
“Personal
representative”
means
the
same
as
described
in
7
45
C.F.R.
§164.502(g).
8
2.
If
a
covered
person,
a
covered
person’s
personal
9
representative,
or
a
covered
person’s
secondary
health
benefit
10
plan
request
a
copy
of
an
explanation
of
benefits
from
a
11
covered
person’s
primary
health
benefit
plan,
the
primary
12
health
benefit
plan
shall
provide
a
copy
of
the
explanation
of
13
benefits
no
later
than
thirty
calendar
days
from
the
date
of
14
the
request.
15
EXPLANATION
16
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
17
the
explanation’s
substance
by
the
members
of
the
general
assembly.
18
This
bill
relates
to
health
benefit
plans,
claims
for
19
reimbursement,
and
explanation
of
benefits
(EOB).
20
Under
the
bill,
a
health
care
professional
who
provides
21
health
care
services
to
a
covered
person
(person)
shall
22
submit
a
claim
for
reimbursement
(claim)
to
the
primary
23
health
benefit
plan
(plan)
designated
by
the
person
or
their
24
personal
representative
(representative)
prior
to
submitting
25
a
claim
to
any
other
plan
designated
by
the
person
or
their
26
representative.
If
the
person,
person’s
representative,
or
27
person’s
secondary
plan
requests
a
copy
of
an
EOB
from
a
28
person’s
primary
plan,
the
primary
plan
shall
provide
a
copy
29
of
the
EOB
no
later
than
30
calendar
days
from
the
date
of
the
30
request.
31
-2-
LSB
1536YH
(2)
91
nls/ko
2/
2