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House
File
735
-
Introduced
HOUSE
FILE
735
BY
MOORE
A
BILL
FOR
An
Act
relating
to
health
carriers,
pharmacy
benefits
managers,
1
and
the
calculation
of
cost-sharing
contributions
by
covered
2
persons.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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735
Section
1.
NEW
SECTION
.
514F.10
Cost-sharing
contribution
1
——
calculation.
2
1.
For
purposes
of
this
section,
unless
the
context
3
otherwise
requires:
4
a.
“Cost-sharing”
means
any
coverage
limit,
copayment,
5
coinsurance,
deductible,
or
other
out-of-pocket
cost
obligation
6
imposed
by
a
health
benefit
plan
on
a
covered
person.
7
b.
“Covered
person”
means
a
policyholder,
subscriber,
8
enrollee,
or
other
individual
participating
in
a
health
benefit
9
plan.
10
c.
“Health
benefit
plan”
means
the
same
as
defined
in
11
section
510B.1.
12
d.
“Health
carrier”
means
the
same
as
defined
in
section
13
514J.102.
14
e.
“Pharmacy
benefits
manager”
means
the
same
as
defined
in
15
section
510B.1.
16
2.
a.
Notwithstanding
the
uniformity
of
treatment
17
requirements
of
section
514C.6,
for
purposes
of
calculating
18
a
covered
person’s
overall
contribution
to
any
cost-sharing
19
requirement
under
a
health
benefit
plan,
a
health
carrier
or
20
a
pharmacy
benefits
manager
shall
include
any
amount
paid
by
21
the
covered
person
or
paid
by
any
other
person
on
behalf
of
the
22
covered
person.
23
b.
If
the
contribution
calculation
under
paragraph
“a”
will
24
result
in
the
ineligibility
of
a
health
savings
account
under
25
section
223
of
the
Internal
Revenue
Code,
the
contribution
26
calculation
for
the
health
savings
account
shall
apply
only
27
after
the
covered
person
has
satisfied
the
minimum
deductible
28
under
section
233
of
the
Internal
Revenue
Code,
except
that
for
29
items
or
services
that
are
preventive
care
pursuant
to
section
30
223(c)(2)(C)
of
the
Internal
Revenue
Code,
the
contribution
31
calculation
under
paragraph
“a”
shall
apply
regardless
of
32
whether
the
minimum
deductible
under
section
233
of
the
33
Internal
Revenue
Code
has
been
satisfied.
34
3.
a.
This
section
applies
to
the
following
classes
of
35
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H.F.
735
health
benefit
plans
delivered,
issued
for
delivery,
continued,
1
or
renewed
in
this
state
on
or
after
January
1,
2026:
2
(1)
Individual
or
group
accident
A
and
sickness
insurance
3
providing
coverage
on
an
expense-incurred
basis.
4
(2)
An
individual
or
group
hospital
or
medical
service
5
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
6
(3)
An
individual
or
group
health
maintenance
organization
7
contract
regulated
under
chapter
514B.
8
(4)
A
plan
established
for
public
employees
pursuant
to
9
chapter
509A.
10
b.
This
section
shall
not
apply
to
accident-only,
specified
11
disease,
short-term
hospital
or
medical,
hospital
confinement
12
indemnity,
credit,
dental,
vision,
Medicare
supplement,
13
long-term
care,
basic
hospital
and
medical-surgical
expense
14
coverage
as
defined
by
the
commissioner
of
insurance,
15
disability
income
insurance
coverage,
coverage
issued
as
a
16
supplement
to
liability
insurance,
workers’
compensation
or
17
similar
insurance,
or
automobile
medical
payment
insurance.
18
4.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
19
chapter
17A
to
administer
this
section.
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
health
carriers,
pharmacy
benefits
24
managers,
and
the
calculation
of
cost-sharing
covered
persons.
25
“Cost-sharing”
and
“health
carrier”
are
defined
in
the
bill.
26
Under
the
bill,
when
a
health
carrier
calculates
a
covered
27
person’s
overall
contribution
to
any
cost-sharing
requirement
28
under
a
health
benefit
plan,
the
health
carrier
and
pharmacy
29
benefits
manager
shall
include
any
amount
paid
by
the
covered
30
person,
or
paid
by
another
person
on
behalf
of
the
covered
31
person.
Where
the
contribution
calculation
would
result
in
the
32
ineligibility
of
a
health
savings
account
(HSA)
under
section
33
223
of
the
Internal
Revenue
Code
(IRC),
the
contribution
34
calculation
for
the
HSA
shall
apply
only
after
the
covered
35
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735
person
has
satisfied
the
minimum
deductible,
except
that
for
1
items
or
services
that
are
preventive
care
pursuant
to
section
2
223(c)(2)(C)
of
the
IRC,
the
contribution
calculation
shall
3
apply
regardless
of
whether
the
minimum
deductible
has
been
4
satisfied.
5
The
bill
applies
to
health
benefit
plans
delivered,
issued
6
for
delivery,
continued,
or
renewed
in
this
state
on
or
after
7
January
1,
2026,
as
enumerated
in
the
bill.
The
bill
specifies
8
the
types
of
specialized
health-related
insurance
not
subject
9
to
the
bill.
10
The
commissioner
of
insurance
may
adopt
rules
to
administer
11
the
bill.
12
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