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Senate
File
188
-
Introduced
SENATE
FILE
188
BY
PETERSEN
,
DONAHUE
,
BISIGNANO
,
TRONE
GARRIOTT
,
TOWNSEND
,
STAED
,
QUIRMBACH
,
WINCKLER
,
WEINER
,
DOTZLER
,
BLAKE
,
and
BENNETT
A
BILL
FOR
An
Act
relating
to
health
insurance
coverage
for
contraceptive
1
devices,
drugs,
and
services.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
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Section
1.
NEW
SECTION
.
514C.19A
Contraceptive
drugs,
1
devices,
and
services.
2
1.
As
used
in
this
section,
unless
the
context
otherwise
3
requires:
4
a.
“Contraceptive
device”
means
any
device
or
non-drug
5
product
that
has
been
approved
as
a
contraceptive
by
the
United
6
States
food
and
drug
administration.
7
b.
“Contraceptive
drug”
means
any
drug
approved
8
as
a
contraceptive
by
the
United
States
food
and
drug
9
administration.
10
c.
“Medical
need”
means
considerations
such
as
severity
of
11
side
effects,
difference
in
permanence
and
reversibility
of
12
a
contraceptive
drug
or
contraceptive
device,
or
an
ability
13
to
adhere
to
the
appropriate
use
of
such
drug
or
device,
as
14
determined
by
a
health
care
professional.
15
d.
“Therapeutically
equivalent
version”
means
a
drug
or
16
device
that
has
the
same
clinical
effect
and
safety
profile
17
as
another
drug
or
device
and
that
meets
the
criteria
for
18
therapeutic
equivalence
as
determined
by
the
United
States
food
19
and
drug
administration.
20
2.
Notwithstanding
the
uniformity
of
treatment
requirements
21
of
section
514C.6,
a
policy,
contract,
or
plan
providing
22
for
third-party
payment
or
prepayment
of
health
or
medical
23
expenses,
and
that
provides
coverage
for
prescription
drugs,
24
shall
not
do
any
of
the
following:
25
a.
Exclude
or
restrict
benefits
for
contraceptive
26
drugs,
contraceptive
devices,
or
generic
equivalents
27
approved
as
substitutable
by
the
United
States
food
and
drug
28
administration,
if
such
policy,
contract,
or
plan
provides
29
benefits
for
other
noncontraceptive
prescription
drugs
or
30
devices.
31
b.
Exclude
or
restrict
benefits
for
outpatient
contraceptive
32
services
which
are
provided
for
the
purpose
of
preventing
33
conception
if
such
policy,
contract,
or
plan
provides
benefits
34
for
other
outpatient
services
provided
by
a
health
care
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professional.
1
c.
Deny
to
an
individual
eligibility,
or
continued
2
eligibility,
to
enroll
in
or
to
renew
coverage
under
the
terms
3
of
the
policy,
contract,
or
plan
because
of
the
individual’s
4
use
or
potential
use
of
contraceptive
drugs,
contraceptive
5
devices,
or
outpatient
contraceptive
services.
6
d.
Provide
a
monetary
payment
or
rebate
to
a
covered
7
individual
to
encourage
such
individual
to
accept
less
than
the
8
minimum
benefits
provided
under
this
section.
9
e.
Penalize
or
otherwise
reduce
or
limit
the
reimbursement
10
to
a
health
care
professional
because
such
professional
11
prescribes
contraceptive
drugs,
contraceptive
devices,
or
12
provides
contraceptive
services.
13
f.
Provide
incentives,
monetary
or
otherwise,
to
a
health
14
care
professional
to
induce
such
professional
to
withhold
15
from
a
covered
individual
contraceptive
drugs,
contraceptive
16
devices,
or
contraceptive
services.
17
g.
Impose
upon
any
covered
individual
receiving
benefits
18
pursuant
to
this
section
any
deductible,
coinsurance,
or
19
copayment
for
benefits
for
contraceptive
drugs,
contraceptive
20
devices,
or
contraceptive
services.
21
3.
Notwithstanding
subsection
2,
paragraph
“g”
,
a
policy,
22
contract,
or
plan
that
provides
coverage
for
more
than
one
23
therapeutically
equivalent
version
of
a
contraceptive
drug
24
or
contraceptive
device
may
impose
cost-sharing
on
any
25
therapeutically
equivalent
version,
provided
that
at
least
one
26
therapeutically
equivalent
version
of
the
contraceptive
drug
27
or
contraceptive
device
is
available
without
cost-sharing.
28
However,
if
a
covered
individual’s
health
care
professional
29
recommends
a
particular
contraceptive
drug
or
contraceptive
30
device
based
on
a
determination
of
medical
need,
coverage
31
shall
be
provided
for
the
recommended
contraceptive
drug
or
32
contraceptive
device
without
cost-sharing.
33
4.
This
section
shall
not
be
construed
to
do
any
of
the
34
following:
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a.
Limit
or
otherwise
discourage
the
use
of
generic
1
equivalent
drugs
approved
by
the
United
States
food
and
drug
2
administration,
whenever
available
and
appropriate.
3
b.
Prohibit
a
third-party
payor
from
requiring
a
covered
4
individual
to
pay
a
deductible,
coinsurance,
or
copayment
5
consistent
with
this
section,
in
addition
to
the
difference
of
6
the
cost
of
a
brand-name
drug
less
the
maximum
covered
amount
7
for
a
generic
equivalent,
when
a
brand-name
drug
is
requested
8
by
a
covered
individual
and
a
suitable
generic
equivalent
is
9
available
and
appropriate.
10
c.
Require
a
third-party
payor
under
a
policy,
contract,
or
11
plan
to
provide
coverage
for
an
experimental
or
investigational
12
contraceptive
drug
or
contraceptive
device,
or
an
experimental
13
or
investigational
contraceptive
service,
except
to
the
extent
14
that
such
policy,
contract,
or
plan
provides
coverage
for
other
15
experimental
or
investigational
outpatient
prescription
drugs
16
or
devices,
or
experimental
or
investigational
outpatient
17
health
care
services.
18
5.
A
policy,
contract,
or
plan
to
which
this
section
19
applies
shall
not
impose
any
burdensome
restrictions
or
delays
20
on
the
coverage
required
by
this
section
and
shall
provide
21
clear,
written,
and
complete
information
on
its
internet
site,
22
and
by
mail
at
the
request
of
a
current
or
potential
covered
23
individual,
about
the
contraceptive
coverage
included
and
24
excluded
from
the
plans
offered
by
the
policy,
contract,
or
25
plan.
26
6.
A
policy,
contract,
or
plan
to
which
this
section
applies
27
shall
include
a
coverage
provision
that
satisfies
subsections
2
28
through
5,
and
shall
provide
that
the
policyholder
may
reject
29
the
coverage
provision
at
the
option
of
the
policyholder.
30
7.
a.
This
section
applies
to
the
following
classes
of
31
policies,
contracts,
and
plans
providing
for
third-party
32
payment
or
prepayment
of
health
or
medical
expenses,
and
that
33
provide
coverage
for
prescription
drugs,
provider
contracts,
34
policies,
or
plans
delivered,
issued
for
delivery,
continued,
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or
renewed
in
this
state
on
or
after
January
1,
2026:
1
(1)
Individual
or
group
accident
and
sickness
insurance
2
providing
coverage
on
an
expense-incurred
basis.
3
(2)
An
individual
or
group
hospital
or
medical
service
4
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
5
(3)
An
individual
or
group
health
maintenance
organization
6
contract
regulated
under
chapter
514B.
7
(4)
A
plan
established
for
public
employees
pursuant
to
8
chapter
509A.
9
b.
This
section
shall
not
apply
to
accident-only,
specified
10
disease,
short-term
hospital
or
medical,
hospital
confinement
11
indemnity,
credit,
dental,
vision,
Medicare
supplement,
12
long-term
care,
basic
hospital
and
medical-surgical
expense
13
coverage
as
defined
by
the
commissioner
of
insurance,
14
disability
income
insurance
coverage,
coverage
issued
as
a
15
supplement
to
liability
insurance,
workers’
compensation
or
16
similar
insurance,
or
automobile
medical
payment
insurance.
17
Sec.
2.
REPEAL.
Section
514C.19,
Code
2025,
is
repealed.
18
EXPLANATION
19
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
20
the
explanation’s
substance
by
the
members
of
the
general
assembly.
21
This
bill
relates
to
health
insurance
coverage
for
22
contraceptive
devices,
drugs,
and
services.
23
The
bill
prohibits
a
policy,
contract,
or
plan
providing
for
24
third-party
payment
or
prepayment
of
health
or
medical
expenses
25
(policy),
and
that
provides
coverage
for
prescription
drugs,
26
from
excluding
or
restricting
benefits
for
contraceptive
drugs,
27
contraceptive
devices
(contraceptives),
or
generic
equivalents,
28
if
the
policy
provides
benefits
for
other
prescription
drugs
29
or
devices.
“Contraceptive
device”
and
“contraceptive
drug”
30
are
defined
in
the
bill.
The
bill
also
prohibits
a
policy
from
31
excluding
or
restricting
benefits
for
outpatient
contraceptive
32
services
that
are
provided
for
the
purpose
of
preventing
33
conception
if
the
policy
provides
benefits
for
other
outpatient
34
services
provided
by
a
health
care
professional
(professional).
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A
policy
is
prohibited
from
denying
to
an
individual
1
eligibility,
or
continued
eligibility,
to
enroll
in
or
2
renew
coverage
under
the
terms
of
the
policy
because
of
3
the
individual’s
use
or
potential
use
of
contraceptives
4
or
outpatient
contraceptive
services;
providing
a
monetary
5
payment
or
rebate
to
a
covered
individual
to
encourage
such
6
individual
to
accept
less
than
the
minimum
benefits
provided
7
for
under
the
bill;
penalizing,
reducing,
or
limiting
the
8
reimbursement
to
a
professional
because
such
professional
9
prescribes
contraceptives
or
provides
contraceptive
services;
10
and
from
providing
incentives
to
a
professional
to
induce
11
such
professional
to
withhold
from
a
covered
individual
12
contraceptives
or
contraceptive
services.
The
bill
also
13
prohibits
a
policy
from
imposing
upon
any
covered
individual
14
any
deductible,
coinsurance,
or
copayment
for
benefits
for
15
contraceptives
or
contraceptive
services.
16
Under
the
bill,
a
policy
that
provides
coverage
for
more
17
than
one
therapeutically
equivalent
version
of
a
contraceptive
18
may
impose
cost-sharing
requirements,
provided
that
at
least
19
one
therapeutically
equivalent
version
of
the
contraceptive
20
is
available
without
cost-sharing.
If
a
covered
individual’s
21
professional
recommends
a
particular
contraceptive
based
on
a
22
determination
of
medical
need,
a
policy
shall
provide
coverage
23
for
the
recommended
contraceptive
without
cost-sharing.
24
The
bill
does
not
limit
or
otherwise
discourage
the
use
of
25
generic
equivalent
drugs
approved
by
the
United
States
food
26
and
drug
administration,
whenever
available
and
appropriate.
27
When
a
brand-name
drug
is
requested
by
a
covered
individual
and
28
a
suitable
generic
equivalent
is
available
and
appropriate,
29
the
bill
does
not
prohibit
a
third-party
payor
from
requiring
30
the
covered
individual
to
pay
a
deductible,
coinsurance,
31
or
copayment,
in
addition
to
the
difference
of
the
cost
of
32
the
brand-name
drug
less
the
maximum
covered
amount
for
a
33
generic
equivalent.
The
bill
does
not
require
a
third-party
34
payor
under
a
policy
to
provide
benefits
for
experimental
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or
investigational
contraceptives,
or
experimental
or
1
investigational
contraceptive
services,
except
to
the
extent
2
that
such
policy
provides
coverage
for
other
experimental
or
3
investigational
outpatient
prescription
drugs
or
devices,
4
or
experimental
or
investigational
outpatient
health
care
5
services.
6
A
policy
shall
not
impose
any
burdensome
restrictions
or
7
delays
on
the
coverage
required
by
the
bill
and
shall
provide
8
clear,
written,
and
complete
information
on
its
internet
site,
9
and
by
mail
upon
request,
about
the
contraceptive
coverage
10
included
and
excluded
from
the
offered
plans.
11
A
policy
shall
include
a
coverage
provision.
The
policy
12
shall
provide
that
the
policyholder
may
reject
the
coverage
13
provision
at
the
option
of
the
policyholder.
14
The
bill
applies
to
third-party
payment
provider
contracts,
15
policies,
or
plans
delivered,
issued
for
delivery,
continued,
16
or
renewed
in
this
state,
on
or
after
January
1,
2026,
by
the
17
third-party
payment
providers
enumerated
in
the
bill.
The
bill
18
specifies
the
types
of
specialized
health-related
insurance
not
19
subject
to
the
bill.
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