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Section 1. NEW SECTION. 514C.22 COVERAGE FOR PROSTHETIC |
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DEVICES. |
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1. Notwithstanding the uniformity of treatment |
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requirements of section 514C.6, a policy or contract providing |
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for third=party payment or prepayment of health or medical |
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expenses shall provide coverage benefits for prosthetic |
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devices when prescribed by a physician licensed under chapter |
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148, 150, or 150A. Such coverage benefits for prosthetic |
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devices shall provide coverage for prosthetic devices that, at |
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a minimum, equals the coverage and payment for prosthetic |
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devices provided under federal laws for health insurance for |
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the aged and disabled pursuant to 42 U.S.C. } 1395k, 13951, |
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and 1395m, and 42 C.F.R. } 414.202, 414.210, 414.228, and |
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410.100. |
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2. a. This section applies to the following classes of |
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third=party payment provider contracts or policies delivered, |
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issued for delivery, continued, or renewed in this state on or |
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after July 1, 2005: |
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(1) Individual or group accident and sickness insurance |
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providing coverage on an expense=incurred basis. |
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(2) An individual or group hospital or medical service |
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contract issued pursuant to chapter 509, 514, or 514A. |
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(3) An individual or group health maintenance organization |
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contract regulated under chapter 514B. |
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(4) A plan established pursuant to chapter 509A for public |
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employees. |
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(5) An organized delivery system licensed by the director |
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of public health. |
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b. This section shall not apply to accident only, |
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specified disease, short=term hospital or medical, hospital |
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confinement indemnity, credit, dental, vision, Medicare |
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supplement, long=term care, basic hospital and medical= |
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surgical expense coverage as defined by the commissioner, |
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disability income insurance coverage, coverage issued as a |
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supplement to liability insurance, workers' compensation or |
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similar insurance, or automobile medical payment insurance. |
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EXPLANATION |
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This bill provides that despite the uniformity of treatment |
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requirements of Code section 514C.6, an individual or group |
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policy or contract providing for third=party payments of |
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health or medical expenses is required to provide coverage |
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benefits for prosthetic devices that provide, at a minimum, |
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coverage for prosthetic devices equal to the coverage that is |
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provided for under federal laws for the aged and disabled. |
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The bill applies to such contracts or policies delivered, |
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issued for delivery, continued, or renewed in this state on or |
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after July 1, 2005. |
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LSB 3195SC 81 |
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av:rj/gg/14 |
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