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IA HF5
IA HF5A bill for an act relating to insurance coverage for covered individuals for the treatment of autism spectrum disorder and including applicability provisions.(See HF 330.)
summary
Introduced
01/14/2025
01/14/2025
In Committee
01/14/2025
01/14/2025
Crossed Over
Passed
Dead
Introduced Session
91st General Assembly
Bill Summary
This bill relates to insurance coverage for covered individuals for the treatment of autism spectrum disorder (autism). Under current law, a group plan established pursuant to Code chapter 509A for employees of the state that provides for third-party payment or prepayment of health, medical, and surgical coverage benefits (coverage) shall provide coverage to covered individuals under 21 years of age for the diagnostic assessment and treatment of autism, and coverage is required in a maximum benefit amount of not more than $36,000 per year. The bill eliminates the 21-year maximum age limit and the maximum benefit amount. Under current law, a group policy, contract, or plan (policy) providing for third-party payment or prepayment of health, medical, and surgical coverage shall provide coverage for applied behavior analysis (analysis) provided by a practitioner to covered individuals under 19 years of age for the treatment of autism pursuant to a treatment plan if the policy is either a policy issued by a carrier to an employer who on at least 50 percent of the employer’s working days during the preceding calendar year employed more than 50 full-time equivalent employees, or the policy is established pursuant to Code chapter 509A for public employees other than employees of the state. Under the bill, the age restriction is eliminated. Current law requires that the coverage for analysis shall provide an annual maximum benefit of not less than $36,000 for individuals through age six, $25,000 for individuals age 7 through 13, and $12,500 for individuals age 14 through 18. The bill eliminates the maximum benefit amounts and the age categories. The bill makes conforming changes to Code section 514C.22. The bill applies to plans specified in the bill that are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026.
AI Summary
This bill expands insurance coverage for autism spectrum disorder (ASD) treatment by removing age-related restrictions and benefit limits for group health insurance plans in Iowa. Specifically, the bill eliminates the previous age limits for diagnostic assessment and treatment of ASD, which were previously restricted to individuals under 21 years old for state employee plans and under 19 years old for applied behavior analysis (ABA) coverage. The legislation removes annual maximum benefit amounts that previously ranged from $12,500 to $36,000 depending on the individual's age, effectively ensuring that insurance plans cannot impose aggregate annual or lifetime limits on ASD coverage benefits. The bill updates terminology to use "autism spectrum disorder" consistently and ensures that insurance policies cannot restrict the number of visits to ASD service providers or ABA practitioners. These changes will apply to group insurance plans delivered, issued, continued, or renewed in Iowa on or after January 1, 2026, providing more comprehensive and continuous coverage for individuals with autism across all age groups. The modifications aim to improve access to necessary medical treatments and support services for people with autism by removing financial and age-related barriers to care.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Withdrawn. H.J. 418. (on 02/24/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF5 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/HF5.html |
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