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IA HF735
IA HF735A bill for an act relating to health carriers, pharmacy benefits managers, and the calculation of cost-sharing contributions by covered persons.
summary
Introduced
03/04/2025
03/04/2025
In Committee
03/04/2025
03/04/2025
Crossed Over
Passed
Dead
Introduced Session
91st General Assembly
Bill Summary
This bill relates to health carriers, pharmacy benefits managers, and the calculation of cost-sharing covered persons. “Cost-sharing” and “health carrier” are defined in the bill. Under the bill, when a health carrier calculates a covered person’s overall contribution to any cost-sharing requirement under a health benefit plan, the health carrier and pharmacy benefits manager shall include any amount paid by the covered person, or paid by another person on behalf of the covered person. Where the contribution calculation would result in the ineligibility of a health savings account (HSA) under section 223 of the Internal Revenue Code (IRC), the contribution calculation for the HSA shall apply only after the covered person has satisfied the minimum deductible, except that for items or services that are preventive care pursuant to section 223(c)(2)(C) of the IRC, the contribution calculation shall apply regardless of whether the minimum deductible has been satisfied. The bill applies to health benefit plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026, as enumerated in the bill. The bill specifies the types of specialized health-related insurance not subject to the bill. The commissioner of insurance may adopt rules to administer the bill.
AI Summary
This bill introduces new regulations for how health carriers and pharmacy benefits managers (PBMs) calculate cost-sharing contributions for individuals in health benefit plans. Specifically, the bill requires that when calculating a person's out-of-pocket costs, health carriers and PBMs must include any amounts paid by the covered person or paid on their behalf. For health savings accounts (HSAs), the contribution calculation will generally only apply after the minimum deductible is met, with an exception for preventive care services where the calculation applies regardless of deductible status. The bill applies to various types of health benefit plans, including individual and group health insurance, hospital service contracts, and health maintenance organization contracts, starting January 1, 2026. The bill excludes certain specialized insurance types like dental, vision, and workers' compensation coverage. The bill defines key terms such as "cost-sharing" (out-of-pocket expenses), "covered person" (plan participant), and "health carrier" (insurance provider), and grants the insurance commissioner authority to create rules for implementing these provisions.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced, referred to Commerce. H.J. 499. (on 03/04/2025)
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=HF735 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/HF735.html |
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