Requiring insurers to respond if you lose a leg or arm

State Senator Tom Rielly of Oskaloosa gives opening and closing remarks on the floor of the Iowa Senate for House File 311an act requiring coverage for medically necessary prosthetic devices.

HF 311 requires certain health insurance policies to cover medically necessary prosthetic devices designed to replace, in whole or in part, an arm or leg. Coverage must be at least equal to that provided under the most recent federal laws for Medicare, which currently covers prosthetics with no annual or lifetime benefit cap. The prosthetic device must be prescribed by an Iowa licensed physician. The coverage is limited to the most appropriate medically-necessary model of a prosthetics device that adequately meets the medical needs of the patient, as determined by the patients treating physician. Virginia, which has a similar mandate, has determined the cost per person to be 18 to 24 cents per month.

It applies to these types of policies: individual or group accident and sickness insurance providing coverage on an expense-incurred basis; an individual or group hospital or medical service contract; an individual or group health maintenance organization contract; a plan established for public employees; and an organized delivery system licensed by the Director of Public Health. It does not apply to employer self-insured health coverage plan, because the federal Employee Retirement Income Security Act preempts state insurance regulation of such plans. It does not apply to Medicaid, Medicare, and Veterans Administration programs, which are federally regulated and currently cover these types of prosthetics without annual or lifetime caps.

The bill applies to policies, contracts or plans delivered, issued for delivery, continued or renewed in Iowa on or after July 1, 2009. The bill passed the House 64-33.

Category:

News & Politics

Tags:

• Iowa Senate
• Tom Rielly
• Health Care

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