SF 87 requires most health insurance plans in Iowa to cover acupuncture services performed by licensed acupuncturists, starting January 1, 2026. The bill mandates that this coverage must be equally favorable as coverage for general physical illness, meaning out-of-pocket costs (like deductibles or copays) cannot be higher than for standard medical care. It applies to individual, group, and small group health insurance plans but excludes dental, vision, Medicare supplements, workers' compensation, and other specialized coverage. This law directly affects health insurance providers and policyholders by expanding covered services without increasing patient costs relative to conventional medical treatments.
This bill requires most health insurance plans in Iowa to cover infertility diagnosis, treatment, and fertility preservation services starting July 1, 2025. It mandates coverage for up to three egg retrieval cycles with unlimited embryo transfers (using single embryo transfer when medically appropriate), and ensures fertility medications are covered at the same level as other prescription drugs. Plans must apply the same deductibles, copays, and benefit limits for infertility care as for other medical services. Religious employers may opt out of this requirement with written notice to employees. The law applies to standard health insurance plans but excludes dental, vision, short-term, and certain other specialized coverage types.
HF 4 requires healthcare providers to submit claims for reimbursement to a patient's primary health insurance plan first, before submitting to any secondary plans. It also mandates that primary health plans must provide a copy of the "explanation of benefits" (EOB) to the patient, their representative, or a secondary plan within 30 days of a request. The bill directly affects patients, healthcare providers, and health insurance companies by standardizing claim submission order and improving access to EOB documentation. These provisions aim to streamline billing processes and reduce administrative delays for covered individuals. The bill is procedural, focusing on claim handling rules rather than altering health coverage benefits.
SF 71 creates an annual 30-day open enrollment period for Iowa Medicare supplement policies, starting January 1, 2026, beginning on the applicant's birthday. It directly affects Iowans aged 65+ seeking individual policies, or those under 65 who qualify for Medicare due to disability, end-stage renal disease, or environmental hazard exposure. During this period, insurers cannot deny coverage, charge more based on health status, or exclude preexisting conditions. Applicants may switch to policies with the same or fewer benefits than their current coverage. The bill requires insurers to provide clear notice of this enrollment period to applicants.
SF 188 requires most health insurance plans in Iowa to cover contraceptive drugs, devices, and services without cost-sharing (like copays or deductibles), provided the plan covers other prescription drugs or services. It prohibits insurers from denying coverage, reducing benefits, or penalizing providers for offering contraceptive care, and defines "medical need" to allow doctors to recommend specific contraceptives without extra costs. The law applies to individual and group health plans (including those for public employees) issued or renewed on or after January 1, 2026, but excludes dental, vision, and short-term insurance. Insurers must clearly disclose contraceptive coverage details on their websites and via mail upon request.
HF 217 prevents health insurance companies and utilization review organizations in Iowa from requiring prior approval for cancer treatments recommended by a patient's doctor using National Comprehensive Cancer Network (NCCN) protocols. This directly affects cancer patients and their healthcare providers by removing a common administrative barrier to timely care. The bill’s key provision mandates that insurers must cover these NCCN-recommended treatments without prior authorization. It changes the policy by requiring insurers to follow established clinical guidelines for cancer care, rather than imposing separate approval steps.
This Iowa bill (SSB 1060) prohibits health insurance plans from charging patients out-of-pocket costs (like copays or deductibles) for required supplemental and diagnostic breast examinations. It directly affects Iowa residents with health insurance who need these specific follow-up or diagnostic breast exams. The bill defines "cost-sharing" broadly and requires insurers to cover these exams without additional patient payments, with a limited exception for high-deductible health plans (HDHPs): the no-cost rule applies only after the patient meets their annual deductible, except for preventive care. The law takes effect for new or renewed insurance policies in Iowa starting January 1, 2026.
HF 355 establishes a program using Iowa's state income tax form to help uninsured residents find health coverage. Starting in 2025, taxpayers filing returns will see new questions about health coverage for themselves, spouses, dependents, and other household members, along with checkboxes to authorize sharing that information with health agencies. If a taxpayer indicates they lack coverage and authorizes sharing, the tax department forwards their details to the health insurance marketplace and health department to assess eligibility for Medicaid or other programs. This voluntary process aims to simplify enrollment in existing coverage options without penalties for non-participation, directly affecting Iowa residents filing state taxes who may qualify for health benefits.
SF 209 requires most health insurance plans in Iowa to cap out-of-pocket costs for prescription insulin at $25 per prescription (for up to a 31-day supply). It directly affects people with diabetes who have insurance covering insulin, limiting their cost-sharing for four types: rapid-acting, short-acting, intermediate-acting, and long-acting insulin. The bill sets this $25 maximum for plans issued or renewed after January 1, 2026, while excluding certain insurance types like Medicare supplements. Insurers may lower costs below $25 but cannot exceed this cap for covered insulin drugs.
HF 405 requires most health insurance plans in Iowa to cap out-of-pocket costs for prescription insulin at $25 per prescription for up to a 31-day supply. It directly affects people with diabetes who use insulin and are covered under health insurance plans that provide prescription drug coverage. The bill sets this $25 limit for four types of insulin (rapid-acting, short-acting, intermediate-acting, and long-acting) and applies to plans issued or renewed on or after January 1, 2026. It excludes certain insurance types like Medicare supplements, workers’ compensation, and dental/vision plans. The Iowa Insurance Commissioner will implement rules to enforce this requirement.
