This bill, titled "The Patient's Right to Save Act," requires health care providers to disclose discounted cash prices for specific services. It mandates that providers post these prices online, update them within 10 days of changes, and inform patients (both insured and uninsured) about the option to pay the discounted rate before services. If the discounted price is below the average amount insurers pay network providers, providers must also notify patients they may qualify for a deductible credit. The law directly affects health care providers and patients seeking cost transparency, aiming to simplify price comparison without altering insurance coverage rules.
SF 242 requires Iowa health insurance companies to cover diagnosis and treatment for pediatric acute-onset neuropsychiatric syndrome (PANS), PANDAS (a strep-related subset of PANS), and postinfectious autoimmune encephalopathy as medically necessary. It mandates coverage for treatments like antibiotics, behavioral therapy, and immunotherapies without denying or delaying care based on prior treatment for these conditions or unrelated health issues. The law applies to most individual, group, and small group health insurance plans issued in Iowa on or after January 1, 2026, but excludes accident-only, dental, vision, and other specified coverage types. Insurance companies may still request treatment notes from healthcare providers to verify medical necessity.
HF 443 requires health insurance plans in Iowa to cover assertive community treatment services for dependents who receive care from providers enrolled in the state's medical assistance program (chapter 249A). This applies to most individual and group health insurance plans, including hospital and medical service contracts, effective January 1, 2026. The bill does not cover specialized insurance like dental, vision, workers' compensation, or short-term medical plans. It mandates coverage for these specific mental health services to ensure dependents have access to community-based treatment through state-qualified providers. The Iowa Insurance Commissioner may create rules to implement this requirement.
This bill (HF 5) requires health insurance plans in Iowa to cover autism spectrum disorder treatment without age limits or annual benefit caps. It eliminates the previous $36,000 yearly maximum for state employee plans (previously limited to those under 21) and removes the 19-year age restriction for applied behavior analysis coverage. Key provisions mandate minimum coverage of 30 inpatient days and 52 annual outpatient visits, prohibit lifetime limits on autism treatment, and require coverage coordination with other autism-related benefits. The bill applies to group health plans delivered or renewed in Iowa on or after January 1, 2026.
SF 417 requires both Medicaid and most private health insurance plans to cover annual low-dose CT lung cancer screenings for at-risk individuals aged 50 or older. It defines "at-risk" as people with a history of regular smoking or secondhand smoke exposure, a family member diagnosed with lung cancer, or occupational exposure to certain carcinogens like asbestos or radon. The bill mandates that insurers cannot impose copays, deductibles, or other out-of-pocket costs for these screenings and requires Medicaid to provide coverage once a federal waiver is approved. This applies to most health insurance plans but excludes specialized coverages like accident-only or dental insurance.
HF 606 requires health insurance plans (including individual/group accident/sickness, hospital/medical, HMOs, and public employee plans) to provide a special enrollment period for pregnant women. This allows pregnant women to enroll in coverage at any time after a healthcare professional certifies their pregnancy, without fees or penalties. Coverage becomes effective the first day of the month when pregnancy is certified (or the next month if chosen by the woman). The bill applies to most health insurance policies delivered or renewed on or after January 1, 2026, but excludes accident-only, Medicare supplement, dental, vision, and similar coverage types.
HF 500 requires health insurance companies in Iowa to cover maintenance and repairs for complex rehabilitation technology wheelchairs (CRT wheelchairs) starting January 1, 2026. It directly affects patients using CRT wheelchairs (individually configured for medical needs), qualified wheelchair suppliers, and health insurance carriers. The bill mandates that qualified suppliers provide service/repairs and annual preventative maintenance without requiring prior authorization or documentation of ongoing medical necessity from insurers. Suppliers must be accredited, employ certified professionals, and maintain service records that insurers cannot audit. This applies to all health insurance plans covering these devices, ensuring ongoing access to critical mobility support.
HF 658 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 applies to all covered insulin types (rapid-acting, short-acting, intermediate-acting, and long-acting) and affects people with diabetes who have insulin-covered plans. The cap takes effect for new or renewed policies starting January 1, 2026, but excludes specialized coverage like Medicare supplements, dental, or workers’ compensation plans. Plans may offer lower costs than $25 but cannot exceed this limit. This directly reduces financial burdens for Iowans managing diabetes through their insurance.
HF 735 requires health insurers and pharmacy benefits managers in Iowa to include all payments made by a plan participant (or others on their behalf) when calculating their total out-of-pocket cost-sharing under health plans. It specifically protects Health Savings Account (HSA) eligibility by delaying HSA contribution calculations until after a participant meets the federal minimum deductible, except for preventive care services. The bill applies to most health benefit plans issued or renewed in Iowa on or after January 1, 2026, but excludes accident-only, Medicare supplement, dental, vision, and other specialized coverage. It directs Iowa’s insurance commissioner to create implementing rules under Chapter 17A.
HF 636 requires dental insurance carriers in Iowa to cover dental services approved through prior authorization, mandating they reimburse providers at the contracted rate for these services. It directly affects dental care providers, insurance carriers, and patients enrolled in dental plans. The bill prohibits carriers from denying claims for pre-approved services except under specific exceptions, such as when benefit limits were exceeded after authorization or documentation fails to support the service. Contracts attempting to waive these requirements are declared void, and the insurance commissioner may create implementing rules.
