1.Notwithstanding the uniformity of treatment requirements of section 514C.6, a group
policy or contract providing for third-party payment or prepayment of health or medical
expenses shall not do either of the following:
a.Exclude or restrict benefits for prescription contraceptive drugs or prescription
contraceptive devices which prevent conception and which are approved by the United
States food and drug administration, or generic equivalents approved as substitutable by the
United States food and drug administration, if such policy or contract provides benefits for
other outpatient prescription drugs or devices.
b.Exclude or restrict benefits for outpatient contraceptive services which are provided
for the purpose of preventing conception if such policy or contract provides benefits
Free access — add to your briefcase to read the full text and ask questions with AI
1. Notwithstanding the uniformity of treatment requirements of section 514C.6, a group
policy or contract providing for third-party payment or prepayment of health or medical
expenses shall not do either of the following:
a. Exclude or restrict benefits for prescription contraceptive drugs or prescription
contraceptive devices which prevent conception and which are approved by the United
States food and drug administration, or generic equivalents approved as substitutable by the
United States food and drug administration, if such policy or contract provides benefits for
other outpatient prescription drugs or devices.
b. Exclude or restrict benefits for outpatient contraceptive services which are provided
for the purpose of preventing conception if such policy or contract provides benefits for other
outpatient services provided by a health care professional.
2. A person who provides a group policy or contract providing for third-party payment or
prepayment of health or medical expenses which is subject to subsection 1 shall not do any
of the following:
a. Denytoanindividualeligibility,orcontinuedeligibility,toenrollinortorenewcoverage
under the terms of the policy or contract because of the individual’s use or potential use
of such prescription contraceptive drugs or devices, or use or potential use of outpatient
contraceptive services.
b. Provide a monetary payment or rebate to a covered individual to encourage such
individual to accept less than the minimum benefits provided for under subsection 1.
c. Penalize or otherwise reduce or limit the reimbursement of a health care professional
because such professional prescribes contraceptive drugs or devices, or provides
contraceptive services.
d. Provide incentives, monetary or otherwise, to a health care professional to induce
§514C.19, SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES 18
such professional to withhold from a covered individual contraceptive drugs or devices, or
contraceptive services.
3. This section shall not be construed to prevent a third-party payor from including
deductibles, coinsurance, or copayments under the policy or contract, as follows:
a. A deductible, coinsurance, or copayment for benefits for prescription contraceptive
drugsshallnotbegreaterthansuchdeductible, coinsurance, orcopaymentforanyoutpatient
prescription drug for which coverage under the policy or contract is provided.
b. A deductible, coinsurance, or copayment for benefits for prescription contraceptive
devices shall not be greater than such deductible, coinsurance, or copayment for any
outpatient prescription device for which coverage under the policy or contract is provided.
c. A deductible, coinsurance, or copayment for benefits for outpatient contraceptive
services shall not be greater than such deductible, coinsurance, or copayment for any
outpatient health care services for which coverage under the policy or contract is provided.
4. This section shall not be construed to require a third-party payor under a policy or
contract to provide benefits for experimental or investigational contraceptive drugs or
devices, or experimental or investigational contraceptive services, except to the extent
that such policy or contract provides coverage for other experimental or investigational
outpatient prescription drugs or devices, or experimental or investigational outpatient health
care services.
5. This section shall not be construed to limit or otherwise discourage the use of generic
equivalent drugs approved by the United States food and drug administration, whenever
available and appropriate. This section, when a brand name drug is requested by a covered
individual and a suitable generic equivalent is available and appropriate, shall not be
construed to prohibit a third-party payor from requiring the covered individual to pay a
deductible, coinsurance, or copayment consistent with subsection 3, in addition to the
difference of the cost of the brand name drug less the maximum covered amount for a
generic equivalent.
6. A person who provides an individual policy or contract providing for third-party
payment or prepayment of health or medical expenses shall make available a coverage
provision that satisfies the requirements in subsections 1 through 5 in the same manner as
such requirements are applicable to a group policy or contract under those subsections. The
policy or contract shall provide that the individual policyholder may reject the coverage
provision at the option of the policyholder.
7. a. This section applies to the following classes of third-party payment provider
contracts or policies delivered, issued for delivery, continued, or renewed in this state on or
after July 1, 2000:
(1) Individual or group accident and sickness insurance providing coverage on an
expense-incurred basis.
(2) An individual or group hospital or medical service contract issued pursuant to chapter
509, 514, or 514A.
(3) An individual or group health maintenance organization contract regulated under
chapter 514B.
(4) Any other entity engaged in the business of insurance, risk transfer, or risk retention,
which is subject to the jurisdiction of the commissioner.
(5) A plan established pursuant to chapter 509A for public employees.
b. This section shall not apply to accident-only, specified disease, short-term hospital
or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement,
long-term care, basic hospital and medical-surgical expense coverage as defined by the
commissioner, disability income insurance coverage, coverage issued as a supplement to
liability insurance, workers’ compensation or similar insurance, or automobile medical
payment insurance.