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.
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.
