Relating to insurance coverage for supplemental and diagnostic breast examinations

Description

House File 2489 relates to insurance coverage for supplemental and diagnostic breast examinations and does the following:

• Requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to provide coverage for diagnostic and supplemental breast examinations.
• Prohibits the coverage required by the Bill from being less favorable than coverage a health carrier offers for screening mammograms.
• Permits the Iowa Insurance Division (IID) of the Department of Insurance and Financial Services (DIFS) to adopt administrative rules.

Background

Under the current State of Iowa Plan designs, cost-sharing for preventative and screening mammograms, ultrasounds, and magnetic resonance imaging (MRIs) is cost free to the policy holder in nearly all cases, with mammograms making up the majority of the preventative imaging services covered by the Bill. The same services for diagnostic purposes apply plan-specific cost-sharing, and the shifting of these cost-shares from plan members to the plan may result in an increase in claim spend.

House File 2489 is estimated to impact approximately 25.2% of the population of Iowa (807,000). This includes individual coverage, fully insured small and large employer groups, self-insured public employees, and the State of Iowa Plan.

Of the individuals not covered by the mandate, approximately 47.9% are covered by government-sponsored health insurance, 23.0% are covered by employer coverage that is governed by the federal Employee Retirement Income Security Act of 1974 (ERISA), and the remaining 3.9% are uninsured. Additional details are presented in Figure 1. Figure 1 — Population Covered by Insurance Plans Regulated by Iowa Law

Assumptions

• The utilization of imaging may increase due to the removal of the requirement of an abnormality for further imaging.
• State of Iowa Plan costs may increase between 0.03% and 0.15%. The lower end of this range is more likely to occur.
• The costs to the Board of Regents Insurance Plans may increase minimally.

Fiscal Impact

House File 2489 is estimated to increase annual costs to the State of Iowa Insurance Plan by an amount ranging between approximately $100,000 and $500,000 beginning in FY 2025. It is anticipated that the lower end of this range is more likely to occur; however, the estimated cost cannot be determined. House File 2489 is also estimated to minimally increase annual costs to the Board of Regents Insurance Plans.

Sources

• Iowa Insurance Division, Department of Insurance and Financial Services
• Board of Regents
• Wellmark