Iowa HF 2489: A bill for an act relating to insurance coverage for supplemental and diagnostic breast examinations.

Bill Text

Kim Reynolds
GOVERNOR
Office of the Governor Adam Gregg
LT GOVERNOR
May 1, 2024
The Honorable Paul Pate
Secretary of State of Iowa
State Capitol
Des Moines, Iowa 50319
Dear Mr. Secretary,
I hereby transmit:
House File 2489, an Act relating to insurance coverage for supplemental and diagnostic
breast examinations.
The above House File is hereby approved on this date.
Sincerely,
Governor of Iowa
cc: Secretary of the Senate
Clerk of the House
STATE CAPITOL DES MOINES, IOWA 50319 515.281.5211 FAX 515.725.3527 WWW.GOVERNOR.IOWA.GOV

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GENERAL ASSEMBLY
House File 2489
AN ACT
RELATING TO INSURANCE COVERAGE FOR SUPPLEMENTAL AND DIAGNOSTIC
BREAST EXAMINATIONS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
Section 1. NEW SECTION. 5140.4A Supplemental and diagnostic
breast examinations.
1. As used in this section, unless the context otherwise
requires:
3* ^^Breast magnetic resonance imaging" or '^breast MRl"
means an examination of a breast, following administration of
intravenous contrast, using a powerful magnetic field, radio
waves, and a computer to produce detailed pictures of the
structures within the breast.
b. "^Breast ultrasound" means a noninvasive examination of
a breast using high-frequency sound waves to produce detailed
images of the breast.
c. ^Covered person" means a policyholder, subscriber, or
other person participating in a policy, contract, or plan that
provides for third-party payment or prepayment of health or
medical expenses.

House File 2489, p. 2
d, "^Diagnostic breast examination" means a medically
necessary and appropriate examination of the breast that may
include a diagnostic mammogram, breast magnetic resonance
imaging, breast ultrasound, or other breast imaging, and that
is performed for any of the following reasons:
(1) To evaluate an abnormality seen or suspected during a
screening examination for breast cancer.
(2) To evaluate an abnormality detected by another means of
examination.
e, ^Diagnostic mammogram" means a detailed examination of a
breast abnormality using X ray.
f, "^Health care professional" means the same as defined in
section 514J,102.
g. ^^Health care services" means services for the diagnosis,
prevention, treatment, cure, or relief of a health condition,
illness, injury, or disease.
h. '^Screening mammogram" means an examination of a breast
that aids in the early detection and diagnosis of breast
abnormalities including breast cancer.
i. '"Supplemental breast examination" means a medically
necessary and appropriate examination of the breast that may
include breast magnetic resonance imaging, breast ultrasound,
contrast-enhanced mammography, or examination for dense
breast tissue as described by the breast imaging reporting
and data system of the American college of radiology, and
that is performed to screen for breast cancer when there is
no abnormality seen or suspected and based on an individual's
personal or family medical history, or additional factors that
may increase the individual's risk of breast cancer.
2. a. Notwithstanding the uniformity of treatment
requirements of section 514C.6, a policy, contract, or plan
providing for third-party payment or prepayment of health or
medical expenses shall provide coverage for supplemental breast
examinations and diagnostic breast examinations.
b. Coverage required under this section shall not be less
favorable than coverage a health carrier offers for screening
mammograms.
3. a. This section applies to the following classes of
third-party payment provider contracts, policies, or plans

House File 2489, p. 3
delivered, issued for delivery, continued, or renewed in this
state on or after January 1, 2025:
(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) A plan established for public employees pursuant to
chapter 509A.
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 of insurance,
disability income insurance coverage, coverage issued as a
supplement to liability insurance, workers' compensation or
similar insurance, or automobile medical payment insurance.
4. The commissioner of insurance may adopt rules pursuant to
chapter 17A to administer this section.
PAT GRASSLEY
Speaker of the House
AMY SIN(gAlR
President of the Senate
I hereby certify that this bill originated in the House and
is known as House File 2489, Ninetieth General Assembly.
mi/i
ApprovedlMo,y .
MEGH^ NELSON
Chief Clerk of the House
2024 m Kg
KIMN^EYNOL
Governor