2024 Iowa Code
Title XIII - COMMERCE
Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES
Section 514C.25 - Coverage for prosthetic devices.

514C.25 Coverage for prosthetic devices. 1. 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 ormedical expenses shall provide coverage benefits for medically necessary prosthetic deviceswhen prescribed by a physician licensed under chapter 148 or physician assistant licensedunder chapter 148C. Such coverage benefits for medically necessary prosthetic devicesshall provide coverage for medically necessary prosthetic devices that, at a minimum, equalsthe coverage and payment for medically necessary prosthetic devices provided under themost recent federal laws for health insurance for the aged and disabled pursuant to 42U.S.C. §1395k, 13951, and 1395m, and 42 C.F.R. §410.100, 414.202, 414.210, and 414.228, asapplicable. b. For the purposes of this section, “prosthetic device” means an artificial limb device to replace, in whole or in part, an arm or leg. 2. a. This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on orafter July 1, 2009: (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 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 thecommissioner, disability income insurance coverage, coverage issued as a supplement toliability insurance, workers’ compensation or similar insurance, or automobile medicalpayment insurance. 3. Notwithstanding subsection 1, paragraph “a”, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that is issued for usein connection with a health savings account as authorized under Tit. XII of the MedicarePrescription Drug, Improvement, and Modernization Act of 2003, Pub. L. No. 108-173, mayimpose the same deductibles and out-of-pocket limits on the prosthetics coverage benefitsrequired in this section that apply to substantially all health, medical, and surgical coveragebenefits under the policy, contract, or plan. 2009 Acts, ch 89, §1; 2017 Acts, ch 148, §77; 2022 Acts, ch 1066, §50 Sat Dec 23 00:45:13 2023 Iowa Code 2024, Section 514C.25 (24, 0)

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