§ 514c-27

514C.27 Mental illness and substance use disorder treatment coverage for veterans. 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 medicalexpenses issued by a carrier, as defined in section 513B.2, shall provide coverage benefitsto an insured who is a veteran for treatment of mental illness and substance use disorderif either of the following is satisfied: a. The policy or contract is issued to an employer who on at least fifty percent of the employer’s working days during the preceding calendar year employed more than fiftyfull-time equivalent employees. In determining the number of full-time equivalent employeesof an employer, employers who are affiliated or who are able to file a consolidated tax returnfor purposes of state taxation shall be considered one employer. b. The policy or contract is issued to a small employer as defined in section 513B.2, and such policy or contract provides coverage benefits for the treatment of mental illness andsubstance use disorder. 2.

policy or contract is issued to a small employer as defined in section 513B.2, and such policy or contract provides coverage benefits for the treatment of mental illness andsubstance use disorder. 2. Notwithstanding the uniformity of treatment requirements of section 514C.6, a plan established pursuant to chapter 509A for public employees shall provide coverage benefitsto an insured who is a veteran for treatment of mental illness and substance use disorder asdefined in subsection 3. 3. For purposes of this section:a. 'Mental illness' means mental disorders as defined by the commissioner by rule.b. 'Substance use disorder' means a pattern of pathological use of alcohol or a drug that causes impairment in social or occupational functioning, or that produces physiologicaldependency evidenced by physical tolerance or by physical symptoms when the alcohol ordrug is withdrawn. c. 'Veteran' means the same as defined in section 35.1.4. The commissioner, by rule, shall define 'mental illness' consistent with definitions provided in the most recent edition of the American psychiatric association’s diagnostic andstatistical manual of mental disorders, as the definitions may be amended from

consistent with definitions provided in the most recent edition of the American psychiatric association’s diagnostic andstatistical manual of mental disorders, as the definitions may be amended from time to time.The commissioner may adopt the definitions provided in such manual by reference. 5. 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, or individual accident and sickness policies issued to individuals or toindividual members of a member association. 6. A carrier or plan established pursuant to chapter 509A may manage the benefits provided through common methods, including but not limited to providing payment ofbenefits or providing care and treatment under a capitated payment system, prospectivereimbursement rate system, utilization control system, incentive system for the use

imited to providing payment ofbenefits or providing care and treatment under a capitated payment system, prospectivereimbursement rate system, utilization control system, incentive system for the use of leastrestrictive and least costly levels of care, a preferred provider contract limiting choice ofspecific providers, or any other system, method, or organization designed to assure servicesare medically necessary and clinically appropriate. 7. a. A group policy or contract or plan covered under this section shall not impose an aggregate annual or lifetime limit on mental illness or substance use disorder coveragebenefits unless the policy or contract or plan imposes an aggregate annual or lifetime limiton substantially all medical and surgical coverage benefits. b. A group policy or contract or plan covered under this section that imposes an aggregate annual or lifetime limit on substantially all medical and surgical coverage benefitsshall not impose an aggregate annual or lifetime limit on mental illness or substance usedisorder coverage benefits which is less than the aggregate annual or lifetime limit imposedon substantially all medical and surgical coverage benefits. 8.

ime limit on mental illness or substance usedisorder coverage benefits which is less than the aggregate annual or lifetime limit imposedon substantially all medical and surgical coverage benefits. 8. A group policy or contract or plan covered under this section shall at a minimum allow for thirty inpatient days and fifty-two outpatient visits annually. The policy or contractor plan may also include deductibles, coinsurance, or copayments, provided the amounts Sat Dec 23 00:45:13 2023 Iowa Code 2024, Section 514C.27 (28, 1) §514C.27, SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES 2 and extent of such deductibles, coinsurance, or copayments applicable to other medicalor surgical services coverage under the policy or contract or plan are the same. It is nota violation of this section if the policy or contract or plan excludes entirely from coveragebenefits for the cost of providing the following: a. Care that is substantially custodial in nature.b. Services and supplies that are not medically necessary or clinically appropriate.c. Experimental treatments.9. This section applies to third-party payment provider policies or contracts and plans established pursuant to chapter 509A

t medically necessary or clinically appropriate.c. Experimental treatments.9. This section applies to third-party payment provider policies or contracts and plans established pursuant to chapter 509A delivered, issued for delivery, continued, or renewed inthis state on or after January 1, 2011. 2010 Acts, ch 1121, §15; 2014 Acts, ch 1026, §143; 2016 Acts, ch 1011, §95; 2017 Acts, ch 148, §79, 80; 2023 Acts, ch 19, §1201 Section amended Sat Dec 23 00:45:13 2023 Iowa Code 2024, Section 514C.27 (28, 1)