Iowa Health Programs and Continuation

Iowa Special Programs

Healthy and Well Kids in Iowa (HAWK-I) (Iowa Code Chapter 514I)

HAWK-I is Iowa’s State Children’s Health Insurance Program (SCHIP) implementation, codified at Iowa Code Chapter 514I. HAWK-I provides health coverage for uninsured children in families with incomes too high for Medicaid but too low to afford private coverage:

• Eligibility (Iowa Code 514I.2). Generally children under 19 in families with income up to a defined percentage of the federal poverty level.
• Covered services (Iowa Code 514I.3). Comprehensive child-focused benefits including doctor visits, hospitalization, prescription drugs, vision and dental care, and mental health services.
• Enrollment (Iowa Code 514I.6, .8, .9). Continuous open enrollment; no waiting period for most enrollees.
• Funding. Joint state-federal funding through the federal SCHIP program.

HIPIOWA (Iowa Code Chapter 514E)

HIPIOWA is Iowa’s Health Insurance Plan of Iowa — Iowa’s high-risk health insurance pool, codified at Iowa Code Chapter 514E. HIPIOWA was created to provide coverage for individuals who could not obtain coverage in the voluntary market due to health conditions. Since the ACA’s prohibition on preexisting condition exclusions and guaranteed-issue rules took effect in 2014, HIPIOWA’s role has narrowed but the statutory framework remains in the Iowa Code and is tested on the outline:

• Eligibility. Iowa residents unable to obtain coverage through the voluntary market or other defined criteria.
• Coverage. Comprehensive major medical coverage.
• Funding. Member assessments on Iowa health insurers, plus premiums from enrollees.

The Affordable Care Act in Iowa

Iowa relies on the federal Health Insurance Marketplace (healthcare.gov) rather than operating its own state-based exchange. The federal exchange structure means Iowa residents who buy individual coverage outside of an employer go through healthcare.gov; premium tax credits and cost-sharing reductions are administered federally; and essential health benefits apply to non-grandfathered individual and small-group plans.

• Marketplace (ACA Section 1321). Federally facilitated in Iowa.
• Premium tax credits and subsidies (ACA Section 1401, 1402). Administered through the federal marketplace.
• Essential health benefits (ACA Section 1302). Mental health and substance use disorder services, pediatric services (including dental and vision for children), preventive services without cost sharing for in-network preventive care, among others.
• Employer notification (ACA Section 1511 through 1515). Employers must give employees a notice of coverage options through the federal marketplace.

The No Surprises Act (Title I of Division BB of the Consolidated Appropriations Act, 2021; Title XXVII Part E of the PHS Act)

The federal No Surprises Act (effective January 1, 2022) protects consumers from surprise medical bills in defined situations:

• Emergency services. Out-of-network emergency services must be covered at in-network cost-sharing levels; balance billing is prohibited.
• Non-emergency services at in-network facilities. When a patient receives covered services at an in-network facility from an out-of-network provider without giving informed consent, the out-of-network provider may not balance bill.
• Air ambulance services. Out-of-network air ambulance services must be covered at in-network cost-sharing levels.
• Independent Dispute Resolution (IDR). Disputes between insurers and providers over out-of-network payment amounts are resolved through a federal arbitration process.

The No Surprises Act applies to group health plans, group and individual insurance coverage, and federal and state employee benefit plans. It supplements — but does not preempt — stronger state surprise-billing protections.

Iowa State Continuation of Group Health Coverage (Iowa Code Chapter 509B)

Iowa provides state continuation rights for employees of small employers (those not subject to federal COBRA, which applies generally to employers with 20 or more employees). Iowa Code Chapter 509B sets the rules:

• Eligibility (Iowa Code 509B.2). A covered employee or member must have been continuously insured under the group policy for at least 3 months prior to termination of employment or membership.
• Excluded. Continuation is not available for individuals eligible for Medicare or who could obtain coverage under another group arrangement (Iowa Code 509B.3(2)).
• Election period (Iowa Code 509B.3(4)). The employee must request continuation in writing within 10 days following the later of (i) the date the group coverage would otherwise terminate or (ii) the date the employee receives notice of continuation rights. After proper notice, the employee may not elect continuation more than 31 days after termination.
• Premium — 100% of group rate (Iowa Code 509B.3(5)). The employee must pay the contribution required by the employer, but not more than the group rate otherwise due for the insurance being continued. Iowa does not permit an administrative fee on top of the group rate.
• Maximum duration — 9 months (Iowa Code 509B.3(6)(a)). Continuation may last up to 9 months after the date the employee’s group coverage would otherwise have terminated due to termination of employment.
• Employer notice (Iowa Code 509B.5). The employer must notify the employee of continuation rights within 10 days of termination of employment or membership.

Credit Disability Insurance (Iowa Admin Rule 191-28.1 through .17)

Credit disability insurance pays a debtor’s loan payments (or makes the payments on the debtor’s behalf) when the debtor is unable to work due to a covered disability. Iowa Admin Rule 191-28.1 through .17 sets the consumer protections — parallel to credit life:

• Definitions (Iowa Admin Rule 191-28.2; 191-28.7(1)). Creditor, debtor, credit transaction defined.
• Voluntary. Credit disability cannot be a condition of obtaining the underlying loan.
• Term and amount limits. Credit disability term cannot exceed the term of the loan; benefit amount cannot exceed the amount needed to make the loan payments.
• Free look (Iowa Admin Rule 191-28.17). Defined free-look period.
• Disclosure (Iowa Admin Rule 191-28.14). Required disclosures including premium, exclusions, and the right to decline.
• Preexisting conditions (Iowa Admin Rule 191-28.7(2); 191-28.8(2)). Limits on preexisting condition exclusions.
• Refunds (Iowa Admin Rule 191-28.9). Required refunds on early payoff.
• Prohibited transactions (Iowa Admin Rule 191-28.13). Practices that are prohibited.