Iowa Health Insurance Policy Requirements

Iowa regulates health insurance through state law and federal ACA requirements.

Regulatory Structure

Iowa health coverage is regulated by the Insurance Division:

Free Look Period

Iowa provides a 10-day free look period for individual health insurance:

• Policyholder can return for full premium refund
• Begins when policy is delivered
• Applies to individual health policies

Healthcare.gov Marketplace

Iowa uses Healthcare.gov, the federal health insurance marketplace:

• Federal enrollment platform
• Only place to get premium subsidies in Iowa
• Open enrollment: November 1 - January 15
• Special enrollment periods for qualifying life events
• Premium tax credits available based on income
• Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)

Marketplace Features

• All plans cover essential health benefits
• No annual or lifetime limits on essential benefits
• Preventive care covered with no cost sharing
• Cost-sharing reductions available for Silver plans

ACA Compliance in Iowa

Iowa's health insurance market operates under federal Affordable Care Act (ACA) requirements:

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Pre-Existing Condition Protections

For ACA-compliant plans:

Iowa Medicaid Expansion

Iowa expanded Medicaid under the ACA:

• Available to adults with income up to 138% FPL
• Known as Iowa Health Link
• Covers comprehensive health services
• Managed care delivery system

Mental Health Parity

Iowa follows federal mental health parity requirements:

• Mental health benefits must be equal to medical benefits
• Same copays, deductibles, and limits
• Covers mental illness and substance use disorders