Legal Question in Health Care Law in Iowa

I don't believe it is up to the employer unless they are self insured. That's a decision the insurance company gets to make. On the other hand, Iowa is a so called right to work state, and unless there is a contract of employment that guarantees you certain things, the employer can do pretty much anything they want. On the other hand, if the preexisting condition happens to be a disability, you might have some recourse there under the ADA.