Title XIII, COMMERCE (Ch. 505 - 554I)

1. After a health maintenance organization has been in operation twenty-four months, it shall have an annual open enrollment period of at least one month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in t…

1. A health maintenance organization shall establish and maintain a complaint system which has been approved by the commissioner and which shall provide for the resolution of written complaints initiated by enrollees concerning health care services. A health maintenance organizat…

With the exception of investments made in accordance with section 514B.6 , the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by section 511.8 for the investment of assets of life insurance companies or su…

A health maintenance organization shall furnish a surety bond in an amount satisfactory to the commissioner, or deposit with the commissioner cash or securities acceptable to the commissioner in at least the same amount, as a guarantee that its obligations to enrollees will be pe…

1. An enrollee enrolled in a prepaid individual plan shall not be canceled except for the failure to pay the charges permitted under section 514B.10 or for other reasons stated in the rules adopted by the commissioner and subject to review in accordance with chapter 17A . Except …

1. A health maintenance organization may rescind an enrollee’s membership in the health maintenance organization if the enrollee makes a material false statement or misrepresentation in the enrollee’s application for membership. A written notice of rescission shall be sent to the…

A health maintenance organization, unless licensed as an insurer, shall not use in its name, contracts, or literature any words descriptive of an insurance, casualty, or surety business or deceptively similar to the name or description of any insurance or surety corporation doing…

The commissioner may, after notice and hearing, promulgate such reasonable rules under the provisions of chapter 522B that are necessary to provide for the licensing of insurance producers who engage in solicitation or enrollment for a health maintenance organization. [C75, 77, 7…

Any person may apply to the commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter . A person shall not establish or operate a health maintenance organization in this state, nor sell, offer…

1. An insurance company authorized to engage in insuring individuals or groups for the cost of health care in this state or a corporation authorized under chapter 514 may either directly or through a subsidiary or affiliate do one or more of the following: a. Organize and operate…

Any employee of the state, political subdivision of the state, or of any institution supported in whole or in part by public funds may authorize the deduction from the employee’s salary or wages of the amount charged to the employee for any health care services provided through h…

When not otherwise provided, a foreign or domestic health maintenance organization doing business in this state shall pay the commissioner of insurance the fees as required in section 511.24 . [C75, 77, 79, 81, §514B.22 ] 2006 Acts, ch 1117, §60 Referred to in §514B.5

The commissioner shall adopt rules, pursuant to chapter 17A , as are necessary to administer this chapter . [C75, 77, 79, 81, §514B.23 ] 92 Acts, ch 1162, §27

1. The commissioner shall make an examination of the affairs of a health maintenance organization and its providers as often as the commissioner deems necessary for the protection of the interests of the people of this state, but not less frequently than once every five years. 2.…

The provisions of chapter 507C shall apply to health maintenance organizations, which shall be considered insurers for the purposes of chapter 507C . [C75, 77, 79, 81, §514B.25 ] 91 Acts, ch 26, §39 Referred to in §514B.4

The provisions of chapter 508C shall apply to health maintenance organizations. 2000 Acts, ch 1023, §26 ; 2017 Acts, ch 148, §61 ; 2019 Acts, ch 12, §34, 35, 36

1. When the commissioner has cause to believe that grounds for the denial, suspension, or revocation of a certificate of authority exist, the commissioner shall notify the health maintenance organization in writing of the particular grounds for denial, suspension, or revocation a…

The action of the commissioner under section 514B.26 is subject to judicial review in accordance with chapter 17A . [C75, 77, 79, 81, §514B.27 ] 92 Acts, ch 1162, §30

The commissioner may, in the manner provided by law, maintain an action in the name of the state for injunction or other process against the person violating any provision of this chapter . [C75, 77, 79, 81, §514B.28 ]

1. An application for a certificate of authority shall be verified by an officer or authorized representative of the health maintenance organization, shall be in a form prescribed by the commissioner, and shall set forth or be accompanied by the following: a. A copy of the basic …

1. An officer, director, trustee, partner, or employee of a health maintenance organization shall not testify as to or make other public disclosure of any communication made to a provider and deemed privileged under section 622.10 , and which communication has come into the knowl…

1. For the first five years of the existence of a health maintenance organization and the health maintenance organization’s successors and assigns, the following shall not be considered premiums received and taxable under section 432.1 : a. Payments received by the health mainten…

1. Except as otherwise provided in this chapter , laws regulating the insurance business in this state and the operations of corporations authorized under chapter 514 shall not be applicable to any health maintenance organization granted a certificate of authority under this chap…

1. A person may apply to the commissioner for and obtain a certificate of authority to establish and operate a limited service organization in compliance with this chapter . A person shall not establish or operate a limited service organization in this state, or sell, offer to se…

The articles of incorporation, and any subsequent amendments, of a corporation shall be filed with and approved by the commissioner of insurance before filing with the secretary of state. A corporation shall file bylaws and subsequent amendments to the bylaws with the commissione…

A certificate of authority of a health maintenance organization formed under this chapter expires on June 1 succeeding its issue and shall be renewed annually so long as the organization transacts its business in accordance with all legal requirements. A health maintenance organi…

1. The commissioner shall determine whether the applicant for a certificate of authority, with respect to health care services to be furnished: a. Has demonstrated the willingness and potential ability to assure the availability, accessibility, and continuity of service through a…

1. An application for a certificate of authority to provide health care services, directly, shall be forwarded by the commissioner to the director of health and human services for review, comment, and recommendation, with respect to the health care services to be provided directl…

1. The commissioner shall issue or deny a certificate of authority to any person filing an application pursuant to section 514B.3 within a reasonable period of time. Issuance of a certificate of authority shall be granted upon payment of the application fee prescribed in section …

1. The powers of a health maintenance organization include, but are not limited to, the following: a. The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property as may reasona…

The governing body of a health maintenance organization may include providers, other individuals, or both, but it shall establish a mechanism to allow a reasonable representation of enrollees to participate in matters of policy and operation. The commissioner shall establish guid…

Any director, officer or partner of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of a health maintenance organization shall be responsible for these funds in a fiduciary relationship to the enrollees. [C75,…

1. Every enrollee shall receive an evidence of coverage and any amendments. If the enrollee obtains coverage through an insurance policy or a contract issued by a corporation authorized under chapter 514 , the insurer or the corporation shall issue the evidence of coverage. No ev…

A health maintenance organization which provides health care coverage pursuant to an individual or group health maintenance organization contract regulated under this chapter for children of an enrollee shall permit continuation of existing coverage or reenrollment in previously …