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

1. The commissioner may suspend all or any part of section 513B.4 as to the premium rates applicable to one or more small employers for one or more rating periods upon a filing by the small employer carrier and a finding by the commissioner that the suspension is reasonable in li…

The commissioner shall develop, by rule, a uniform application form for use by small employers applying for new health insurance coverage under group health plans offered by small employer carriers. Small employer carriers shall be required to use the uniform application form not…

As used in this subchapter , unless the context otherwise requires: 1. “Actuarial certification” means a written statement by a member of the American academy of actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with the p…

This subchapter applies to a health benefit plan providing coverage to the employees of a small employer in this state if any of the following apply: 1. Any portion of the premium or benefits is paid by or on behalf of the small employer. 2. An eligible employee or dependent is r…

1. Premium rates for health benefit plans subject to this subchapter are subject to the following requirements: a. The index rate for a rating period for any class of business shall not exceed the index rate for any other class of business by more than twenty percent. b. For a cl…

A Taft-Hartley trust or a carrier with the written authorization of such a trust may make a written request to the commissioner for an exemption from the application of any provisions of section 513B.4 with respect to health insurance coverage provided to such a trust. The commis…

1. In order to encourage voluntary participation in wellness or disease management programs, a small employer carrier may offer premium credits or discounts to a small employer for the benefit of eligible employees of that small employer who participate in such a program. An empl…

1. Health insurance coverage subject to this chapter is renewable with respect to all eligible employees or their dependents, at the option of the small employer, except for one or more of the following reasons: a. The health insurance coverage sponsor fails to pay, or to make ti…

A small employer carrier shall make reasonable disclosure in solicitation and sales materials provided to small employers of all of the following: 1. The extent to which premium rates for a specific small employer are established or adjusted due to the claim experience, health st…

1. A small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation which demonstrate that its rating methods and practices are based …

1. A carrier offering group health insurance coverage shall not establish rules for eligibility, including continued eligibility, of an individual to enroll under the terms of the coverage based on any of the following health status-related factors in relation to the individual o…

This chapter shall be known and may be cited as the “Individual Health Insurance Market Reform Act” . 95 Acts, ch 5, §3

1. The Iowa individual health benefit reinsurance association is established as a nonprofit corporation. a. All persons that provide health benefit plans in this state including insurers providing accident and sickness insurance under chapter 509 , 514 , or 514A , whether on an i…

1. A self-funded employer-sponsored health benefit plan qualified under the federal Employee Retirement Income Security Act of 1974 may voluntarily elect to participate in the Iowa individual health benefit reinsurance association established in section 513C.10 in accordance with…

The commissioner shall adopt rules administering this chapter . 97 Acts, ch 103, §41

The purpose and intent of this chapter is to promote the availability of health insurance coverage to individuals regardless of their health status or claims experience, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rul…

As used in this chapter , unless the context otherwise requires: 1. “Actuarial certification” means a written statement by a member of the American academy of actuaries or other individual acceptable to the commissioner that an individual carrier is in compliance with the provisi…

1. Except as provided in subsection 2 , for purposes of this chapter , carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier and any restrictions or limitations imposed by this chapter shall apply as if all i…

1. Premium rates for any block of individual health benefit plan business issued on or after January 1, 1996, or the date rules are adopted by the commissioner of insurance and become effective, whichever date is later, by a carrier subject to this chapter shall be limited to the…

1. An individual health benefit plan subject to this chapter is renewable with respect to an eligible individual or dependents, at the option of the individual, except for one or more of the following reasons: a. The individual fails to pay, or to make timely payment of, premiums…

1. a. A carrier shall file with the commissioner, in a form and manner prescribed by the commissioner, the basic or standard health benefit plan. A basic or standard health benefit plan filed pursuant to this paragraph may be used by a carrier beginning thirty days after it is fi…

The board of directors of the Iowa comprehensive health insurance association, with the approval of the commissioner, shall adopt the form and level of coverage of the basic health benefit plan and the standard health benefit plan for the individual market which shall provide ben…

1. A carrier or an agent shall not do either of the following: a. Encourage or direct individuals to refrain from filing an application for coverage with the carrier because of the health status, claims experience, industry, occupation, or geographic location of the individuals. …

1. As used in this chapter , unless the context otherwise requires: a. “Association health plan” or “AHP” means a multiple employer welfare arrangement formed as an association health plan pursuant to 29 C.F.R. pt. 2510 . b. “Commissioner” means the commissioner of insurance. c. …

1. The commissioner of insurance shall adopt rules as necessary pursuant to chapter 17A to administer this chapter . 2. The commissioner of insurance may take any enforcement action under the commissioner’s authority to enforce compliance with this chapter . 2018 Acts, ch 1063, §…

1. A corporation organized under chapter 504, Code 1989 , or current chapter 504 for the purpose of establishing, maintaining, and operating a nonprofit hospital service plan, whereby hospital service may be provided by the corporation or by a hospital with which it has a contrac…

Every such corporation shall be subject to examination under the provisions of chapter 507 and any acts amendatory thereto, so far as the chapter may be applicable. [C39, § 8895.10; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.10 ]

All acquisition costs in connection with the solicitation of subscribers to such hospital service plan or medical service plan or pharmaceutical or optometric service plan, and administration costs including salaries paid its officers, if any, shall at all times be subject to the…

The funds of any corporation subject to the provisions of this chapter shall be invested only in securities permitted by the laws of this state for the investment of funds of life insurance companies. [C39, § 8895.12; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.12 ]

Any dispute arising between a corporation organized under chapter 504, Code 1989 , or current chapter 504 , and governed by this chapter, and a provider may be submitted to the commissioner of insurance for a decision. All decisions and findings of the commissioner of insurance m…

Any dissolution, merger, or liquidation of a corporation organized under chapter 504, Code 1989 , or current chapter 504 , and governed by this chapter shall be under the supervision of the commissioner of insurance who shall have all powers with respect thereto granted to the co…

Every corporation organized under chapter 504, Code 1989 , or current chapter 504 , and governed by this chapter , is hereby declared to be a charitable and benevolent institution but its property and funds, including subscribers’ contracts, shall not be exempt from taxation. For…

An employee or employees of the state, or of any county, city or of any institution supported in whole or in part by public funds, or any subdivisions thereof, may authorize the deduction from their salary or wages of the amount of their subscription payments to any corporation o…

No nonprofit medical service corporation shall be permitted to operate until it shall have entered into contracts with at least one hundred fifty physicians and surgeons licensed to practice medicine and surgery pursuant to chapter 148 , or one hundred fifty dentists licensed to …

Medical or surgical services or procedures constituting the practice of podiatry, also known as chiropody, as provided in chapter 149 , and covered by the terms of any individual, group, blanket, or franchise policy providing accident or health benefits hereafter delivered or her…

A corporation subject to this chapter may combine with any other corporation subject to this chapter as permitted under chapter 504 and upon the approval by the commissioner of insurance. Each corporation shall comply with chapter 504 , the corporation’s articles of incorporation…

Persons desiring to form a nonprofit hospital service corporation, or a nonprofit medical service corporation, or a nonprofit pharmaceutical or optometric service corporation shall have been incorporated under the provisions of chapter 504, Code 1989 , or shall incorporate under …

A utilization review program shall be established for purposes of health care cost control, according to usual and customary third-party insurance payment or reimbursement procedures, by a corporation subject to this chapter and by physician providers as defined in section 135.1 …

1. A corporation organized under chapter 504, Code 1989 , or current chapter 504 , and governed by this chapter , may become a mutual insurer under a plan which is approved by the commissioner of insurance. The plan shall state whether the insurer will be organized as a for-profi…

A nonprofit health service corporation authorized to do business in this state shall file in the office of the commissioner a power of attorney and an agreement in writing that service of process in any action or proceeding against the corporation may be made on the commissioner …

The articles of incorporation, and any subsequent amendments, of a corporation shall have endorsed on or annexed to those articles or amendments the approval of the commissioner of insurance before the same shall be filed for record. A corporation shall file with the commissioner…

1. a. At least two-thirds of the directors of a hospital service corporation, medical service corporation, dental service corporation, or pharmaceutical or optometric service corporation subject to this chapter shall be at all times subscribers and not more than one-third of the …

1. A hospital service corporation organized under chapter 504, Code 1989 , or current chapter 504 , and governed by this chapter , may enter into contracts for the rendering of hospital service to any of its subscribers with hospitals maintained and operated by the state or any o…

1. The contracts by any such corporation with the subscribers for health care service shall at all times be subject to the approval of the commissioner of insurance. The commissioner shall require that participating pharmacies be reimbursed by the pharmaceutical service corporati…

The contracts by any such corporation with participating hospitals for hospital service or with participating physicians and surgeons, dentists, podiatric physicians, osteopathic physicians, or osteopathic physicians and surgeons for medical and surgical service, or with particip…

Every such corporation shall annually, on or before the first day of March, file in the office of the commissioner of insurance a statement verified by at least two of the principal officers of said corporation showing its condition on the thirty-first day of December then next p…