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

This chapter may be cited as the “Uniform Individual Accident and Sickness Act.” This chapter shall take effect on the fourth day of July, 1951. A policy, filed with and approved by the insurance commissioner prior to the effective date of this chapter for use, delivery, or issue…

1. A policy of insurance against loss or expense from sickness or from the bodily injury or death by accident of the insured shall not be issued or delivered to any person in this state and an application, rider, or endorsement shall not be used in connection with the policy unti…

1. The commissioner shall notify an insurer which has filed a policy form pursuant to section 514A.13 that does not comply with this chapter or chapter 514D , or rules adopted pursuant to those chapters. The notice shall inform the insurer that it is unlawful for the insurer to i…

The commissioner may at any time, after opportunity for hearing, withdraw the commissioner’s previously given approval of any such form on any of the grounds stated in section 514A.14 . It shall be unlawful for the insurer to issue a form or use the form in connection with any po…

1. No policy of accident and sickness insurance shall be delivered or issued for delivery to any person in this state unless: a. The entire money and other considerations therefor are expressed therein; and b. The time at which the insurance takes effect and terminates is express…

1. Required provisions. Except as provided in subsection 3 of this section , each such policy delivered or issued for delivery to any person in this state shall contain the provisions specified in this subsection in the words in which the same appear in this section ; provided, h…

In the event of the death of the insured of any policy covered by this chapter , the insurer, upon receipt of notice of the insured’s death supported by a certified copy of a valid death certificate and a request for a pro rata refund by a party entitled to claim such a refund, s…

1. An insurer which accepts an individual for coverage under an individual policy or contract of accident and health insurance shall waive any time period applicable to a preexisting condition exclusion or limitation period requirement of the policy or contract with respect to pa…

1. Other policy provisions. A policy provision which is not subject to section 514A.3 shall not make a policy, or any portion of a policy, less favorable in any respect to the insured or the beneficiary than the provisions of the policy which are subject to this chapter . 2. Poli…

1. The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is endorsed on the policy when issued as a part thereof or is furnished to the policyholder within thirty days after the policy is issued. If any such policy d…

The acknowledgment by any insurer of the receipt of notice given under any policy covered by this chapter , or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder shall not operate as a waiver of any of…

If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premiu…

Nothing in this chapter shall apply to or affect any of the following: 1. Any policy of workers’ compensation insurance or any policy of liability insurance with or without supplementary expense coverage therein. 2. Any policy or contract of reinsurance. 3. Any blanket or group p…

As provided in this chapter , unless the context otherwise requires: 1. “Basic health care services” means services which an enrollee might reasonably require in order to be maintained in good health, including as a minimum, emergency care, inpatient hospital and physician care, …

Charges to enrollees may be established in accordance with actuarial principles for various categories of enrollees, but the charges shall not be determined according to the status of an individual enrollee’s health or sex and shall not be excessive, inadequate, or unfairly discr…

If the commissioner disapproves a filing made pursuant to sections 514B.9 and 514B.10 , the commissioner shall notify the filer and in the notice specify the reasons for the disapproval. A hearing shall be granted by the commissioner within a reasonable period of time from the re…

1. A health maintenance organization shall annually on or before the first day of March file with the commissioner or a depository designated by the commissioner a report verified by at least two of the principal officers of the health maintenance organization and covering the pr…

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 …