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

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 …

1. Any policy of individual or group accident and sickness insurance providing coverage on an expense incurred basis, and any individual or group hospital or medical service contracts issued pursuant to chapters 509 , 514 , and 514A , which provide coverage for a family member of…

1. Definitions. For purposes of this section , unless the context otherwise requires: a. “Child” means, with respect to an adoption or a placement for adoption of a child, an individual who has not attained age eighteen as of the date of the issuance of a final adoption decree, o…

1. Notwithstanding section 514C.6 , a policy or contract providing for third-party payment or prepayment of health or medical expenses shall include a provision for the payment of necessary medical or surgical care and treatment provided by a physician assistant licensed pursuant…

1. Notwithstanding section 514C.6 , a person who provides an individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509 , 509A , 514 , or 514A or an individual or group health maintenan…

1. Notwithstanding section 514C.6 , a person who provides an individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509 , 509A , 514 , or 514A or an individual or group health maintenan…

1. As used in this section , unless the context otherwise requires: a. “Carrier” means an entity that provides health benefit plans in this state. “Carrier” includes an insurance company, group hospital or medical service corporation, health maintenance organization, multiple emp…

1. Except as provided under subsection 2 or 3 , a carrier, as defined in section 513B.2 , or a plan established pursuant to chapter 509A for public employees, that terminates its contract with a participating health care provider, shall continue to provide coverage under the cont…

A carrier, as defined in section 513B.2 , or a plan established pursuant to chapter 509A for public employees, shall not prohibit a participating provider from, or penalize a participating provider for, doing either of the following: 1. Discussing treatment options with a covered…

1. A carrier, as defined in section 513B.2 , or a plan established pursuant to chapter 509A for public employees, which provides coverage for emergency services, is responsible for charges for emergency services provided to a covered individual, including services furnished outsi…

1. Except as provided under subsection 2 or 3 , if a carrier, as defined in section 513B.2 , or a plan established pursuant to chapter 509A for public employees, terminates its contract with a participating health care provider, a covered individual who is undergoing a specified …

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a policy or contract providing for third-party payment or prepayment of health or medical expenses shall provide coverage benefits for the cost associated with equipment, supplies, and self-management…

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a group policy or contract providing for third-party payment or prepayment of health or medical expenses shall not do either of the following: a. Exclude or restrict benefits for prescription contrace…

An insurer, a hospital service corporation, or a medical service corporation, which covers the costs of skilled nursing care under an individual or group policy of accident and health insurance regulated under chapter 509 or 514A , a nonprofit hospital or medical and surgical ser…

1. Notwithstanding section 514C.6 , and subject to the terms and conditions of the policy or contract, a policy or contract providing for third-party payment or prepayment of health or medical expenses shall provide coverage for the administration of general anesthesia and hospit…

1. Third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2006, that provide reimbursement for immunizations shall provide reimbursement for immunizations containing no more than trace amounts …

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a group policy, contract, or plan providing for third-party payment or prepayment of health, medical, and surgical coverage benefits issued by a carrier, as defined in section 513B.2 , shall provide c…

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a contract, policy, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage benefits for any vaccination or immunization shall provide coverage ben…

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a contract, policy, or plan providing for third-party payment or prepayment for cancer treatment shall not discriminate between coverage benefits for prescribed, orally administered anticancer medicat…

1. a. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage benefits for medically necessary prosthetic devices when prescribed …

1. Definitions. For purposes of this section , unless the context otherwise requires: a. “Approved cancer clinical trial” means a scientific study of a new therapy for the treatment of cancer in human beings that meets the requirements set forth in subsection 3 and consists of a …

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a group policy or contract providing for third-party payment or prepayment of health or medical expenses issued by a carrier, as defined in section 513B.2 , shall provide coverage benefits to an insur…

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a group plan established pursuant to chapter 509A for employees of the state providing for third-party payment or prepayment of health, medical, and surgical coverage benefits shall provide coverage b…

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not impose a copayment or coinsurance amount on an insured for services provided by a do…

A policy of accident and sickness insurance issued in this state which provides payment or reimbursement for any service which is within the lawful scope of practice of a licensed dentist shall provide benefits for the service whether the service is performed by a licensed physic…

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not impose a copayment or coinsurance amount on an insured for services provided by a ph…

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a group policy, contract, or plan providing for third-party payment or prepayment of health, medical, and surgical coverage benefits shall provide coverage benefits for applied behavior analysis provi…

1. Notwithstanding section 514C.6 , a policy or contract providing for third-party payment or prepayment of health or medical expenses shall include a provision for the payment of necessary behavioral health services provided by any of the following: a. A licensed master social w…

1. Notwithstanding section 514C.6 , a policy or contract providing for third-party payment or prepayment of health or medical expenses shall include a provision for the payment of necessary behavioral health services provided by a person who holds a provisional license to practic…

1. As used in this section , unless the context otherwise requires: a. “Covered person” means the same as defined in section 514J.102 . b. “Facility” means the same as defined in section 514J.102 . c. “Health care professional” means the same as defined in section 514J.102 . d. “…

1. Notwithstanding the uniformity of treatment requirements of section 514C.6 , a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not deny coverage or payment for behavioral health services, including behavioral health…

1. As used in this section , unless the context otherwise requires: a. “Biomarker” means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic interven…

1. An individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509 , 514 , or 514A , and delivered, amended, or renewed on or after July 1, 1995, that provides dental care benefits with a…

1. A contract between a dental plan and a dentist for the provision of services to covered individuals under the plan shall not require that a dentist provide services to those covered individuals at a fee set by the dental plan unless such services are covered services under the…

1. Definitions. As used in this section unless the context otherwise provides: a. “Commissioner” means the commissioner of insurance. b. “Contracting entity” means any person, third-party administrator, health carrier, or dental carrier that enters into a contract with a dental c…

1. Definitions. As used in this section unless the context otherwise provides: a. “Commissioner” means the commissioner of insurance. b. “Covered person” means the same as defined in section 514C.3C . c. “Dental care provider” means the same as defined in section 514C.3C . d. “De…

1. Definitions. As used in this section , unless the context otherwise provides: a. “Commissioner” means the commissioner of insurance. b. “Covered person” means the same as defined in section 514C.3C . c. “Dental care provider” means the same as defined in section 514C.3C . d. “…

1. Definitions. As used in this section , unless the context otherwise provides: a. “Dental care provider” means the same as defined in section 514C.3C . b. “Dental care services” means the same as defined in section 514C.3C . c. “Dental carrier” means the same as defined in sect…

1. a. A policy or contract providing for third-party payment or prepayment of health or medical expenses shall provide minimum mammography examination coverage, including, but not limited to, the following classes of third-party payment provider contracts or policies delivered, i…

1. As used in this section , unless the context otherwise requires: a. “Breast magnetic resonance imaging” or “breast MRI” means an examination of a breast, following administration of intravenous contrast, using a powerful magnetic field, radio waves, and a computer to produce d…

1. A group policy or contract providing for third-party payment or prepayment for prescription drugs shall not require a person covered under the policy or contract to obtain prescription drugs from a mail order pharmacy as a condition of obtaining benefits for prescription drugs…

1. A statutory provision to mandate a health care coverage or service, or to mandate the offering of a health care coverage or service, applies to all state-regulated third-party payors and to employee welfare benefit plans described in 29 U.S.C. §1001 et seq. However, if an empl…

Notwithstanding the uniformity of treatment requirements of section 514C.6 , a third-party payor as defined in that section shall not deny or fail to renew, or include an exception to or exclusion of benefits in, a policy or contract of individual or group accident and sickness i…

1. An insurer, health maintenance organization, or hospital and medical service plan providing health care coverage to individuals in this state shall not consider the availability of or eligibility for medical assistance under Tit. XIX of the federal Social Security Act and chap…

1. An insurer shall not deny coverage or enrollment of a child under the health plan of the obligor upon any of the following grounds: a. The child is born out of wedlock. b. The child is not claimed as a dependent on the obligor’s federal income tax return. c. The child does not…

The purpose of this chapter is to provide reasonable standardization, simplification, and disclosure of the terms and coverages of individual accident and sickness insurance policies issued under chapter 514A and individual subscriber contracts issued under chapter 514 , in order…