reglab/housing_qa huggingface dataset:
IA Code § 513B.1 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.1 - Title — purpose.

513B.1 Title — purpose.   1. This subchapter shall be known and may be cited as the “Model Small Group Rating Law”.   2. The intent of this subchapter is to promote the availability of health insurance coverage to small employers, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules for continuity of coverage for employers and covered individuals, and to improve the efficiency and fairness of the small group health insurance marketplace.  91 Acts, ch 244, §1; 93 Acts, ch 80, §1
IA Code § 513B.3 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.3 - Applicability and scope.

513B.3 Applicability and scope.   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 reimbursed in any manner by or on behalf of the small employer for any portion of the premium or benefits.   3. The health insurance coverage is treated by the employer or any of the eligible employees or dependents as part of a coverage or program for the purposes of section 106, 125, or 162 of the Internal Revenue Code as defined in section 422.3.   4. a. Except as provided in paragraph “b”, for purposes of this subchapter, 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 subchapter shall apply as if all health insurance coverages delivered or issued for delivery to small employers in this state by such carriers were issued by one carrier.   b. An affiliated carrier which is a health maintenance organization possessing a certificate of authority issued pursuant to chapter 514B shall be considered to be a separate carrier for the purposes of this subchapter.   c. Unless otherwise authorized by the commissioner, a small employer carrier shall not enter into one or more ceding arrangements with respect to health insurance coverages delivered or issued for delivery to small employers in this state if the arrangements would result in less than fifty percent of the insurance obligation or risk for such health insurance coverages being retained by the ceding carrier.  91 Acts, ch 244, §3; 92 Acts, ch 1167, §2; 97 Acts, ch 103, §12, 13
IA Code § 513B.4A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.4A - Exemption from premium rate restrictions.

513B.4A Exemption from premium rate restrictions.   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 commissioner may grant an exemption if the commissioner finds that application of section 513B.4 with respect to the trust would have a substantial adverse effect on the participants and beneficiaries of such trust, and would require significant modifications to one or more collective bargaining arrangements under which the trust is established or maintained. An exemption granted under this section shall not apply to an individual if the individual participates in a trust as an associate member of an employee organization.  93 Acts, ch 80, §5; 97 Acts, ch 103, §18
IA Code § 513B.4B (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.4B - Small employer incentives — suspension or modification of premium rate restrictions.

513B.4B Small employer incentives — suspension or modification of premium rate restrictions.   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 employee shall not be penalized in any way for not participating in such a program.   2. The commissioner shall adopt, by rule or order, provisions allowing suspension or modification of premium rate restrictions to enable a small employer carrier to provide premium credits or discounts to a small employer based on measurable reductions in costs of that small employer, including but not limited to tobacco use cessation, participation in established wellness or disease management programs, and economies of acquisition or administration.  2007 Acts, ch 57, §7, 8
IA Code § 513B.6 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.6 - Disclosure of rating practices and renewability provisions.

513B.6 Disclosure of rating practices and renewability provisions.   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 status, or duration of coverage of the employees or dependents of the small employer.   2. The provisions concerning the small employer carrier’s right to change premium rates and factors, including case characteristics, which affect changes in premium rates.   3. The provisions relating to any preexisting condition provision.   4. The provisions relating to renewability of coverage.  91 Acts, ch 244, §6; 92 Acts, ch 1167, §10; 97 Acts, ch 103, §20, 21; 2017 Acts, ch 148, §39, 40
IA Code § 513B.7 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.7 - Maintenance of records.

513B.7 Maintenance of records.   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 upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.   2. A small employer carrier shall file each March 1 with the commissioner an actuarial certification that the small employer carrier is in compliance with this section and that the rating methods of the small employer carrier are actuarially sound. A copy of the certification shall be retained by the small employer carrier at its principal place of business.   3. A small employer carrier shall make the information and documentation described in subsection 1 available to the commissioner upon request. The information is not a public record or otherwise subject to disclosure under chapter 22, and is considered proprietary and trade secret information and is not subject to disclosure by the commissioner to persons outside of the division except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.  91 Acts, ch 244, §7; 97 Acts, ch 103, §22; 98 Acts, ch 1100, §68; 2017 Acts, ch 148, §41
IA Code § 513B.9A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.9A - Eligibility to enroll.

513B.9A Eligibility to enroll.   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 or a dependent of the individual:   a. Health status.   b. Medical condition, including both physical and mental conditions.   c. Claims experience.   d. Receipt of health care.   e. Medical history.   f. Genetic information.   g. Evidence of insurability, including conditions arising out of acts of domestic violence.   h. Disability.   2. Subsection 1 does not require group health insurance coverage to provide particular benefits other than those provided under the terms of the coverage, and does not prevent a coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the coverage.   3. Rules for eligibility to enroll under group health insurance coverage include rules defining any applicable waiting periods for such enrollment.   4. a. A carrier offering health insurance coverage shall not require an individual, as a condition of enrollment or continued enrollment under the coverage, to pay a premium or contribution which is greater than a premium or contribution for a similarly situated individual enrolled in the coverage on the basis of a health status-related factor in relation to the individual or to a dependent of an individual enrolled under the coverage.   b. Paragraph “a” shall not be construed to do either of the following:   (1) Restrict the amount that an employer may be charged for health insurance coverage.   (2) Prevent a carrier offering group health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.  97 Acts, ch 103, §23; 2017 Acts, ch 148, §42 - 44
IA Code § 513B.11 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.11 - Notice of intent to operate as a risk-assuming carrier or reinsuring carrier.

513B.11 Notice of intent to operate as a risk-assuming carrier or reinsuring carrier.   1. a. Upon the approval of a plan of operation by the commissioner under section 513B.13, subsection 4, a small employer carrier authorized to transact the business of insurance in this state shall notify the commissioner of the carrier’s intention to operate as a risk-assuming carrier or a reinsuring carrier. The notification shall be made as deemed appropriate by the commissioner. A small employer carrier seeking to operate as a risk-assuming carrier shall make an application pursuant to section 513B.12.   b. The notification of the commissioner concerning the carrier’s intention pursuant to paragraph “a” is binding for a five-year period from the date notification is given, except that the initial notification given by carriers after July 1, 1992, is binding for a two-year period. The commissioner may permit a carrier to modify the carrier’s decision at any time for good cause.   c. The commissioner shall establish an application process for small employer carriers seeking to change their status pursuant to this subsection. If a small employer carrier has been acquired by another such carrier, the commissioner may waive or modify the time periods established in paragraph “b”.   2. A reinsuring carrier that applies and is approved to operate as a risk-assuming carrier shall not be permitted to continue to reinsure any health insurance coverage with the program. The carrier shall pay a prorated assessment based upon business issued as a reinsuring carrier for any portion of the year that the business was reinsured.  92 Acts, ch 1167, §12; 93 Acts, ch 80, §10; 97 Acts, ch 103, §25
IA Code § 513B.12 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.12 - Application to become a risk-assuming carrier.

513B.12 Application to become a risk-assuming carrier.   1. A small employer carrier may apply to become a risk-assuming carrier by filing an application with the commissioner in a form and manner prescribed by the commissioner.   2. In evaluating an application made pursuant to this section, the commissioner shall consider the following factors:   a. The carrier’s financial condition.   b. The carrier’s history of rating and underwriting small employer groups.   c. The carrier’s commitment to market fairly to all small employers in the state or the carrier’s established geographic service area, as applicable.   d. The carrier’s experience with managing the risk of small employer groups.   3. The commissioner shall provide public notice of an application by a small employer carrier to be a risk-assuming carrier and shall provide at least a sixty-day period for public comment prior to making a decision on the application. If the application is not acted upon within ninety days of the receipt of the application by the commissioner, the carrier may request a hearing.   4. The commissioner may rescind the approval granted to a risk-assuming carrier under this section if the commissioner finds any of the following:   a. The carrier’s financial condition will no longer support the assumption of risk from issuing coverage to small employers in compliance with section 513B.10 without the protection provided by the program.   b. The carrier has failed to market fairly to all small employers in the state or the carrier’s established geographic service area, as applicable.   c. The carrier has failed to provide coverage to eligible small employers as required under section 513B.10.   5. A small employer carrier electing to be a risk-assuming carrier shall not be subject to the provisions of section 513B.13.   6. During the period of time that the operation of the small employer carrier reinsurance program is suspended pursuant to section 513B.13, subsection 14, a small employer carrier is not required to make an application to become a risk-assuming carrier pursuant to this section.  92 Acts, ch 1167, §13; 2005 Acts, ch 70, §8  Referred to in §513B.11
IA Code § 513B.14 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.14 - Health benefit plan standards.

513B.14 Health benefit plan standards. Repealed by  2001 Acts, ch 69, §38, 39  .
IA Code § 513B.15 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.15 - Periodic market evaluation.

513B.15 Periodic market evaluation.   The board shall study and report at least every three years to the commissioner on the effectiveness of this subchapter. The report shall analyze the effectiveness of the subchapter in promoting rate stability, product availability, and coverage affordability. The report may contain recommendations for actions to improve the overall effectiveness, efficiency, and fairness of the small group health insurance marketplace. The report shall address whether carriers and producers are fairly and actively marketing or issuing health insurance coverages to small employers in fulfillment of the purposes of this subchapter. The report may contain recommendations for market conduct or other regulatory standards or action.  92 Acts, ch 1167, §16; 97 Acts, ch 103, §33
IA Code § 513B.16 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.16 - Applicability of certain state laws.

513B.16 Applicability of certain state laws. Repealed by  2001 Acts, ch 69, §38, 39  .
IA Code § 513B.17 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.17 - Discretion of the commissioner.

513B.17 Discretion of the commissioner.   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 light of the financial condition of the carrier or that the suspension would enhance the efficiency and fairness of the marketplace for small employer health insurance.   2. The commissioner may suspend or modify the normal workweek requirement of thirty or more hours under the definition of eligible employee upon a finding by the commissioner that the suspension would enhance the availability of health insurance to employees of small employers.   3. The commissioner may adopt, by rule or order, transition provisions to facilitate the implementation and administration of this chapter.  91 Acts, ch 244, §8  CS91, §513B.8  92 Acts, ch 1167, §18  C93, §513B.17  93 Acts, ch 80, §14; 97 Acts, ch 103, §34; 2005 Acts, ch 70, §10
IA Code § 513B.17A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.17A - Restoration of terminated coverage.

513B.17A Restoration of terminated coverage. Repealed by  2001 Acts, ch 69, §38, 39  .
IA Code § 513B.18 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513B - SMALL GROUP HEALTH COVERAGE|Section 513B.18 - Uniform application form.

513B.18 Uniform application form.   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 less than six months after the rules developing the form become effective under chapter 17A.  2007 Acts, ch 169, §1
IA Code § 513C.1 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM|Section 513C.1 - Short title.

513C.1 Short title.   This chapter shall be known and may be cited as the “Individual Health Insurance Market Reform Act”.  95 Acts, ch 5, §3
IA Code § 513C.2 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM|Section 513C.2 - Purpose.

513C.2 Purpose.   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 rules regarding the renewal of coverage, to establish limitations on the use of preexisting condition exclusions, to assure fair access to health plans, and to improve the overall fairness and efficiency of the individual health insurance market.  95 Acts, ch 5, §4
IA Code § 513C.4 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM|Section 513C.4 - Applicability and scope.

513C.4 Applicability and scope.   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 individual health benefit plans delivered or issued for delivery to residents of this state by such affiliated carriers were issued by one carrier.   2. An affiliated carrier that is a health maintenance organization having a certificate of authority under section 514B.5 shall be considered to be a separate carrier for the purposes of this chapter.  95 Acts, ch 5, §6; 96 Acts, ch 1034, §48
IA Code § 513C.7 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM|Section 513C.7 - Availability of coverage.

513C.7 Availability of coverage.   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 filed unless the commissioner disapproves of its use.   b. The commissioner may at any time, after providing notice and an opportunity for a hearing to the carrier, disapprove the continued use by a carrier of a basic or standard health benefit plan on the grounds that the plan does not meet the requirements of this chapter.   2. The individual basic or standard health benefit plan shall not deny, exclude, or limit benefits for a covered individual for losses incurred more than twelve months following the effective date of the individual’s coverage due to a preexisting condition. A preexisting condition shall not be defined more restrictively than any of the following:   a. A condition that would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment during the twelve months immediately preceding the effective date of coverage.   b. A condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve months immediately preceding the effective date of coverage.   c. A pregnancy existing on the effective date of coverage.   3. A carrier shall not modify a basic or standard health benefit plan with respect to an individual or dependent through riders, endorsements, or other means to restrict or exclude coverage for certain diseases or medical conditions otherwise covered by the health benefit plan.  95 Acts, ch 5, §9; 97 Acts, ch 103, §37 – 39; 99 Acts, ch 165, §9, 10; 2003 Acts, ch 91, §24; 2004 Acts, ch 1158, §2, 21; 2008 Acts, ch 1188, §40, 41, 43; 2012 Acts, ch 1023, §157; 2017 Acts, ch 148, §54, 55
IA Code § 513C.8 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM|Section 513C.8 - Health benefit plan standards.

513C.8 Health benefit plan standards.   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 benefits substantially similar to the current state of the individual market.  95 Acts, ch 5, §10; 2001 Acts, ch 125, §3; 2004 Acts, ch 1110, §36; 2004 Acts, ch 1158, §3  Referred to in §513C.3
IA Code § 513C.9 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM|Section 513C.9 - Standards to assure fair marketing.

513C.9 Standards to assure fair marketing.   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.   b. Encourage or direct individuals to seek coverage from another carrier because of the health status, claims experience, industry, occupation, or geographic location of the individuals.   2. Subsection 1, paragraph “a”, shall not apply with respect to information provided by a carrier or an agent to an individual regarding the established geographic service area of the carrier or the restricted network provision of the carrier.   3. A carrier shall not, directly or indirectly, enter into any contract, agreement, or arrangement with an agent that provides for, or results in, the compensation paid to an agent for a sale of a basic or standard health benefit plan to vary because of the health status or permitted rating characteristics of the individual or the individual’s dependents.   4. Notwithstanding subsection 3, a commission shall be paid to an agent related to the sale of a basic or standard health benefit plan under this chapter. A commission paid pursuant to this subsection shall not be considered by the board for purposes of section 513C.10, subsection 5.   5. Subsection 3 does not apply with respect to the compensation paid to an agent on the basis of percentage of premium, provided that the percentage shall not vary because of the health status or other permitted rating characteristics of the individual or the individual’s dependents.   6. Denial by a carrier of an application for coverage from an individual shall be in writing and shall state the reason or reasons for the denial.   7. A violation of this section by a carrier or an agent is an unfair trade practice under chapter 507B.   8. If a carrier enters into a contract, agreement, or other arrangement with a third-party administrator to provide administrative, marketing, or other services related to the offering of individual health benefit plans in this state, the third-party administrator is subject to this section as if it were a carrier.  95 Acts, ch 5, §11; 97 Acts, ch 103, §40; 2006 Acts, ch 1117, §56; 2017 Acts, ch 148, §56