reglab/housing_qa huggingface dataset:
IA Code § 514B.4 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.4 - Applicant for certificate of authority.

514B.4 Applicant for certificate of authority.   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 adequate personnel and facilities.   b. Has arrangements established in accordance with rules adopted by the commissioner for a continuous review of health care processes and outcomes. If a health maintenance organization is accredited by the national committee on quality assurance, or another accreditation entity approved by the commissioner, an external peer review under rules of the commissioner shall not be applicable. However, at the discretion of the commissioner, an on-site inspection of the health maintenance organization may be conducted.   c. Has a procedure established in accordance with rules adopted by the commissioner to develop, compile, evaluate, and report statistics relating to the cost of its operations, the pattern of utilization of its services, the availability and accessibility of its services, and other matters as may be reasonably required by the commissioner.   2. The commissioner, in administering this section and sections 514B.25 and 514B.26, may contract with qualified persons to make recommendations concerning the determinations required to be made by the commissioner. Such recommendations may be accepted in full or in part by the commissioner.  [C75, 77, 79, 81, §514B.4]  92 Acts, ch 1162, §21; 99 Acts, ch 165, §11; 2012 Acts, ch 1023, §157  Referred to in §514B.3, 514B.5
IA Code § 514B.4A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.4A - Direct provision of health care services.

514B.4A Direct provision of health care services.   1. An application for a certificate of authority to provide health care services, directly, shall be forwarded by the commissioner to the director of public health for review, comment, and recommendation, with respect to the health care services to be provided directly, to assure that the applicant has demonstrated the willingness and potential ability to provide the health care services through adequate personnel and facilities.   2. Rules proposed by the commissioner for adoption for the direct provision of health care services by a health maintenance organization, shall be forwarded by the commissioner to the director of public health for review, comment, and recommendation, prior to submission to the administrative rules coordinator pursuant to section 17A.4.   3. The director of public health shall respond to the commissioner, with respect to an application or proposed rule, with any comments or recommendations within thirty days of the forwarding of the application or proposed rules to the director of public health.  92 Acts, ch 1237, §12
IA Code § 514B.5 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.5 - Issuance and denial of a certificate of authority.

514B.5 Issuance and denial of a certificate of authority.   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 514B.22 if the commissioner is satisfied that the following conditions are met:   a. The persons responsible for the conduct of the affairs of the applicant are competent and trustworthy.   b. The commissioner finds that the health maintenance organization’s proposed plan of operation meets the requirements of section 514B.4.   c. The health maintenance organization provides or arranges for the provision of basic health care services on a prepaid basis, except that the health maintenance organization may impose deductible and coinsurance charges subject to approval by the commissioner. The commissioner has the authority to promulgate rules pursuant to chapter 17A establishing reasonable maximum deductible and coinsurance charges which may be imposed by health maintenance organizations.   d. The health maintenance organization is fiscally sound and may reasonably be expected to meet its obligations to enrollees. In making this determination, the commissioner may consider:   (1) The financial soundness of the health maintenance organization’s arrangements for health care services in relation to its schedule of charges.   (2) The adequacy of the health maintenance organization’s working capital.   (3) Any agreement made by the health maintenance organization with an insurer, a corporation authorized under chapter 514 or any other organization for insuring the payment of the cost of health care services or for providing immediate alternative coverage in the event of discontinuance of the health maintenance organization.   (4) Any agreement made with providers for the provision of health care services.   (5) Any surety bond or deposit of cash or securities submitted in accordance with section 514B.16.   e. The enrollees may participate in matters of policy and operation pursuant to section 514B.7.   f. Nothing in the proposed method of operation as shown by the information submitted pursuant to section 514B.3 or by independent investigation is contrary to the public interest.   2. A certificate of authority shall be denied only after compliance with the requirements of section 514B.26.  [C75, 77, 79, 81, §514B.5]  92 Acts, ch 1162, §22, 23; 2012 Acts, ch 1023, §117  Referred to in §513C.4, 514B.3, 514B.9
IA Code § 514B.6 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.6 - Powers of health maintenance organizations.

514B.6 Powers of health maintenance organizations.   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 reasonably be required for transacting the business of the organization.   b. The making of loans to a medical group under contract with it or to a corporation under its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees.   c. The furnishing of health care services to the public through providers which are under contract with or employed by the health maintenance organization.   d. The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration.   e. The contracting with an insurance company authorized to insure groups or individuals in this state for the cost of health care or with a corporation authorized under chapter 514 for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization.   f. The offering, in addition to basic health care services, of health care services and indemnity benefits to enrollees or groups of enrollees.   g. The acceptance from any person of payments covering all or part of the charges made to enrollees of the health maintenance organization.   2. A health maintenance organization shall file notice with the commissioner before the exercise of any power granted in subsection 1, paragraphs “a” and “b”. The commissioner shall disapprove the exercise of power if in the commissioner’s opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. The commissioner may adopt rules exempting from the filing requirement of this section those activities having a minimum effect.  [C75, 77, 79, 81, §514B.6]  92 Acts, ch 1162, §24; 2012 Acts, ch 1023, §118  Referred to in §514B.15
IA Code § 514B.7 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.7 - Governing body.

514B.7 Governing body.   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 guidelines to implement this section.  [C75, 77, 79, 81, §514B.7]  86 Acts, ch 1180, §8  Referred to in §514B.3, 514B.5
IA Code § 514B.8 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.8 - Fiduciary responsibilities.

514B.8 Fiduciary responsibilities.   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, 77, 79, 81, §514B.8]
IA Code § 514B.9 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.9 - Evidence of coverage.

514B.9 Evidence of coverage.   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 evidence of coverage or amendment shall be issued or delivered to any person in this state until a copy of the form of the evidence of coverage or amendment has been filed with and approved by the commissioner.   2. An evidence of coverage shall contain a clear and complete statement of:   a. The health care services and the insurance or other benefits, if any, to which the enrollee is entitled in the total context of the organizational structure of the health maintenance organization.   b. Any limitations on the services or benefits to be provided, including any deductible or coinsurance charges permitted under section 514B.5, subsection 1, paragraph “c”.   c. The manner in which information is available on the method of obtaining health care services.   d. The total amount of payment for health care services and indemnity or service benefits, if any, which the enrollee is obligated to pay with respect to individual contracts, or an indication whether the plan offered through the health maintenance organization is contributory or noncontributory with respect to group contracts.   e. The health maintenance organization’s method for resolving enrollee complaints.   f. The mechanism by which enrollees shall be allowed to participate in matters of policy and operation.   3. A copy of the form of the evidence of coverage to be used in this state and any amendment shall be subject to the filing and approval requirements of this section unless it is subject to the jurisdiction of the commissioner under the laws governing health insurance or corporations authorized under chapter 514 in which event the filing and approval provisions of such laws apply. To the extent, however, that those provisions are less strict than those provided under this section, then the requirements of this section shall apply.   4. Enrollees shall be entitled to receive the most recent annual statement of the financial condition of the health maintenance organization in which they are enrolled, which statement shall include a balance sheet and summary of receipts and disbursements.  [C75, 77, 79, 81, §514B.9]  2012 Acts, ch 1023, §119  Referred to in §514B.11
IA Code § 514B.9A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.9A - Coverage of children — continuation or reenrollment.

514B.9A Coverage of children — continuation or reenrollment.   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 existing coverage for an individual who meets the requirements of section 513B.2, subsection 14, paragraph “a”, “b”, “c”, “d”, or “e”, and who is an unmarried child of an enrollee who so elects, at least through the policy anniversary date on or after the date the child marries, ceases to be a resident of this state, or attains the age of twenty-five years old, whichever occurs first, or so long as the unmarried child maintains full-time status as a student in an accredited institution of postsecondary education.  2009 Acts, ch 118, §10, 11
IA Code § 514B.10 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.10 - Charges.

514B.10 Charges.   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 discriminatory.  [C75, 77, 79, 81, §514B.10]  95 Acts, ch 185, §10  Referred to in §514B.11, 514B.17
IA Code § 514B.11 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.11 - Disapproval of filings.

514B.11 Disapproval of filings.   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 request for the hearing, which request must be made within thirty days after receipt by the filer of the notice of disapproval. The commissioner may require the submission of whatever relevant information the commissioner deems necessary in determining whether to disapprove a filing.  [C75, 77, 79, 81, §514B.11]
IA Code § 514B.12 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.12 - Annual report.

514B.12 Annual report.   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 preceding calendar year. The report shall be on forms prescribed by the commissioner and shall include:   a. Financial statements of the organization including a balance sheet as of the end of the preceding calendar year and statement of profit and loss for the year then ended, certified by a certified public accountant or an independent public accountant.   b. Any material changes in the information submitted pursuant to section 514B.3.   c. The number of persons enrolled during the year, the number of enrollees as of the end of the year and the number of enrollments terminated during the year.   d. Other information relating to the performance of the health maintenance organization as is necessary to enable the commissioner to carry out the commissioner’s duties under this chapter.   2. The commissioner shall refuse to renew a certificate of authority of a health maintenance organization that fails to comply with the provisions of this section and the organization’s right to transact new business in this state shall immediately cease until the organization has so complied.   3. A health maintenance organization that fails to timely file the report required under subsection 1 is in violation of this section and shall pay an administrative penalty of five hundred dollars to the treasurer of state for deposit as provided in section 505.7.   4. The commissioner may give notice to a health maintenance organization that the organization has not timely filed the report required under subsection 1 and is in violation of this section. If the organization fails to file the required report and comply with this section within ten days of the date of the notice, the organization shall pay an additional administrative penalty of one hundred dollars for each day that the failure continues to the treasurer of state for deposit as provided in section 505.7.  [C75, 77, 79, 81, §514B.12]  92 Acts, ch 1162, §25; 2003 Acts, ch 91, §29; 2004 Acts, ch 1101, §73; 2006 Acts, ch 1117, §59; 2009 Acts, ch 181, §74  Referred to in §514B.33
IA Code § 514B.13 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.13 - Open enrollment.

514B.13 Open enrollment.   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 the order in which the prospective enrollees apply for enrollment. A health maintenance organization may apply to the commissioner for authorization to impose such underwriting restrictions upon enrollment as are necessary to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees, or to avoid unreasonably high or unmarketable charges for enrollee coverage for health care services. The commissioner shall approve or deny the application made pursuant to this section within a reasonable period of time from the receipt of the application.   2. Health maintenance organizations providing services exclusively on a group contract basis may limit the open enrollment provided for in this section to all members of the group covered by the contract, including those members of the group who previously waived coverage.  [C75, 77, 79, 81, §514B.13]  2005 Acts, ch 70, §13; 2018 Acts, ch 1041, §127; 2019 Acts, ch 59, §186
IA Code § 514B.14 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.14 - Complaint system.

514B.14 Complaint system.   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 organization shall submit to the commissioner an annual report in a form prescribed by the commissioner which shall include:   a. A description of the procedures of the complaint system.   b. The total number of complaints handled through the complaint system and a compilation of causes underlying the complaints filed.   c. The number, amount and disposition of malpractice claims settled during the year by the health maintenance organization and any of its providers.   2. The health maintenance organization shall maintain statistical information of written complaints filed with it concerning benefits over which the health maintenance organization does not have control and shall submit to the commissioner a summary report at the time and in the format that the commissioner may require. Complaints involving other persons shall be referred to those persons and a copy of the complaint sent to the commissioner.  [C75, 77, 79, 81, §514B.14]  92 Acts, ch 1162, §26; 2012 Acts, ch 1023, §157  Referred to in §514B.3
IA Code § 514B.15 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.15 - Investments.

514B.15 Investments.   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 constituting the legal reserves of life insurance companies or such other securities or investments as the commissioner may permit. For purposes of this section, investable funds of a health maintenance organization are all moneys held in trust for the purpose of fulfilling the obligations incurred by a health maintenance organization in providing health care services to enrollees.  [C75, 77, 79, 81, §514B.15]
IA Code § 514B.16 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.16 - Protection against insolvency.

514B.16 Protection against insolvency.   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 performed. The commissioner may waive this requirement when satisfied that the assets of the organization or its contracts with other organizations are sufficient to reasonably assure the performance of its obligations.  [C75, 77, 79, 81, §514B.16]  Referred to in §514B.5
IA Code § 514B.17 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.17 - Cancellation of enrollees.

514B.17 Cancellation of enrollees.   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 as provided in subsection 2 concerning prepaid group plans, notice of cancellation to an enrollee shall not be effective unless delivered to the enrollee by the health maintenance organization in a manner prescribed by the commissioner and at least thirty days before the effective date of cancellation and unless accompanied by a statement of reason for cancellation. At any time before cancellation of the policy for nonpayment, the enrollee may pay to the health maintenance organization the full amount due, including court costs if any, and from the date of payment by the enrollee or the collection of the judgment, coverage shall revive and be in full force and effect.   2. The effect of cancellation of a prepaid group plan providing health care services to enrollees, and the duty to provide notice and liability for benefits, is the same as provided under section 509B.5, subsection 2, for the termination of accident or health insurance for employees or members.  [C75, 77, 79, 81, §514B.17]  95 Acts, ch 185, §11
IA Code § 514B.17A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.17A - Rescission.

514B.17A Rescission.   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 enrollee by certified mail addressed to the enrollee and sent to the enrollee’s last address known to the health maintenance organization and shall state the reason for the rescission. The enrollee may appeal the rescission to the commissioner as provided by the commissioner by rules adopted under chapter 17A.   2. An enrollee’s membership in a health maintenance organization shall not be rescinded as provided in subsection 1 more than two years after the date of the enrollee’s enrollment in the health maintenance organization.  2008 Acts, ch 1123, §24; 2017 Acts, ch 54, §76