reglab/housing_qa huggingface dataset:
IA Code § 514B.18 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.18 - False representation.

514B.18 False representation.   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 business in this state. No health maintenance organization or any person on its behalf shall advertise or merchandise its services in a manner to misrepresent its services or capacity for service, nor shall it engage in misleading, deceptive or unfair practices with respect to advertising or merchandising. This section does not exempt health maintenance organizations which are engaged in the business of insurance from regulation under the provisions of chapter 507B.  [C75, 77, 79, 81, §514B.18]
IA Code § 514B.19 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.19 - Regulation of insurance producers.

514B.19 Regulation of insurance producers.   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, 79, 81, §514B.19]  2001 Acts, ch 16, §14, 37
IA Code § 514B.20 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.20 - Powers of insurers and hospital and medical service corporations.

514B.20 Powers of insurers and hospital and medical service corporations.   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 a health maintenance organization under the provisions of this chapter.   b. Contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through the health maintenance organization.   c. Contract with a health maintenance organization to provide coverage in the event of the failure of the health maintenance organization to meet its obligations.   2. Any two or more insurance companies, corporations, or their subsidiaries or affiliates may jointly organize and operate a health maintenance organization.  [C75, 77, 79, 81, §514B.20]  2012 Acts, ch 1023, §157
IA Code § 514B.21 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.21 - Public employees included.

514B.21 Public employees included.   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 health maintenance organizations under this chapter in the manner provided in section 514.16.  [C75, 77, 79, 81, §514B.21]
IA Code § 514B.22 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.22 - Fees.

514B.22 Fees.   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
IA Code § 514B.23 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.23 - Rules.

514B.23 Rules.   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
IA Code § 514B.24 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.24 - Examinations permitted.

514B.24 Examinations permitted.   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. Every health maintenance organization and provider shall submit its books and records to the commissioner and in every way facilitate the examination. For the purpose of examinations, the commissioner may administer oaths to and examine the officers and agents of the health maintenance organization and the principals of its providers concerning their business. The expenses of examinations under this section shall be assessed against the organization being examined and remitted to the commissioner.   3. In lieu of the examination required by this section, the commissioner may accept the report of an examination made by the appropriate departments in other states.  [C75, 77, 79, 81, §514B.24]  92 Acts, ch 1162, §28; 2000 Acts, ch 1023, §25; 2018 Acts, ch 1041, §127  Referred to in §514B.30
IA Code § 514B.25 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.25 - Financially impaired or insolvent health maintenance organizations.

514B.25 Financially impaired or insolvent health maintenance organizations.   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
IA Code § 514B.25A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.25A - Impairment and insolvency protection.

514B.25A Impairment and insolvency protection.   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  2019 amendment applies beginning March 29, 2019; 2019 Acts, ch 12, §35, 36
IA Code § 514B.26 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.26 - Administrative procedures.

514B.26 Administrative procedures.   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 and shall issue a notice of a time fixed for a hearing, which shall be held not less than ten days after the receipt by the health maintenance organization of the notice.   2. At the time and place fixed for a hearing, the person charged shall have an opportunity to be heard and to show cause why the order should not be made by the commissioner. Upon good cause shown, the commissioner may permit any person to intervene, appear, and be heard at the hearing by counsel or in person. Nothing contained in this chapter shall require the observance at any hearing of formal rules of pleading or evidence. The provisions of section 507B.6, subsections 4 and 5, relating to the powers and duties of the commissioner in relation to the hearing and relating to the rights and obligations of persons upon whom the commissioner has served notice shall apply to this chapter.   3. After the hearing, or upon the failure of the health maintenance organization to appear at the hearing, the commissioner shall take action as the commissioner deems advisable and which is permitted by the commissioner under the provisions of this chapter and shall reduce the findings to writing. Copies of the written findings shall be mailed to the health maintenance organization charged with violation of this chapter.  [C75, 77, 79, 81, §514B.26]  92 Acts, ch 1162 §29; 2018 Acts, ch 1041, §127; 2019 Acts, ch 24, §78  Referred to in §514B.4, 514B.5, 514B.27
IA Code § 514B.27 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.27 - Judicial review.

514B.27 Judicial review.   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
IA Code § 514B.28 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.28 - Injunction.

514B.28 Injunction.   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]
IA Code § 514B.29 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.29 - Penalty.

514B.29 Penalty. Repealed by  2004 Acts, ch 1110, §71  .
IA Code § 514B.30 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.30 - Communications in professional confidence.

514B.30 Communications in professional confidence.   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 knowledge or possession of such officer, director, trustee, partner, or employee by reason of employment with the health maintenance organization. To the extent necessary to effectuate the examinations provided in section 514B.24 only, the commissioner may examine medical or hospital records of a person receiving basic health care services under the provisions of this chapter but shall not testify as to such confidential communications or make other public disclosure thereof without the express consent of the person or the person’s legal representative, if the person is deceased or incompetent. The provisions of section 622.10 respecting waiver shall apply to this section.   2. A health maintenance organization is hereby prohibited from releasing the names of its membership list of enrollees, whether or not for value or consideration, except to the extent necessary to effectuate the provisions of this chapter or to conduct research or analyses regarding cost or quality issues.  [C75, 77, 79, 81, §514B.30]  92 Acts, ch 1162, §31; 92 Acts, ch 1206, §6; 2018 Acts, ch 1041, §127
IA Code § 514B.31 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.31 - Taxation.

514B.31 Taxation.   Payments received by a health maintenance organization for health care services, insurance, indemnity, or other benefits to which an enrollee is entitled through a health maintenance organization authorized under this chapter and payments by a health maintenance organization to providers for health care services, to insurers, or corporations authorized under chapter 514 for insurance, indemnity, or other service benefits authorized under this chapter are not premiums received and taxable under the provisions of section 432.1 for the first five years of the existence of the health maintenance organization, its successors or assigns. After the first five years, the payments received shall be considered premiums received and shall be taxable under the provisions of section 432.1, subsection 1. However, payments made by the United States secretary of health and human services under contracts issued under section 1833 or 1876 of the federal Social Security Act, section 4015 of the federal Omnibus Budget Reconciliation Act of 1987, or chapter 249A for enrolled members shall not be considered premiums received and shall not be taxable under section 432.1.  [C75, 77, 79, 81, §514B.31]  90 Acts, ch 1173, §1; 2002 Acts, ch 1158, §8  Referred to in §514E.1
IA Code § 514B.32 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.32 - Construction.

514B.32 Construction.   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 chapter with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.   2. Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives does not violate any provision of law prohibiting solicitation or advertising by health professionals. Upon a prospective enrollee’s request, a list of locations of services and a list of providers who have current agreements with the health maintenance organization shall be made available.   3. Any health maintenance organization authorized under this chapter is not practicing medicine and shall not be subject to the limitations provided in section 135B.26 on types of contracts entered into between doctors and hospitals.   4. A health maintenance organization authorized under this chapter shall be considered a person for purposes of chapter 507B.  [C75, 77, 79, 81, §514B.32]  83 Acts, ch 28, §1; 93 Acts, ch 88, §16
IA Code § 514B.33 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS|Section 514B.33 - Establishment of limited service organizations.

514B.33 Establishment of limited service organizations.   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 sell, or solicit offers to purchase or receive advance or periodic consideration in conjunction with a limited service organization without obtaining a certificate of authority under this chapter.   2. When not otherwise provided, a foreign or domestic limited service organization doing business in this state shall pay the commissioner the fees as required in section 511.24.   3. The commissioner shall adopt rules pursuant to chapter 17A establishing a certification process for limited service organizations.   4. Sections 514B.3B and 514B.12 apply to all foreign and domestic limited service organizations authorized to do business in this state.   5. a. For purposes of this section, “limited service organization” means an organization providing dental care services, vision care services, mental health services, substance abuse services, pharmaceutical services, podiatric care services, or such other services as may be determined by the commissioner.   b. “Limited service organization” does not include an organization providing hospital, medical, surgical, or emergency services, except as such services are provided incident to those services identified in paragraph “a”.  97 Acts, ch 186, §9; 2003 Acts, ch 91, §30; 2006 Acts, ch 1117, §61  Referred to in §507C.3, 508C.3
IA Code § 514C.2 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES|Section 514C.2 - Skilled nursing care covered in hospitals.

514C.2 Skilled nursing care covered in hospitals.   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 service plan regulated under chapter 514, or a health care service contract regulated under chapter 514B, shall also cover the costs of skilled nursing care in a hospital if the level of care needed by the insured or subscriber has been reclassified from acute care to skilled nursing care and no designated skilled nursing care beds or swing beds are available in the hospital or in another hospital or health care facility within a thirty-mile radius of the hospital. The insurer or corporation shall reimburse the insured or subscriber based on the skilled nursing care rate.  84 Acts, ch 1034, §1; 95 Acts, ch 185, §12
IA Code § 514C.3 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES|Section 514C.3 - Dentist’s services under accident and sickness insurance policies.

514C.3 Dentist’s services under accident and sickness insurance policies.   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 physician or a licensed dentist. As used in this section, “licensed physician” includes persons licensed under chapter 148, and “policy of accident and sickness insurance” includes individual policies or contracts issued pursuant to chapter 514, 514A, or 514B, and group policies as defined in section 509B.1, subsection 3.  88 Acts, ch 1127, §1; 2006 Acts, ch 1117, §63; 2008 Acts, ch 1088, §129
IA Code § 514C.3A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES|Section 514C.3A - Disclosures relating to dental coverage reimbursement rates.

514C.3A Disclosures relating to dental coverage reimbursement rates.   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 base payment for those benefits determined upon a usual and customary fee charged by licensed dentists, shall disclose all of the following:   a. The frequency of the determination of the usual and customary fee.   b. A general description of the methodology used to determine usual and customary fees, including geographic considerations.   c. The percentile that determines the maximum benefit that the insurer or nonprofit health service corporation will pay for any dental procedure, if the usual and customary fee is determined by taking a sample of fees submitted on actual claims from licensed dentists and then determining the benefit by selecting a percentile of those fees.   2. The disclosure shall be provided upon request to all group and individual policyholders and subscribers. All proposals for dental care benefits shall inform the prospective policyholder or subscriber that information regarding usual and customary fee determinations is available from the insurer or nonprofit health service corporation. All employee benefit descriptions or supplemental documents shall notify the employee that information regarding reimbursement rates is available from the employer.  95 Acts, ch 78, §1; 95 Acts, ch 209, §26
IA Code § 514C.3B (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES|Section 514C.3B - Dental coverage — fee schedules.

514C.3B Dental coverage — fee schedules.   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 dental plan.   2. A person or entity providing third-party administrator services shall not make available any dentists in its dentist network to a dental plan that sets fees for dental services that are not covered services.   3. For the purposes of this section:   a. “Covered services” means services reimbursed under the dental plan.   b. “Dental plan” means any policy or contract of insurance which provides for coverage of dental services not in connection with a medical plan that provides for the coverage of medical services.   4. Nothing in this section shall be construed as limiting the ability of an insurer or a third-party administrator to restrict any of the following as they relate to covered services:   a. Balance billing.   b. Waiting periods.   c. Frequency limitations.   d. Deductibles.   e. Maximum annual benefits.  2010 Acts, ch 1179, §1
IA Code § 514C.4 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES|Section 514C.4 - Mandated coverage for mammography.

514C.4 Mandated coverage for mammography.   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, issued for delivery, continued, or renewed in this state.   (1) Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.   (2) An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.   (3) An individual or group health maintenance organization contract regulated under chapter 514B.   (4) An individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law.   b. A long-term care policy or contract is specifically excluded from regulation under this section.   2. As used in this section, “minimum mammography examination coverage” means benefits which are better than or equal to the following minimum requirements:   a. One baseline mammogram for any woman who is thirty-five through thirty-nine years of age, or more frequent mammograms if recommended by the woman’s physician.   b. A mammogram every two years for any woman who is forty through forty-nine years of age, or more frequently if recommended by the woman’s physician.   c. A mammogram every year for any woman who is fifty years of age or older, or more frequently if recommended by the woman’s physician.   3. Mammogram benefits may be subject to any policy or contract provisions which apply generally to other services covered by the policy or contract.   4. The commissioner of insurance shall adopt rules under chapter 17A necessary to implement this section.  89 Acts, ch 289, §1; 92 Acts, ch 1162, §32, 33; 2003 Acts, ch 135, §1 – 3; 2012 Acts, ch 1023, §157
IA Code § 514C.5 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES|Section 514C.5 - Prescription drug benefit restrictions.

514C.5 Prescription drug benefit restrictions.   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 if the pharmacy selected by the covered person agrees to provide pharmaceutical services under the same terms and conditions as those provided by the mail order pharmacy.   2. Group third-party payor policies or contracts delivered, issued for delivery, continued, or renewed in this state on or after July 1, 1990, are subject to this section, including but not limited to the following classes:   a. A group accident and sickness insurance policy.   b. A group hospital or medical service contract.   c. A group health maintenance organization contract.   d. A group Medicare supplemental policy.  90 Acts, ch 1130, §1