reglab/housing_qa huggingface dataset:
IA Code § 514G.108 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.108 - Prompt payment of claims — requirements.

514G.108 Prompt payment of claims — requirements.   1. An insurer providing long-term care insurance under this chapter and subject to state insurance regulation shall either accept and pay or deny a clean claim. For the purposes of this section, “clean claim” means a properly completed paper or electronic request for payment that contains all necessary information for the insurer to timely adjudicate and pay claims for long-term care benefits under the policy, does not involve coordination of benefits for third-party liability or subrogation, and does not involve the existence of particular circumstances requiring special treatment that prevents a prompt payment from being made.   2. The commissioner shall adopt rules establishing processes for timely adjudication and payment of claims for long-term care benefits by insurers.   3. Payment of a clean claim shall include interest at the rate of ten percent per annum when an insurer or other entity that administers or processes claims on behalf of the insurer fails to timely pay a clean claim.  2008 Acts, ch 1175, §9
IA Code § 514G.109 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.109 - Benefit trigger determinations — notice — appeals.

514G.109 Benefit trigger determinations — notice — appeals.   1. Notice. When a long-term care insurer determines that the benefit trigger in an insured’s long-term care insurance policy has not been met, the insurer shall provide a clear, written notice to the insured of all of the following:   a. The reason that the insurer determined that the insured’s benefit trigger has not been met.   b. The insurer’s internal appeal process provided under the insured’s long-term care insurance policy.   c. The insured’s right, after exhaustion of the insurer’s internal appeal process, to have the benefit trigger determination reviewed under the independent review process set forth in section 514G.110.   2. Internal appeal.   a. An insured may request an internal appeal of a benefit trigger determination by sending a written request to the insurer, along with any additional supporting information, within sixty days after the insured receives the notice described in subsection 1. The internal appeal shall be considered by an individual or group of individuals designated by the insurer, provided that the individual or individuals making the internal appeal decision shall not be the same individual or individuals who made the initial benefit trigger determination. All internal appeals shall be completed and written notice of the internal appeal decision sent to the insured within sixty days of the insurer’s receipt of all necessary information upon which a final determination can be made.   b. If the determination that the benefit trigger was not met is upheld upon internal appeal, the notice of the appeal decision shall describe additional internal appeal rights that are offered by the insurer, if any. Nothing in this paragraph shall require an insurer to offer any internal appeal rights other than those described in paragraph “a”.   c. If the determination that the benefit trigger was not met is upheld after the internal appeal process has been exhausted and there is no new information not previously provided to the insurer for consideration, the insurer shall provide the insured with a written description of the insured’s right to request an independent review of the benefit trigger determination.   3. Receipt of notice. Notices required by this section shall be deemed received within five days after the date of mailing.  2008 Acts, ch 1175, §10, 18  Referred to in §514G.110
IA Code § 514G.111 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.111 - Authority to promulgate rules.

514G.111 Authority to promulgate rules.   The commissioner may adopt rules pursuant to chapter 17A related to long-term care insurance and to the administration and enforcement of this chapter, including but not limited to the following:   1. Promoting adequate premiums and protecting policyholders in the event of substantial rate increases.   2. Establishing minimum standards for producer education, compensation, and testing; marketing practices; reporting practices; and penalties related to the sale of long-term care insurance in this state.   3. Establishing loss ratio standards for long-term care insurance policies with specific reference to such policies.   4. Providing standards for full and fair disclosure by setting forth the manner and content of disclosures required for the sale of long-term care insurance policies including terms of renewability; initial and subsequent conditions of eligibility; nonduplication of coverage provisions; coverage of dependents; effect of preexisting conditions; termination, continuation, or conversion of policies; probationary periods; limitations, exceptions, and reductions; elimination periods; requirements for replacement; recurrent conditions; and definitions of terms.   5. Requiring certain remedial actions necessitated by changes in the long-term care insurance market to provide fair and reasonable protections for long-term care insurance purchasers and beneficiaries.   6. Ensuring the prompt payment of clean claims.   7. Administering the independent review process of insurers’ benefit trigger determinations.  2008 Acts, ch 1175, §12
IA Code § 514G.112 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.112 - Severability.

514G.112 Severability.   If any provision of this chapter or the application of this chapter to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of the provision to other persons or circumstances shall not be affected.  2008 Acts, ch 1175, §13
IA Code § 514G.113 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.113 - Penalties.

514G.113 Penalties.   In addition to any other penalties provided by the laws of this state, any insurer or any producer found to have violated a provision of this chapter or any other requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to three times the amount of any commission paid for each policy involved in the violation, or up to ten thousand dollars, whichever is greater. A fine collected under this section shall be deposited as provided in section 505.7.  2008 Acts, ch 1175, §14; 2009 Acts, ch 181, §75
IA Code § 514H.1 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.1 - Definitions.

514H.1 Definitions.   As used in this chapter, unless the context otherwise requires:   1. “Deficit Reduction Act of 2005” means section 6021(a)(1)(A) of Pub. L. No. 109-171 as it pertains to the expansion of state long-term care insurance partnership programs.   2. “Long-term care facility” means a facility licensed under chapter 135C or an assisted living program certified under chapter 231C.   3. “Long-term care insurance” means long-term care insurance as defined in section 514G.103 and regulated in section 514G.105.   4. “Qualified long-term care insurance policy” means a long-term care insurance contract that is issued by an insurer or other person who complies with section 514H.4.   5. “Qualified long-term care services” means qualified long-term care services as defined in section 7702B(c) of the Internal Revenue Code.   6. “Qualified state long-term care insurance partnership” means an approved state plan amendment, according to the Deficit Reduction Act of 2005 that provides for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary.  2005 Acts, ch 166, §2, 13; 2008 Acts, ch 1175, §15; 2009 Acts, ch 145, §13, 14
IA Code § 514H.2 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.2 - Iowa long-term care asset disregard incentive program — establishment and administration.

514H.2 Iowa long-term care asset disregard incentive program — establishment and administration.   1. The Iowa long-term care asset disregard incentive program is established to do all of the following:   a. Provide incentives for individuals to insure against the costs of providing for their long-term care needs.   b. Provide a mechanism for individuals to qualify for coverage of the costs of their long-term care needs under the medical assistance program without first being required to substantially exhaust all their resources.   c. Assist in developing methods for increasing access to and the affordability of long-term care insurance.   d. Alleviate the financial burden on the state’s medical assistance program by encouraging the pursuit of private initiatives.   2. The insurance division of the department of commerce shall administer the program in cooperation with the division responsible for medical services within the department of human services. Each agency shall take all necessary actions, including filing an appropriate medical assistance state plan amendment to the state Medicaid plan to take full advantage of the benefits and features of the Deficit Reduction Act of 2005.  2005 Acts, ch 166, §3, 13; 2009 Acts, ch 145, §15
IA Code § 514H.3 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.3 - Eligibility.

514H.3 Eligibility.   An individual who is the beneficiary of a qualified long-term care insurance policy approved by the insurance division may be eligible for assistance under the medical assistance program using the asset disregard provisions pursuant to section 514H.5.  2005 Acts, ch 166, §4, 13; 2009 Acts, ch 145, §16  Referred to in §514H.5
IA Code § 514H.4 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.4 - Insurer requirements.

514H.4 Insurer requirements.   An insurer or other person who wishes to issue a qualified long-term care insurance policy in Iowa shall conform with all policy guidelines as expressed in the Deficit Reduction Act of 2005 and in Iowa law and rules.  2005 Acts, ch 166, §5, 13; 2009 Acts, ch 145, §17  Referred to in §514H.1
IA Code § 514H.5 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.5 - Asset disregard adjustment.

514H.5 Asset disregard adjustment.   1. As used in this section, “asset disregard” means a one dollar increase in the amount of assets an individual who is the beneficiary of a qualified long-term care insurance policy and meets the requirements of section 514H.3 may retain under section 249A.35 for each one dollar of benefit paid out under the individual’s qualified long-term care insurance policy for qualified long-term care services.   2. When the division responsible for medical services within the department of human services determines whether an individual is eligible for medical assistance under chapter 249A, the division shall make an asset disregard adjustment for any individual who meets the requirements of section 514H.3. The asset disregard shall be available after benefits of the qualified long-term care insurance policy have been applied to the cost of qualified long-term care services as required under this chapter.  2005 Acts, ch 166, §6, 13; 2009 Acts, ch 145, §18  Referred to in §249A.35, 514H.3, 514H.6, 514H.7, 514H.8
IA Code § 514H.6 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.6 - Application of asset disregard to determination of individual’s assets.

514H.6 Application of asset disregard to determination of individual’s assets.   A public program administered by the state that provides long-term care services and bases eligibility upon the amount of the individual’s assets shall apply the asset disregard under section 514H.5 in determining the amount of the individual’s assets.  2005 Acts, ch 166, §7, 13
IA Code § 514H.7 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.7 - Prior program — discontinuation of program.

514H.7 Prior program — discontinuation of program.   1. If the Iowa long-term care asset disregard incentive program is discontinued, an individual who is covered by a qualified long-term care insurance policy prior to the date the program is discontinued is eligible to continue to receive an asset disregard as defined under section 514H.5.   2. An individual who is covered by a long-term care insurance policy under the long-term care asset preservation program established pursuant to chapter 249G, Code 2005, on or before November 17, 2005, is eligible to continue to receive the asset adjustment as defined under that chapter.   3. The insurance division, in cooperation with the department of human services, shall adopt rules to provide an asset disregard to individuals who are covered by a long-term care insurance policy prior to November 17, 2005, consistent with the Iowa long-term care asset disregard incentive program.  2005 Acts, ch 166, §8, 13; 2009 Acts, ch 145, §19
IA Code § 514H.8 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.8 - Reciprocal agreements to extend asset disregard.

514H.8 Reciprocal agreements to extend asset disregard.   The division responsible for medical services within the department of human services may enter into reciprocal agreements with other states to extend the asset disregard under section 514H.5 to Iowa residents who had purchased or were covered by qualified long-term care insurance policies in other states.  2005 Acts, ch 166, §9, 13; 2009 Acts, ch 145, §20
IA Code § 514H.9 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514H - LONG-TERM CARE ASSET DISREGARD INCENTIVES|Section 514H.9 - Rules.

514H.9 Rules.   The insurance division of the department of commerce in cooperation with the department of human services shall adopt rules pursuant to chapter 17A as necessary to administer this chapter.  2005 Acts, ch 166, §10, 13; 2009 Acts, ch 145, §21
IA Code § 514I.1 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.1 - Intent of the general assembly.

514I.1 Intent of the general assembly.   1. It is the intent of the general assembly to provide health care coverage to eligible children that improves access to preventive, diagnostic, and treatment health services which result in improved health status using in part resources made available from the passage of Tit. XXI of the federal Social Security Act.   2. It is the intent of the general assembly that the program be implemented and administered in compliance with Tit. XXI of the federal Social Security Act. If, as a condition of receiving federal funds for the program, federal law requires implementation and administration of the program in a manner not provided in this chapter, during a period when the general assembly is not in session, the department, with the approval of the hawk-i board, shall proceed to implement and administer those provisions, subject to review by the next regular session of the general assembly.   3. It is the intent of the general assembly, recognizing the importance of outreach to the successful utilization of the program by eligible children, that within the limitations of funding allowed for outreach and administration expenses, the maximum amount possible be used for outreach.   4. It is the intent of the general assembly that the hawk-i program be an integral part of the continuum of health insurance coverage and that the program be developed and implemented in such a manner as to facilitate movement of families between health insurance providers and to facilitate the transition of families to private sector health insurance coverage.   5. It is the intent of the general assembly that if federal reauthorization of the state children’s health insurance program provides sufficient federal allocations to the state and authorization to cover such children as an option under the state children’s health insurance program, the department shall expand coverage under the state children’s health insurance program to cover children with family incomes at or below three hundred percent of the federal poverty level.  98 Acts, ch 1196, §2, 16; 2003 Acts, ch 108, §131; 2008 Acts, ch 1188, §5, 6; 2009 Acts, ch 118, §23
IA Code § 514I.2 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.2 - Definitions.

514I.2 Definitions.   As used in this chapter, unless the context otherwise requires:   1. “Benchmark benefit package” means any of the following:   a. The standard blue cross/blue shield preferred provider option service benefit plan, described in and offered under 5 U.S.C. §8903(1).   b. A health benefits coverage plan that is offered and generally available to state employees in this state.   c. The plan of a health maintenance organization as defined in 42 U.S.C. §300e, with the largest insured commercial, nonmedical assistance enrollment of covered lives in the state.   2. “Cost sharing” means the payment of a premium or copayment as provided for by Tit. XXI of the federal Social Security Act and section 514I.10.   3. “Department” means the department of human services.   4. “Director” means the director of human services.   5. “Eligible child” means an individual who meets the criteria for participation in the program under section 514I.8.   6. “Hawk-i board” or “board” means the entity which adopts rules and establishes policy for, and directs the department regarding, the hawk-i program.   7. “Hawk-i program” or “program” means the healthy and well kids in Iowa program created in this chapter to provide health insurance coverage to eligible children.   8. “Health insurance coverage” means health insurance coverage as defined in 42 U.S.C. §300gg-91.   9. “Participating insurer” means any entity licensed by the division of insurance of the department of commerce to provide health insurance in Iowa that has contracted with the department to provide health insurance coverage to eligible children under this chapter.   10. “Qualified child health plan” or “plan” means health insurance coverage provided by a participating insurer under this chapter.  98 Acts, ch 1196, §3, 16; 2003 Acts, ch 108, §131; 2008 Acts, ch 1188, §7; 2009 Acts, ch 118, §24; 2014 Acts, ch 1092, §184; 2017 Acts, ch 148, §92; 2019 Acts, ch 124, §1
IA Code § 514I.3 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.3 - Hawk-i program — established.

514I.3 Hawk-i program — established.   1. The hawk-i program, a statewide program designed to improve the health of children and to provide health insurance coverage to eligible children on a regional basis which complies with Tit. XXI of the federal Social Security Act, is established and shall be implemented January 1, 1999.   2. Health insurance coverage under the program shall be provided by participating insurers and through qualified child health plans.   3. The department of human services is designated to receive the state and federal funds appropriated or provided for the program, and to submit and maintain the state plan for the program, which is approved by the centers for Medicare and Medicaid services of the United States department of health and human services.   4. Nothing in this chapter shall be construed or is intended as, or shall imply, a grant of entitlement for services to persons who are eligible for participation in the program based upon eligibility consistent with the requirements of this chapter. Any state obligation to provide services pursuant to this chapter is limited to the extent of the funds appropriated or provided for this chapter.   5. Participating insurers under this chapter are not subject to the requirements of chapters 513B and 513C.   6. Health care coverage provided under this chapter in accordance with Tit. XXI of the federal Social Security Act shall be recognized as prior creditable coverage for the purposes of private individual and group health insurance coverage.  98 Acts, ch 1196, §4, 16; 2002 Acts, ch 1050, §45; 2003 Acts, ch 108, §131; 2009 Acts, ch 118, §25
IA Code § 514I.6 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.6 - Participating insurers.

514I.6 Participating insurers.   Participating insurers shall meet the qualifying standards established by rule under this chapter and shall perform all of the following functions:   1. Provide plan cards and membership booklets to qualifying families.   2. Provide or reimburse accessible, quality medical or dental services.   3. Require that any plan provided by the participating insurer establishes and maintains a conflict management system that includes methods for both preventing and resolving disputes involving the health or dental care needs of eligible children, and a process for resolution of such disputes.   4. Provide the department with all of the following information pertaining to the participating insurer’s plan:   a. A list of providers of medical or dental services under the plan.   b. Information regarding plan rules relating to referrals to specialists.   c. Information regarding the plan’s conflict management system.   d. Other information as directed by the board.   5. Submit a plan for a health improvement program to the department, for approval by the board.   6. Develop a plan for provider network development including criteria for access to pediatric subspecialty services.   7. Permit any chiropractor licensed under chapter 151 who is located in the geographic coverage area served by the plan and who agrees to abide by the plan’s terms, conditions, reimbursement rates, and quality standards to serve as a participating provider in any plan offered to eligible children under this chapter, including but not limited to a limited provider network plan as defined in section 514C.13.  98 Acts, ch 1196, §7, 16; 2003 Acts, ch 108, §131; 2003 Acts, ch 124, §8; 2009 Acts, ch 118, §32, 33; 2010 Acts, ch 1133, §2; 2019 Acts, ch 124, §8
IA Code § 514I.7 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.7 - Administrative contractor.

514I.7 Administrative contractor. Repealed by 2019 Acts, ch 124, §9.
IA Code § 514I.8A (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.8A - Hawk-i — all income-eligible children.

514I.8A Hawk-i — all income-eligible children.   The department shall provide coverage to individuals under nineteen years of age who meet the income eligibility requirements for the hawk-i program and for whom federal financial participation is or becomes available for the cost of such coverage.  2009 Acts, ch 118, §14
IA Code § 514I.9 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514I - HEALTHY AND WELL KIDS IN IOWA PROGRAM|Section 514I.9 - Program benefits.

514I.9 Program benefits.   1. The hawk-i board shall review the benefits package annually and shall determine additions to or deletions from the benefits package offered. The hawk-i board shall submit the recommendations to the general assembly for any amendment to the benefits package.   2. Benefits, in addition to those required by rule, may be provided to eligible children by a participating insurer if the benefits are provided at no additional cost to the state.  98 Acts, ch 1196, §10, 16; 2003 Acts, ch 108, §131; 2010 Acts, ch 1061, §180; 2013 Acts, ch 138, §104