reglab/housing_qa huggingface dataset:
IA Code § 514D.7 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514D - ACCIDENT AND SICKNESS INSURANCE POLICIES|Section 514D.7 - Exclusions.

514D.7 Exclusions.   This chapter does not apply to any of the following:   1. A policy of credit accident and health or credit accident and sickness insurance.   2. A policy of accident and sickness insurance which is exempt from the provisions of sections 514A.1 to 514A.12 by virtue of an exemption set forth in section 514A.1 or 514A.8.   3. Any evidence of coverage issued to an enrollee of a health maintenance organization under chapter 514B.  [C81, §514D.7]
IA Code § 514D.8 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514D - ACCIDENT AND SICKNESS INSURANCE POLICIES|Section 514D.8 - Title and effective date of chapter.

514D.8 Title and effective date of chapter.   This chapter may be cited as the “Uniform Individual Accident and Health Insurance Minimum Standards Act”. This chapter takes effect July 1, 1980. Rules issued by the commissioner of insurance pursuant to this chapter shall be subject to the provisions of chapter 17A, and all rules issued by the commissioner of insurance shall give the issuers of policies and contracts a reasonable time to achieve compliance.  [C81, §514D.8]
IA Code § 514D.9 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514D - ACCIDENT AND SICKNESS INSURANCE POLICIES|Section 514D.9 - Regulations regarding limitation on compensation.

514D.9 Regulations regarding limitation on compensation.   The commissioner shall issue rules to establish minimum standards to assure fair and reasonable benefits, claim payment, marketing practices, and compensation arrangements and reporting practices for the following classes of policies:   1. Medicare supplement insurance.   2. Nursing home insurance.   3. Long-term care insurance.  90 Acts, ch 1234, §32
IA Code § 514E.3 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION|Section 514E.3 - Health insurance trust fund — deposit of moneys.

514E.3 Health insurance trust fund — deposit of moneys. Repealed by 97 Acts, ch 103, §56.
IA Code § 514E.4 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION|Section 514E.4 - Association policy — coverage and benefit requirements — deductibles — coinsurance.

514E.4 Association policy — coverage and benefit requirements — deductibles — coinsurance.   The association policy shall pay for medically necessary eligible health care services as established in the benefit plans adopted by the association’s board of directors and approved by the commissioner. The plans shall provide benefits, deductibles, and coinsurance that reflect the current state of the individual insurance market. The board may modify the benefits provided under the plans to reflect the current state of the individual insurance market with the approval of the commissioner.  86 Acts, ch 1156, §4; 90 Acts, ch 1039, §18; 2004 Acts, ch 1110, §47; 2004 Acts, ch 1158, §14
IA Code § 514E.5 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION|Section 514E.5 - Iowa choice health care coverage.

514E.5 Iowa choice health care coverage. Repealed by  2009 Acts, ch 118, §4, 5  .
IA Code § 514E.6 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION|Section 514E.6 - Iowa choice health care coverage advisory council.

514E.6 Iowa choice health care coverage advisory council. Repealed by  2009 Acts, ch 118, §4, 5  .
IA Code § 514E.8 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION|Section 514E.8 - Policies — renewal provisions — election to continue coverage upon death of policyholder.

514E.8 Policies — renewal provisions — election to continue coverage upon death of policyholder.   1. An association policy shall contain provisions under which the association is obligated to renew the coverage for an individual until the day the individual becomes eligible for Medicare coverage based on age, provided that any individual who is covered by an association policy and is eligible for Medicare coverage based on age prior to January 1, 2005, may continue to renew the coverage under the association policy.   2. The association shall not change the rates for association policies except on a class basis with a clear disclosure in the policy of the association’s right to do so.   3. An association policy shall provide that upon the death of the individual in whose name the policy is issued, every other individual then covered under the contract may elect, within a period specified in the policy, to continue coverage under the same or a different policy until such time as the person would have ceased to be entitled to coverage had the individual in whose name the policy was issued lived.  86 Acts, ch 1156, §8; 2004 Acts, ch 1110, §50; 2004 Acts, ch 1158, §18; 2005 Acts, ch 70, §18, 51; 2006 Acts, ch 1030, §84
IA Code § 514E.9 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION|Section 514E.9 - Rules.

514E.9 Rules.   Pursuant to chapter 17A, the commissioner shall adopt rules to provide for disclosure by carriers of the availability of insurance coverage from the association, and to otherwise implement this chapter.  86 Acts, ch 1156, §9; 97 Acts, ch 103, §54; 2017 Acts, ch 148, §89
IA Code § 514E.10 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION|Section 514E.10 - Collective action — immunity.

514E.10 Collective action — immunity.   Neither the participation by carriers or members in the association, the establishment of rates, forms, or procedures for coverage issued by the association, nor any joint or collective action required by this chapter shall be the basis of any legal civil action, or criminal liability against the association or members of it either jointly or separately.  86 Acts, ch 1156, §10
IA Code § 514E.11 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION|Section 514E.11 - Notice of association policy.

514E.11 Notice of association policy.   Every carrier, including a health maintenance organization subject to chapter 514B, authorized to provide health care insurance or coverage for health care services in Iowa, shall provide a notice of the availability of coverage by the association to any person who receives a rejection of coverage for health insurance or health care services, or a rate for health insurance or coverage for health care services that will exceed the rate of an association policy, and that person is eligible to apply for health insurance provided by the association. Application for the health insurance shall be on forms prescribed by the association’s board of directors and made available to the carriers and other entities providing health care insurance or coverage for health care services regulated by the commissioner.  86 Acts, ch 1156, §11; 97 Acts, ch 103, §55; 2004 Acts, ch 1110, §51; 2004 Acts, ch 1158, §19; 2017 Acts, ch 148, §90
IA Code § 514F.1 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514F - UTILIZATION AND COST CONTROL|Section 514F.1 - Utilization and cost control review committees.

514F.1 Utilization and cost control review committees.   The licensing boards under chapters 148, 149, 151, and 152 shall establish utilization and cost control review committees of licensees under the respective chapters, selected from licensees who have practiced in Iowa for at least the previous five years, or shall accredit and designate other utilization and cost control organizations as utilization and cost control committees under this section, for the purposes of utilization review of the appropriateness of levels of treatment and of giving opinions as to the reasonableness of charges for diagnostic or treatment services of licensees. Persons governed by the various chapters of Title XIII, subtitle 1, of the Code and self-insurers for health care benefits to employees may utilize the services of the utilization and cost control review committees upon the payment of a reasonable fee for the services, to be determined by the respective boards. The respective boards under chapters 148, 149, 151, and 152 shall adopt rules necessary and proper for the administration of this section pursuant to chapter 17A. It is the intent of this general assembly that conduct of the utilization and cost control review committees authorized under this section shall be exempt from challenge under federal or state antitrust laws or other similar laws in regulation of trade or commerce.  86 Acts, ch 1180, §10; 87 Acts, ch 115, §63; 88 Acts, ch 1199, §6; 89 Acts, ch 164, §6; 90 Acts, ch 1233, §32; 2007 Acts, ch 10, §177; 2008 Acts, ch 1088, §135
IA Code § 514F.2 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514F - UTILIZATION AND COST CONTROL|Section 514F.2 - Utilization and cost control.

514F.2 Utilization and cost control.   Nothing contained in the chapters of Title XIII, subtitle 1, of the Code shall be construed to prohibit or discourage insurers, nonprofit service corporations, health maintenance organizations, or self-insurers for health care benefits to employees from providing payments of benefits or providing care and treatment under capitated payment systems, prospective reimbursement rate systems, utilization control systems, incentive systems for the use of least restrictive and least costly levels of care, preferred provider contracts limiting choice of specific provider, or other systems, methods or organizations designed to contain costs without sacrificing care or treatment outcome, provided these systems do not limit or make optional payment or reimbursement for health care services on a basis solely related to the license under or the practices authorized by chapter 151 or on a basis that is dependent upon a method of classification, categorization, or description based upon differences in terminology used by different licensees under the chapters of Title IV, subtitle 3, of the Code in describing human ailments or their diagnosis or treatment.  86 Acts, ch 1180, §10
IA Code § 514F.3 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514F - UTILIZATION AND COST CONTROL|Section 514F.3 - Preferred providers.

514F.3 Preferred providers.   The commissioner of insurance shall adopt rules for preferred provider contracts and organizations, both those that limit choice of specific provider and those that do not. The rules adopted shall include, but not be limited to, the following subjects: preferred provider arrangements and participation requirements, health benefit plans, and civil penalties.  88 Acts, ch 1112, §604
IA Code § 514F.4 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514F - UTILIZATION AND COST CONTROL|Section 514F.4 - Utilization review requirements.

514F.4 Utilization review requirements.   1. A third-party payor which provides health benefits to a covered individual residing in this state shall not conduct utilization review, either directly or indirectly, under a contract with a third-party who does not meet the requirements established for accreditation by the utilization review accreditation commission, national committee on quality assurance, or another national accreditation entity recognized and approved by the commissioner.   2. This section does not apply to any utilization review performed solely under contract with the federal government for review of patients eligible for services under any of the following:   a. Tit. XVIII of the federal Social Security Act.   b. The civilian health and medical program of the uniformed services.   c. Any other federal employee health benefit plan.   3. For purposes of this section, unless the context otherwise requires:   a. “Third-party payor” means:   (1) An insurer subject to chapter 509 or 514A.   (2) A health service corporation subject to chapter 514.   (3) A health maintenance organization subject to chapter 514B.   (4) A preferred provider arrangement.   (5) A multiple employer welfare arrangement.   (6) A third-party administrator.   (7) A fraternal benefit society.   (8) A plan established pursuant to chapter 509A for public employees.   (9) Any other benefit program providing payment, reimbursement, or indemnification for health care costs for an enrollee or an enrollee’s eligible dependents.   b. “Utilization review” means a program or process by which an evaluation is made of the necessity, appropriateness, and efficiency of the use of health care services, procedures, or facilities given or proposed to be given to an individual within this state. Such evaluation does not apply to requests by an individual or provider for a clarification, guarantee, or statement of an individual’s health insurance coverage or benefits provided under a health insurance policy, nor to claims adjudication. Unless it is specifically stated, verification of benefits, preauthorization, or a prospective or concurrent utilization review program or process shall not be construed as a guarantee or statement of insurance coverage or benefits for any individual under a health insurance policy.  99 Acts, ch 41, §5; 2010 Acts, ch 1061, §180
IA Code § 514F.5 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514F - UTILIZATION AND COST CONTROL|Section 514F.5 - Experimental treatment review.

514F.5 Experimental treatment review.   1. A carrier, as defined in section 513B.2, or a plan established pursuant to chapter 509A for public employees, that limits coverage for experimental medical treatment, drugs, or devices, shall develop and implement a procedure to evaluate experimental medical treatments and shall submit a description of the procedure to the division of insurance. The procedure shall be in writing and must describe the process used to determine whether the carrier or chapter 509A plan will provide coverage for new medical technologies and new uses of existing technologies. The procedure, at a minimum, shall require a review of information from appropriate government regulatory agencies and published scientific literature concerning new medical technologies, new uses of existing technologies, and the use of external experts in making decisions. A carrier or chapter 509A plan shall include appropriately licensed or qualified professionals in the evaluation process. The procedure shall provide a process for a person covered under a plan or contract to request a review of a denial of coverage because the proposed treatment is experimental. A review of a particular treatment need not be reviewed more than once a year.   2. A carrier or chapter 509A plan that limits coverage for experimental treatment, drugs, or devices shall clearly disclose such limitations in a contract, policy, or certificate of coverage.  99 Acts, ch 41, §6; 2017 Acts, ch 148, §91
IA Code § 514F.6 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514F - UTILIZATION AND COST CONTROL|Section 514F.6 - Credentialing — retrospective payment.

514F.6 Credentialing — retrospective payment.   1. The commissioner shall adopt rules to provide for the retrospective payment of clean claims for covered services provided by a physician, advanced registered nurse practitioner, or physician assistant during the credentialing period, once the physician, advanced registered nurse practitioner, or physician assistant is credentialed.   2. For purposes of this section:   a. “Advanced registered nurse practitioner” means a person currently licensed as a registered nurse under chapter 152 or 152E who is licensed by the board of nursing as an advanced registered nurse practitioner.   b. “Clean claim” means the same as defined in section 507B.4A, subsection 2, paragraph “b”.   c. “Credentialing” means a process through which a health insurer makes a determination based on criteria established by the health insurer concerning whether a physician, advanced registered nurse practitioner, or physician assistant is eligible to provide health care services to an insured and to receive reimbursement for the health care services provided under an agreement entered into between the physician, advanced registered nurse practitioner, or physician assistant and the health insurer.   d. “Credentialing period” means the time period between the health insurer’s receipt of a physician’s, advanced registered nurse practitioner’s, or physician assistant’s application for credentialing and approval of that application by the health insurer.   e. “Physician” means a licensed doctor of medicine and surgery or a licensed doctor of osteopathic medicine and surgery.   f. “Physician assistant” means a person who is licensed to practice as a physician assistant under the supervision of one or more physicians.  2008 Acts, ch 1123, §28; 2010 Acts, ch 1121, §16; 2013 Acts, ch 90, §155; 2015 Acts, ch 56, §24
IA Code § 514G.10 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.10 - Long-term care consumer guide.

514G.10 Long-term care consumer guide. Repealed by  2008 Acts, ch 1175, §16  .
IA Code § 514G.101 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.101 - Title and purpose.

514G.101 Title and purpose.   This chapter may be known and cited as the “Long-term Care Insurance Act”. The purpose of this chapter is to promote the public interest, to promote the availability of long-term care insurance, to protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage.  2008 Acts, ch 1175, §2
IA Code § 514G.102 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.102 - Scope.

514G.102 Scope.   The requirements of this chapter apply to policies delivered or issued for delivery in this state on or after July 1, 2008. The requirements of this chapter related to independent review of benefit trigger determinations apply to all claims made on or after January 1, 2009. The requirements of this chapter related to prompt payment of claims and the payment of interest apply to all long-term care insurance policies. This chapter is not intended to supersede the obligations of entities subject to this chapter to comply with the substance of other applicable insurance laws not in conflict with this chapter, except that laws and regulations designed and intended to apply to Medicare supplement insurance policies shall not be applied to long-term care insurance.  2008 Acts, ch 1175, §3; 2009 Acts, ch 145, §11, 55; 2015 Acts, ch 128, §21, 50, 51
IA Code § 514G.104 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.104 - Extraterritorial jurisdiction — group long-term care insurance.

514G.104 Extraterritorial jurisdiction — group long-term care insurance.   Group long-term care insurance coverage shall not be offered to a resident of this state under a group policy issued in another state unless either this state or another state with statutory and regulatory requirements for long-term care insurance that are substantially similar to those adopted in this state has made a determination that the group to which the policy is issued meets the requirements of section 514G.103, subsection 9, paragraph “d”.  2008 Acts, ch 1175, §5; 2009 Acts, ch 145, §12
IA Code § 514G.106 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.106 - Incontestability period.

514G.106 Incontestability period.   1. An insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim if the policy or certificate has been in force for less than six months upon a showing of misrepresentation that is material to the insurer’s acceptance for coverage.   2. An insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim if the policy or certificate has been in force for at least six months but less than two years, upon a showing of misrepresentation that is both material to the acceptance for coverage and pertains to the condition for which benefits are sought.   3. An insurer shall not contest a long-term care insurance policy or certificate that has been in force for two or more years solely upon the grounds of misrepresentation. Such a policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured’s health.   4. A long-term care insurance policy or certificate may be field-issued if the compensation paid to the field issuer is not based on the number of policies or certificates issued. For the purposes of this subsection, a “field-issued” policy means a policy or certificate issued by a producer or third-party administrator pursuant to the underwriting authority granted to the producer or third-party administrator by an insurer and using the insurer’s underwriting guidelines.   5. An insurer that has paid benefits under a long-term care insurance policy or certificate shall not recover such benefit payments if the policy or certificate is rescinded.   6. The provisions of this section are applicable to life insurance policies or certificates that accelerate benefits for long-term care. However, if an insured dies, the remaining death benefits of a life insurance policy that accelerates benefits for long-term care are not governed by this section but by the provisions of section 508.28. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.  2008 Acts, ch 1175, §7
IA Code § 514G.107 (2021)
2021 Iowa Code|Title XIII - COMMERCE|Chapter 514G - LONG-TERM CARE INSURANCE ACT|Section 514G.107 - Nonforfeiture benefits.

514G.107 Nonforfeiture benefits.   1. Except as otherwise provided in subsection 2, a long-term care insurance policy or certificate shall not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate that includes a nonforfeiture benefit. A nonforfeiture benefit may be offered in the form of a rider that is attached to the policy or certificate. If the policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that is available for a specified period of time following a substantial increase in premium rates.   2. When a group long-term care insurance policy or certificate is delivered or issued for delivery in this state, an offer of benefits shall be made to the group policyholder that meets the requirements of subsection 1. However, if the policy is delivered or issued for delivery to a group as described in section 514G.103, subsection 9, paragraph “d”, that is not a continuing care retirement community or other similar entity, the offer of benefits shall be made to each proposed certificate holder.   3. The commissioner shall, by rule, specify the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates, the standards for such nonforfeiture benefits, and the standards for contingent benefit upon lapse including a specified period of time during which a contingent benefit upon lapse will be available and what constitutes a substantial premium rate increase that will trigger a contingent benefit upon lapse as provided in subsection 1.  2008 Acts, ch 1175, §8