reglab/statecodes huggingface dataset:
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM › Section 513C.7 - Availability of coverage.

513C.7 Availability of coverage.
1. a. A carrier shall file with the commissioner, in a form and manner prescribed by the commissioner, the basic or standard health benefit plan. A basic or standard health benefit plan filed pursuant to this paragraph may be used by a carrier beginning thirty days after it is filed unless the commissioner disapproves of its use.
b. The commissioner may at any time, after providing notice and an opportunity for a hearing to the carrier, disapprove the continued use by a carrier of a basic or standard health benefit plan on the grounds that the plan does not meet the requirements of this chapter.
2. The individual basic or standard health benefit plan shall not deny, exclude, or limit benefits for a covered individual for losses incurred more than twelve months following the effective date of the individual’s coverage due to a preexisting condition. A preexisting condition shall not be defined more restrictively than any of the following:
a. A condition that would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment during the twelve months immediately preceding the effective date of coverage.
b. A condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve months immediately preceding the effective date of coverage.
c. A pregnancy existing on the effective date of coverage.
3. A carrier shall not modify a basic or standard health benefit plan with respect to an individual or dependent through riders, endorsements, or other means to restrict or exclude coverage for certain diseases or medical conditions otherwise covered by the health benefit plan.
95 Acts, ch 5, §9; 97 Acts, ch 103, §37 – 39; 99 Acts, ch 165, §9, 10; 2003 Acts, ch 91, §24; 2004 Acts, ch 1158, §2, 21; 2008 Acts, ch 1188, §40, 41, 43; 2012 Acts, ch 1023, §157; 2017 Acts, ch 148, §54, 55
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM › Section 513C.8 - Health benefit plan standards.

513C.8 Health benefit plan standards.
The board of directors of the Iowa comprehensive health insurance association, with the approval of the commissioner, shall adopt the form and level of coverage of the basic health benefit plan and the standard health benefit plan for the individual market which shall provide benefits substantially similar to the current state of the individual market.
95 Acts, ch 5, §10; 2001 Acts, ch 125, §3; 2004 Acts, ch 1110, §36; 2004 Acts, ch 1158, §3
Referred to in §513C.3
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM › Section 513C.9 - Standards to assure fair marketing.

513C.9 Standards to assure fair marketing.
1. A carrier or an agent shall not do either of the following:
a. Encourage or direct individuals to refrain from filing an application for coverage with the carrier because of the health status, claims experience, industry, occupation, or geographic location of the individuals.
b. Encourage or direct individuals to seek coverage from another carrier because of the health status, claims experience, industry, occupation, or geographic location of the individuals.
2. Subsection 1, paragraph “a”, shall not apply with respect to information provided by a carrier or an agent to an individual regarding the established geographic service area of the carrier or the restricted network provision of the carrier.
3. A carrier shall not, directly or indirectly, enter into any contract, agreement, or arrangement with an agent that provides for, or results in, the compensation paid to an agent for a sale of a basic or standard health benefit plan to vary because of the health status or permitted rating characteristics of the individual or the individual’s dependents.
4. Notwithstanding subsection 3, a commission shall be paid to an agent related to the sale of a basic or standard health benefit plan under this chapter. A commission paid pursuant to this subsection shall not be considered by the board for purposes of section 513C.10, subsection 5.
5. Subsection 3 does not apply with respect to the compensation paid to an agent on the basis of percentage of premium, provided that the percentage shall not vary because of the health status or other permitted rating characteristics of the individual or the individual’s dependents.
6. Denial by a carrier of an application for coverage from an individual shall be in writing and shall state the reason or reasons for the denial.
7. A violation of this section by a carrier or an agent is an unfair trade practice under chapter 507B.
8. If a carrier enters into a contract, agreement, or other arrangement with a third-party administrator to provide administrative, marketing, or other services related to the offering of individual health benefit plans in this state, the third-party administrator is subject to this section as if it were a carrier.
95 Acts, ch 5, §11; 97 Acts, ch 103, §40; 2006 Acts, ch 1117, §56; 2017 Acts, ch 148, §56
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM › Section 513C.11 - Self-funded employer-sponsored health benefit plan participation in reinsurance association.

513C.11 Self-funded employer-sponsored health benefit plan participation in reinsurance association.
1. A self-funded employer-sponsored health benefit plan qualified under the federal Employee Retirement Income Security Act of 1974 may voluntarily elect to participate in the Iowa individual health benefit reinsurance association established in section 513C.10 in accordance with the plan of operation and subject to such terms and conditions adopted by the board of the association established in section 514E.2 to provide portability and continuity to its covered employees and their covered spouses and dependents subject to the same terms and conditions as a participating insurer.
2. If the federal Employee Retirement Income Security Act of 1974 is amended such that the state may require the participation of a self-funded employer, the individual reinsurance requirements shall apply equally to such employers.
3. When and if the federal government imposes conditions of portability and continuity on self-funded employers qualified under the federal Employee Retirement Income Security Act of 1974 that the commissioner deems are substantially similar to those required of Iowa insurers, coverage under such qualified plans shall be deemed qualified prior coverage for purposes of chapter 513B and this chapter.
95 Acts, ch 5, §13; 2002 Acts, ch 1119, §67
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513D - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 513D.2 - Rules and enforcement.

513D.2 Rules and enforcement.
1. The commissioner of insurance shall adopt rules as necessary pursuant to chapter 17A to administer this chapter.
2. The commissioner of insurance may take any enforcement action under the commissioner’s authority to enforce compliance with this chapter.
2018 Acts, ch 1063, §6; 2019 Acts, ch 59, §184; 2019 Acts, ch 89, §16; 2021 Acts, ch 181, §12
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.1 - Applicability — definitions.

514.1 Applicability — definitions.
1. A corporation organized under chapter 504, Code 1989, or current chapter 504 for the purpose of establishing, maintaining, and operating a nonprofit hospital service plan, whereby hospital service may be provided by the corporation or by a hospital with which it has a contract for service, to the public who become subscribers to this plan under a contract which entitles each subscriber to hospital service; or a corporation organized for the purpose of establishing, maintaining, and operating a plan whereby health care service may be provided at the expense of this corporation, by licensed physicians and surgeons, dentists, podiatric physicians, osteopathic physicians, osteopathic physicians and surgeons or chiropractors, to subscribers under contract, entitling each subscriber to health care service, as provided in the contract; or a corporation organized for the purpose of establishing, maintaining, and operating a nonprofit pharmaceutical service plan or optometric service plan, whereby pharmaceutical or optometric service may be provided by this corporation or by a licensed pharmacy with which it has a contract for service, to the public who become subscribers to this plan under a contract which entitles each subscriber to pharmaceutical or optometric service; shall be governed by this chapter and is exempt from all other provisions of the insurance laws of this state, unless specifically designated in this chapter, not only in governmental relations with the state but for every other purpose, and additions enacted after July 1, 1939, shall not apply to these corporations unless they are expressly designated in the additions.
2. For the purposes of this chapter:
a. “Health care” means that care necessary for the purpose of preventing, alleviating, curing, or healing human physical or mental illness, injury, or disability.
b. “Provider” means a person as defined in section 4.1, subsection 20, which is licensed or authorized in this state to furnish health care services.
c. “Subscriber” means an individual who enters into a contract for health care services with a corporation subject to this chapter and includes a person eligible for mandatory medical assistance or optional medical assistance as defined under chapter 249A, with respect to whom the department of human services has entered into a contract with a firm operating under this chapter.
[C39, §8895.01; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.1]
83 Acts, ch 27, §11; 83 Acts, ch 96, §157, 159; 84 Acts, ch 1122, §3; 86 Acts, ch 1180, §3; 96 Acts, ch 1034, §68; 2003 Acts, ch 108, §96; 2004 Acts, ch 1049, §191; 2004 Acts, ch 1175, §394; 2007 Acts, ch 22, §86; 2013 Acts, ch 138, §76; 2014 Acts, ch 1026, §114
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.2 - Incorporation.

514.2 Incorporation.
Persons desiring to form a nonprofit hospital service corporation, or a nonprofit medical service corporation, or a nonprofit pharmaceutical or optometric service corporation shall have been incorporated under the provisions of chapter 504, Code 1989, or shall incorporate under the provisions of current chapter 504.
[C39, §8895.02; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.2]
2003 Acts, ch 108, §97; 2004 Acts, ch 1049, §191; 2004 Acts, ch 1086, §87; 2004 Acts, ch 1175, §394; 2006 Acts, ch 1030, §62
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.2A - Service of process.

514.2A Service of process.
A nonprofit health service corporation authorized to do business in this state shall file in the office of the commissioner a power of attorney and an agreement in writing that service of process in any action or proceeding against the corporation may be made on the commissioner and shall be of the same legal force and validity as if made upon the corporation, and that the authority shall continue in force so long as any liability remains outstanding in this state. A copy of the power of attorney, certified by the commissioner, shall be deemed sufficient evidence of the appointment and shall be admitted in evidence with the same force and effect as the original. Service of process made on the commissioner as the attorney for service of process shall be made as provided in section 505.30.
2003 Acts, ch 91, §27; 2018 Acts, ch 1018, §7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.3 - Approval by commissioner.

514.3 Approval by commissioner.
The articles of incorporation, and any subsequent amendments, of a corporation shall have endorsed on or annexed to those articles or amendments the approval of the commissioner of insurance before the same shall be filed for record. A corporation shall file with the commissioner bylaws and subsequent amendments to the bylaws within thirty days of the adoption of the bylaws and amendments.
[C39, §8895.03; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.3]
2000 Acts, ch 1023, §22; 2002 Acts, ch 1119, §180
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.5 - Contracts for service.

514.5 Contracts for service.
1. A hospital service corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter, may enter into contracts for the rendering of hospital service to any of its subscribers with hospitals maintained and operated by the state or any of its political subdivisions, or by any corporation, association, or individual. Such hospital service corporation may also contract with an ambulatory surgical facility to provide surgical services to the corporation’s subscribers. Hospital service is meant to include bed and board, general nursing care, use of the operating room, use of the delivery room, ordinary medications and dressings and other customary routine care. “Ambulatory surgical facility” means a facility constructed and operated for the specific purpose of providing surgery to patients admitted to and discharged from the facility within the same day.
2. A medical service corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter, may enter into contracts with subscribers to furnish health care service through physicians and surgeons, dentists, podiatric physicians, osteopathic physicians, osteopathic physicians and surgeons, or chiropractors.
3. Any pharmaceutical or optometric service corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter, may enter into contracts for the rendering of pharmaceutical or optometric service to any of its subscribers. Membership in any pharmaceutical service corporation shall be open to all pharmacies licensed under chapter 155A.
4. A hospital service corporation or medical service corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter, may enter into contracts with subscribers and providers to furnish health care services not otherwise allocated by this section.
[C39, §8895.05; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.5]
83 Acts, ch 27, §13; 84 Acts, ch 1122, §4; 86 Acts, ch 1180, §4; 87 Acts, ch 215, §48; 96 Acts, ch 1034, §68; 2003 Acts, ch 108, §98; 2004 Acts, ch 1049, §191; 2004 Acts, ch 1175, §394; 2016 Acts, ch 1011, §121; 2017 Acts, ch 29, §146
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.8 - Contracts with providers — approval.

514.8 Contracts with providers — approval.
The contracts by any such corporation with participating hospitals for hospital service or with participating physicians and surgeons, dentists, podiatric physicians, osteopathic physicians, or osteopathic physicians and surgeons for medical and surgical service, or with participating pharmacies for pharmaceutical service, or with participating optometrists for optometric service, or with other providers shall at all times be subject to the approval of the commissioner of insurance.
[C39, §8895.08; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.8]
84 Acts, ch 1122, §7; 96 Acts, ch 1034, §68
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.9 - Annual report.

514.9 Annual report.
Every such corporation shall annually, on or before the first day of March, file in the office of the commissioner of insurance a statement verified by at least two of the principal officers of said corporation showing its condition on the thirty-first day of December then next preceding, which shall be in such form and shall contain such matters as the commissioner of insurance shall prescribe.
[C39, §8895.09; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.9]
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.9A - Certificate of authority — renewal.

514.9A Certificate of authority — renewal.
A certificate of authority of a corporation formed under this chapter expires on June 1 succeeding its issue and shall be renewed annually so long as the corporation transacts its business in accordance with all legal requirements. A corporation shall submit annually, on or before March 1, a completed application for renewal of its certificate of authority. A corporation that fails to timely file an application for renewal shall pay an administrative penalty of five hundred dollars to the treasurer of state for deposit as provided in section 505.7. A duly certified copy or duplicate of the certificate is admissible in evidence for or against the corporation with the same effect as the original.
2006 Acts, ch 1117, §57; 2009 Acts, ch 181, §72
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.10 - Examination.

514.10 Examination.
Every such corporation shall be subject to examination under the provisions of chapter 507 and any acts amendatory thereto, so far as the chapter may be applicable.
[C39, §8895.10; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.10]
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.11 - Costs approved.

514.11 Costs approved.
All acquisition costs in connection with the solicitation of subscribers to such hospital service plan or medical service plan or pharmaceutical or optometric service plan, and administration costs including salaries paid its officers, if any, shall at all times be subject to the approval of the commissioner of insurance.
[C39, §8895.11; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.11]
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.12 - Investment of funds.

514.12 Investment of funds.
The funds of any corporation subject to the provisions of this chapter shall be invested only in securities permitted by the laws of this state for the investment of funds of life insurance companies.
[C39, §8895.12; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.12]
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.13 - Arbitration of disputes.

514.13 Arbitration of disputes.
Any dispute arising between a corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter, and a provider may be submitted to the commissioner of insurance for a decision. All decisions and findings of the commissioner of insurance may be judicially reviewed in accordance with the terms of chapter 17A.
[C39, §8895.13; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.13]
84 Acts, ch 1122, §8; 2017 Acts, ch 29, §147
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.14 - Dissolution or merger.

514.14 Dissolution or merger.
Any dissolution, merger, or liquidation of a corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter shall be under the supervision of the commissioner of insurance who shall have all powers with respect thereto granted to the commissioner under the insurance laws of this state.
[C39, §8895.14; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.14]
2017 Acts, ch 29, §148
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.15 - Nonexempt from taxation.

514.15 Nonexempt from taxation.
Every corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter, is hereby declared to be a charitable and benevolent institution but its property and funds, including subscribers’ contracts, shall not be exempt from taxation. For purposes of this section, the term “subscriber contract” shall mean only those benefit contracts issued or delivered in Iowa by corporations subject to this chapter, including certificates issued under such contracts, and which provide coverage to residents of Iowa on a risk basis.
[C39, §8895.15; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.15; 82 Acts, ch 1003, §6]
85 Acts, ch 239, §3; 2017 Acts, ch 29, §149
Rate of tax; §432.2
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.16 - Governmental employees included.

514.16 Governmental employees included.
An employee or employees of the state, or of any county, city or of any institution supported in whole or in part by public funds, or any subdivisions thereof, may authorize the deduction from their salary or wages of the amount of their subscription payments to any corporation operating a nonprofit hospital service plan or medical service plan or pharmaceutical or optometric service plan, as provided in this chapter. The governing body of the state, or of the county, city or of any institution supported in whole or in part by public funds, or any subdivisions thereof, may authorize deductions from the salaries or wages of employees subscribing to such nonprofit hospital service plan or medical service plan or pharmaceutical or optometric service plan. The authorization by an employee or employees for deductions from the employee’s or employees’ salaries or wages shall be evidenced by a written request signed by the employee directed to and filed with the treasurer of the state, county, city or of any institution supported in whole or in part by public funds, or any subdivisions thereof, and said treasurer is authorized to draw and deliver checks in favor of the hospital service corporation or medical service corporation or pharmaceutical or optometric service corporation stipulated in such authorization for the amount covering the sum total of the deductions authorized. The foregoing provisions are not to be deemed an assignment of salaries or wages.
[C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.16]
Referred to in §509A.3, 514B.21
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.17 - Physicians and surgeons, podiatric physicians, or dentists — number required.

514.17 Physicians and surgeons, podiatric physicians, or dentists — number required.
No nonprofit medical service corporation shall be permitted to operate until it shall have entered into contracts with at least one hundred fifty physicians and surgeons licensed to practice medicine and surgery pursuant to chapter 148, or one hundred fifty dentists licensed to practice dentistry pursuant to chapter 153, or at least one hundred fifty osteopathic physicians and surgeons licensed to practice osteopathic medicine and surgery pursuant to chapter 148, or at least twenty-five podiatric physicians licensed to practice podiatry pursuant to chapter 149, who agree to furnish medical and surgical, podiatric, or dental service and be governed by the bylaws of the corporation.
[C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.17]
96 Acts, ch 1034, §68; 2008 Acts, ch 1088, §127
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.18 - Podiatric physicians.

514.18 Podiatric physicians.
Medical or surgical services or procedures constituting the practice of podiatry, also known as chiropody, as provided in chapter 149, and covered by the terms of any individual, group, blanket, or franchise policy providing accident or health benefits hereafter delivered or hereafter issued for delivery in Iowa and covering an Iowa risk may be performed by any practitioner, selected by the insured, licensed under chapter 149 to perform such medical or surgical services or procedures. Any provision of such policy or exclusion or limitation denying an insured the free choice of such licensed podiatric physician, also known as chiropodist, shall to the extent of the denial, be void, but such voidance shall not affect the validity of the other provisions of the policy.
[C66, 71, 73, 75, 77, 79, 81, §514.18]
95 Acts, ch 108, §18; 2017 Acts, ch 29, §150
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.19 - Combined service corporations.

514.19 Combined service corporations.
A corporation subject to this chapter may combine with any other corporation subject to this chapter as permitted under chapter 504 and upon the approval by the commissioner of insurance. Each corporation shall comply with chapter 504, the corporation’s articles of incorporation, and the corporation’s bylaws. The combined service corporation shall continue the service benefits previously provided by each corporation and may, subject to the approval of the commissioner of insurance, offer other service benefits not previously provided by the corporations before combining, which are permitted under this chapter.
83 Acts, ch 27, §14; 2004 Acts, ch 1049, §191; 2004 Acts, ch 1175, §393; 2007 Acts, ch 22, §87
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.21 - Utilization review program.

514.21 Utilization review program.
A utilization review program shall be established for purposes of health care cost control, according to usual and customary third-party insurance payment or reimbursement procedures, by a corporation subject to this chapter and by physician providers as defined in section 135.1 and registered nurse providers licensed under chapter 152. This utilization review program shall not be used directly or indirectly to circumvent the provisions for payment or reimbursement to providers of health care services as provided in section 509.3, subsection 1, paragraphs “f” and “g”, and section 514.7.
86 Acts, ch 1180, §9; 89 Acts, ch 164, §4
Utilization and cost control; see also chapter 514F
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514 - NONPROFIT HEALTH SERVICE CORPORATIONS › Section 514.23 - Mutualization plan.

514.23 Mutualization plan.
1. A corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter, may become a mutual insurer under a plan which is approved by the commissioner of insurance. The plan shall state whether the insurer will be organized as a for-profit corporation pursuant to chapter 490 or 491 or a nonprofit corporation pursuant to chapter 504. Upon consummation of the plan, the corporation shall fully comply with the requirements of the law that apply to a mutual insurance company. If the insurer is to be organized under chapter 504, then at least seventy-five percent of the initial board of directors of the mutual insurer so formed shall be policyholders who are also nonproviders of health care. All directors comprising this initial board of directors shall be selected by an independent committee appointed by the state commissioner of insurance. This independent committee shall consist of seven to eleven persons who are current policyholders, who are nonproviders of health care, and who are not directors of a corporation subject to this chapter. For purposes of this subsection, a “nonprovider of health care” is an individual who is not any of the following:
a. A “provider” as defined in section 514B.1, subsection 7.
b. A person who has material financial or fiduciary interest in the delivery of health care services or a related industry.
c. An employee of an institution which provides health care services.
d. A spouse or a member of the immediate family of a person described in paragraphs “a” through “c”.
2. A corporation organized under chapter 504, Code 1989, or current chapter 504, and governed by this chapter, which becomes a mutual insurer under this section shall continue as a mutual insurer to be governed by the provisions of section 514.7 and shall also be governed by section 509.3, subsection 1, paragraph “f”.
85 Acts, ch 239, §4; 86 Acts, ch 1180, §6; 90 Acts, ch 1205, §36; 2004 Acts, ch 1049, §191; 2004 Acts, ch 1175, §393; 2017 Acts, ch 29, §151, 152
Referred to in §504.1108, 514E.1
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.1 - Definition of accident and sickness insurance policy.

514A.1 Definition of accident and sickness insurance policy.
1. As used in this chapter, “policy of accident and sickness insurance” includes a policy or contract covering insurance against loss resulting from sickness, or from bodily injury or death by accident, or both. For the purposes of this chapter the words “policy of accident and sickness insurance” are interchangeable without deviation of meaning with the words “policy of accident and health insurance” or the words “policy of accident or health insurance”.
2. This chapter applies to all individual policies of such accident and sickness insurance written by Iowa or non-Iowa companies or associations duly licensed under chapter 508, 515, or 520 and, societies, orders, or associations licensed under chapter 512B writing sickness and accident policies providing benefits for loss of time.
3. Orders, societies or associations which admit to membership only persons engaged in one or more crafts or hazardous occupations in the same or similar lines of business and the societies or auxiliaries to such orders shall not be subject to the provisions of this chapter nor shall any religious order be subject to the provisions of this chapter.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.1]
89 Acts, ch 83, §72, 73; 2012 Acts, ch 1023, §115
Referred to in §514D.2, 514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.2 - Form of policy.

514A.2 Form of policy.
1. No policy of accident and sickness insurance shall be delivered or issued for delivery to any person in this state unless:
a. The entire money and other considerations therefor are expressed therein; and
b. The time at which the insurance takes effect and terminates is expressed therein; and
c. It purports to insure only one person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family who shall be deemed the policyholder, any two or more eligible members of that family, including husband, wife, dependent children or any children under a specified age which shall not exceed nineteen years and any other person dependent upon the policyholder; and
d. The style, arrangement and over-all appearance of the policy give no undue prominence to any portion of the text, and unless every printed portion of the text of the policy and of any endorsements or attached papers is plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten point with a lower-case unspaced alphabet length not less than one hundred and twenty point (the “text” shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description if any, and captions and subcaptions); and
e. The exceptions and reductions of indemnity are set forth in the policy and, except those which are set forth in section 514A.3, are printed, at the insurer’s option, either included with the benefit provision to which they apply, or under an appropriate caption such as “exceptions”, or “exceptions and reductions”, provided that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies; and
f. Each such form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof; and
g. It contains no provision purporting to make any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the commissioner.
2. If any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of such other state shall have advised the commissioner that any such policy is not subject to approval or disapproval by such official, the commissioner may by ruling require that such policy meet the standards set forth in subsection 1 of this section and in section 514A.3.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.2]
Referred to in §514A.12, 514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.3A - Refund of unearned premium upon death of insured.

514A.3A Refund of unearned premium upon death of insured.
In the event of the death of the insured of any policy covered by this chapter, the insurer, upon receipt of notice of the insured’s death supported by a certified copy of a valid death certificate and a request for a pro rata refund by a party entitled to claim such a refund, shall refund the unearned premium prorated to the month of the insured’s death. Refund of the premium and termination of the coverage shall be without prejudice to any claim originating prior to the date of the insured’s death. The commissioner of insurance shall adopt by rule the minimum amount required for issuance of a refund.
2004 Acts, ch 1110, §39
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.3B - Additional requirements.

514A.3B Additional requirements.
1. An insurer which accepts an individual for coverage under an individual policy or contract of accident and health insurance shall waive any time period applicable to a preexisting condition exclusion or limitation period requirement of the policy or contract with respect to particular services in an individual health benefit plan for the period of time the individual was previously covered by qualifying previous coverage as defined in section 513C.3, by chapter 249A or 514I, or by Medicare coverage provided pursuant to Tit. XVIII of the federal Social Security Act that provided benefits with respect to such services, provided that the coverage was continuous to a date not more than sixty-three days prior to the effective date of the new policy or contract.
2. An insurer issuing an individual policy or contract of accident and health insurance which provides coverage for children of the insured 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 insured or 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.
3. For the purposes of any policies of accident and sickness insurance issued in this state, “creditable coverage” means health benefits or coverage provided to an individual under any of the following:
a. A group health plan.
b. Health insurance coverage.
c. Part A or Part B Medicare pursuant to Tit. XVIII of the federal Social Security Act.
d. Medicaid pursuant to Tit. XIX of the federal Social Security Act, other than coverage consisting solely of benefits under section 1928 of that Act.
e. 10 U.S.C. ch. 55.
f. A health or medical care program provided through the Indian health service or a tribal organization.
g. A state health benefits risk pool.
h. A health plan offered under 5 U.S.C. ch. 89.
i. A public health plan as defined under federal regulations.
j. A health benefit plan under section 5(e) of the federal Peace Corps Act, 22 U.S.C. §2504(e).
k. A short-term limited duration policy.
l. The hawk-i program authorized by chapter 514I.
2008 Acts, ch 1188, §42, 43; 2009 Acts, ch 118, §9, 11, 21, 22; 2017 Acts, ch 148, §60
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.4 - Conforming to statute.

514A.4 Conforming to statute.
1. Other policy provisions. A policy provision which is not subject to section 514A.3 shall not make a policy, or any portion of a policy, less favorable in any respect to the insured or the beneficiary than the provisions of the policy which are subject to this chapter.
2. Policy conflicting with this chapter. A policy delivered or issued for delivery to any person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this chapter.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.4]
2019 Acts, ch 59, §185
Referred to in §514A.12, 514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.5 - Application.

514A.5 Application.
1. The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is endorsed on the policy when issued as a part thereof or is furnished to the policyholder within thirty days after the policy is issued. If any such policy delivered or issued for delivery to any person in this state shall be reinstated or renewed, and the insured or the beneficiary or assignee of such policy shall make written request to the insurer for a copy of the application, if any, for such reinstatement or renewal, the insurer shall within fifteen days after the receipt of such request at its home office or any branch office of the insurer, deliver or mail to the person making such request, a copy of such application. If such copy shall not be so delivered or mailed, the insurer shall be precluded from introducing such application as evidence in any action or proceeding based upon or involving such policy or its reinstatement or renewal.
2. No alteration of any written application for any such policy shall be made by any person other than the applicant without the applicant’s written consent, except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant.
3. The falsity of any statement in the application for any policy covered by this chapter may not bar the right to recovery thereunder unless such false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.5]
2005 Acts, ch 70, §12
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.6 - Notice — waiver.

514A.6 Notice — waiver.
The acknowledgment by any insurer of the receipt of notice given under any policy covered by this chapter, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.6]
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.7 - Age limit.

514A.7 Age limit.
If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.7]
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.8 - Nonapplication to certain policies.

514A.8 Nonapplication to certain policies.
Nothing in this chapter shall apply to or affect any of the following:
1. Any policy of workers’ compensation insurance or any policy of liability insurance with or without supplementary expense coverage therein.
2. Any policy or contract of reinsurance.
3. Any blanket or group policy of insurance.
4. Life insurance, endowment or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to accident and sickness insurance as provide additional benefits in case of death or dismemberment or loss of sight by accident, or as operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.8]
2018 Acts, ch 1041, §102
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.10 - Judicial review.

514A.10 Judicial review.
Judicial review of the actions of the commissioner may be sought in accordance with the terms of the Iowa administrative procedure Act, chapter 17A.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.10]
2003 Acts, ch 44, §114
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.11 - Inconsistent acts not applicable.

514A.11 Inconsistent acts not applicable.
All Acts or parts of Acts inconsistent with this chapter shall not apply to the provisions hereof to the extent of said inconsistency.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.11]
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.12 - Title and effective date of chapter.

514A.12 Title and effective date of chapter.
This chapter may be cited as the “Uniform Individual Accident and Sickness Act.” This chapter shall take effect on the fourth day of July, 1951. A policy, filed with and approved by the insurance commissioner prior to the effective date of this chapter for use, delivery, or issue for delivery to any person in this state, may continue to be used, or delivered, or issued for delivery to any person in this state for a period of five years from and after said effective date without being subject to the provisions of sections 514A.2, 514A.3 and 514A.4; and any rider or endorsement filed with and approved by the insurance commissioner at any time may be used, or delivered, or issued for delivery to any person holding such a policy without being subject to the provisions of sections 514A.2, 514A.3 and 514A.4.
[C54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514A.12]
Referred to in §514D.3, 514D.7
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.13 - Filing requirement — prior approval.

514A.13 Filing requirement — prior approval.
1. A policy of insurance against loss or expense from sickness or from the bodily injury or death by accident of the insured shall not be issued or delivered to any person in this state and an application, rider, or endorsement shall not be used in connection with the policy until a copy of the policy form and of the classification of risks and the premium rates, or, in the case of cooperatives or assessment companies the estimated costs pertaining to the policy, have been filed with and approved by the commissioner.
2. A filing is deemed to be approved unless disapproved by the commissioner within thirty days of receipt of the filing by the commissioner. Subsequent rate changes are also subject to this section.
91 Acts, ch 213, §17; 92 Acts, ch 1162, §20; 2018 Acts, ch 1041, §127
Referred to in §514A.14
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.14 - Disapproval of filing.

514A.14 Disapproval of filing.
1. The commissioner shall notify an insurer which has filed a policy form pursuant to section 514A.13 that does not comply with this chapter or chapter 514D, or rules adopted pursuant to those chapters. The notice shall inform the insurer that it is unlawful for the insurer to issue the form or use it in connection with any policy, if the commissioner finds upon review of the form, either of the following:
a. The benefits provided are unreasonable in relation to the premium charged.
b. The form contains a provision which is unjust, unfair, inequitable, misleading, deceptive, or which encourages misrepresentation of the policy.
2. In a notice provided under subsection 1, the commissioner shall specify the reasons for disapproval and state that a hearing will be granted within twenty days after request in writing by the insurer.
91 Acts, ch 213, §18
Referred to in §514A.15
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514A - ACCIDENT AND HEALTH INSURANCE › Section 514A.15 - Withdrawal of approval.

514A.15 Withdrawal of approval.
The commissioner may at any time, after opportunity for hearing, withdraw the commissioner’s previously given approval of any such form on any of the grounds stated in section 514A.14. It shall be unlawful for the insurer to issue a form or use the form in connection with any policy after the effective date of the withdrawal of approval. The notice of any hearing granted under this section shall specify the matters to be considered at the hearing. Any decision affirming disapproval or directing withdrawal of approval under this section shall be in writing and shall specify the reasons for the disapproval or withdrawal of approval.
91 Acts, ch 213, §19
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS › Section 514B.2 - Establishment of health maintenance organizations.

514B.2 Establishment of health maintenance organizations.
Any person may apply to the commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. A person shall not establish or operate a health maintenance organization in this state, nor sell, offer to sell, or solicit offers to purchase or receive advance or periodic consideration in conjunction with a health maintenance organization without obtaining a certificate under this chapter.
[C75, 77, 79, 81, §514B.2]
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS › Section 514B.3A - Articles — approval — bylaws.

514B.3A Articles — approval — bylaws.
The articles of incorporation, and any subsequent amendments, of a corporation shall be filed with and approved by the commissioner of insurance before filing with the secretary of state. A corporation shall file bylaws and subsequent amendments to the bylaws with the commissioner within thirty days of adoption of the bylaws and amendments.
2000 Acts, ch 1023, §24; 2009 Acts, ch 145, §10