reglab/statecodes huggingface dataset:
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.6 - Uniformity of treatment — employee welfare benefit plans.

514C.6 Uniformity of treatment — employee welfare benefit plans.
1. A statutory provision to mandate a health care coverage or service, or to mandate the offering of a health care coverage or service, applies to all state-regulated third-party payors and to employee welfare benefit plans described in 29 U.S.C. §1001 et seq. However, if an employee welfare benefit plan subject to federal regulation is not subject to a substantially similar requirement, the statutory provision does not apply to a state-regulated third-party payor until the employee welfare benefit plans are subject to a substantially similar standard under federal regulations as determined by the commissioner.
2. For purposes of this section unless the context otherwise requires, a third-party payor means:
a. An accident and sickness insurer, subject to chapter 509 or 514A.
b. A nonprofit health service corporation, subject to chapter 514.
c. A health maintenance organization, subject to chapter 514B.
d. Any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
91 Acts, ch 213, §20
Referred to in §514C.7, 514C.11, 514C.12, 514C.18, 514C.19, 514C.20, 514C.22, 514C.23, 514C.24, 514C.25, 514C.26, 514C.27, 514C.28, 514C.29, 514C.30, 514C.31, 514C.32, 514C.33, 514C.34, 514C.35
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.7 - Prohibition on restricting coverage in certain instances involving a diagnosis of a fibrocystic condition.

514C.7 Prohibition on restricting coverage in certain instances involving a diagnosis of a fibrocystic condition.
Notwithstanding the uniformity of treatment requirements of section 514C.6, a third-party payor as defined in that section shall not deny or fail to renew, or include an exception to or exclusion of benefits in, a policy or contract of individual or group accident and sickness insurance solely based upon an insured being diagnosed as having a fibrocystic condition.
92 Acts, ch 1046, §1
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.8 - Coordination of health care benefits with state medical assistance.

514C.8 Coordination of health care benefits with state medical assistance.
1. An insurer, health maintenance organization, or hospital and medical service plan providing health care coverage to individuals in this state shall not consider the availability of or eligibility for medical assistance under Tit. XIX of the federal Social Security Act and chapter 249A, when determining eligibility of the individual for coverage or calculating payments to the individual under the health care coverage plan.
2. The state acquires the rights of an individual to payment from an insurer, health maintenance organization, or hospital or medical service plan to the extent payment for covered expenses is made pursuant to chapter 249A for health care items or services provided to the individual. Upon presentation of proof that payment was made pursuant to chapter 249A for covered expenses, the insurer, health maintenance organization, or hospital or medical service plan shall make payment to the state medical assistance program to the extent of the coverage provided in the policy or contract.
3. An insurer shall not impose requirements on the state with respect to the assignment of rights pursuant to this section that are different from the requirements applicable to an agent or assignee of a covered individual.
4. For purposes of this section, “insurer” means an entity which offers a health benefit plan, including a group health plan under the federal Employee Retirement Income Security Act of 1974.
95 Acts, ch 185, §13; 2010 Acts, ch 1061, §180
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.10 - Coverage for adopted child.

514C.10 Coverage for adopted child.
1. Definitions. For purposes of this section, unless the context otherwise requires:
a. “Child” means, with respect to an adoption or a placement for adoption of a child, an individual who has not attained age eighteen as of the date of the issuance of a final adoption decree, or upon an interlocutory adoption decree becoming a final adoption decree, as provided in chapter 600, or as of the date of the placement for adoption.
b. “Placement for adoption” means the assumption and retention of a legal obligation for the total or partial support of the child in anticipation of the adoption of the child. The child’s placement with a person terminates upon the termination of such legal obligation.
2. Coverage required. A policy or contract providing for third-party payment or prepayment of health or medical expenses shall provide coverage benefits to a dependent child adopted by, or placed for adoption with, an insured or enrollee under the same terms and conditions as apply to a biological, dependent child of the insured or enrollee. The issuer of the policy or contract shall not restrict coverage under the policy or contract for a dependent child adopted by, or placed for adoption with, the insured or enrollee solely on the basis of a preexisting condition of such dependent child at the time that the child would otherwise become eligible for coverage under the plan, if the adoption or placement occurs while the insured or enrollee is eligible for coverage under the policy or contract. This section applies to the following classes of third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after July 1, 1995:
a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. An individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law.
95 Acts, ch 185, §15; 2017 Acts, ch 148, §62
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.12 - Postdelivery benefits and care.

514C.12 Postdelivery benefits and care.
1. Notwithstanding section 514C.6, a person who provides an individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509, 509A, 514, or 514A or an individual or group health maintenance organization contract issued and regulated under chapter 514B, which is delivered, amended, or renewed on or after July 1, 1996, and which provides maternity benefits, which are not limited to complications of pregnancy, or newborn care benefits, shall not terminate inpatient benefits or require discharge of a mother or the newborn from a hospital following delivery earlier than determined to be medically appropriate by the attending physician after consultation with the mother and in accordance with guidelines adopted by rule by the commissioner. The guidelines adopted by rule shall be consistent with or may adopt by reference the guidelines for perinatal care established by the American academy of pediatrics and the American college of obstetricians and gynecologists which provide that when complications are not present, the postpartum hospital stay ranges from a minimum of forty-eight hours for a vaginal delivery to a minimum of ninety-six hours for a cesarean birth, excluding the day of delivery. The guidelines adopted by rule by the commissioner shall also provide that in the event of a discharge from the hospital prior to the minimum stay established in the guidelines, a postdischarge follow-up visit shall be provided to the mother and newborn by providers competent in postpartum care and newborn assessment if determined medically appropriate as directed by the attending physician, in accordance with the guidelines.
2. When performing utilization review of inpatient hospital services related to maternity and newborn care, including but not limited to length of postdelivery stay and postdischarge follow-up care, any person who provides an individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509, 509A, 514, or 514A, or an individual or group health maintenance organization contract issued and regulated under chapter 514B, shall use the guidelines adopted by rule by the commissioner, and shall not deselect, require additional documentation, require additional utilization review, terminate services to, reduce payment to, or in any manner provide a disincentive to an attending physician solely on the basis that the attending physician provided or directed the provision of services in compliance with the guidelines adopted by rule.
3. Preauthorization or precertification for a hospital stay or for a postdischarge follow-up visit in accordance with the guidelines adopted by rule by the commissioner shall not be required.
96 Acts, ch 1202, §1
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.14 - Continuity of care — pregnancy.

514C.14 Continuity of care — pregnancy.
1. Except as provided under subsection 2 or 3, a carrier, as defined in section 513B.2, or a plan established pursuant to chapter 509A for public employees, that terminates its contract with a participating health care provider, shall continue to provide coverage under the contract to a covered person in the second or third trimester of pregnancy for continued care from such health care provider. Such persons may continue to receive such treatment or care through postpartum care related to the child birth and delivery. Payment for covered benefits and benefit levels shall be according to the terms and conditions of the contract.
2. A covered person who makes an involuntary change in health plans may request that the new health plan cover the services of the covered person’s physician specialist who is not a participating health care provider under the new health plan, if the covered person is in the second or third trimester of pregnancy. Continuation of such coverage shall continue through postpartum care related to the child birth and delivery. Payment for covered benefits and benefit levels shall be according to the terms and conditions of the new health plan contract.
3. A carrier or a plan established under chapter 509A, that terminates the contract of a participating health care provider for cause shall not be liable to pay for health care services provided by the health care provider to a covered person following the date of termination.
99 Acts, ch 41, §1; 2017 Acts, ch 148, §67; 2018 Acts, ch 1026, §157
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.15 - Treatment options.

514C.15 Treatment options.
A carrier, as defined in section 513B.2, or a plan established pursuant to chapter 509A for public employees, shall not prohibit a participating provider from, or penalize a participating provider for, doing either of the following:
1. Discussing treatment options with a covered individual, notwithstanding the carrier’s or plan’s position on such treatment option.
2. Advocating on behalf of a covered individual within a review or grievance process established by the carrier or chapter 509A plan, or established by a person contracting with the carrier or chapter 509A plan.
99 Acts, ch 41, §2; 2017 Acts, ch 148, §68; 2018 Acts, ch 1041, §103
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.16 - Emergency room services.

514C.16 Emergency room services.
1. A carrier, as defined in section 513B.2, or a plan established pursuant to chapter 509A for public employees, which provides coverage for emergency services, is responsible for charges for emergency services provided to a covered individual, including services furnished outside any contractual provider network or preferred provider network. Coverage for emergency services is subject to the terms and conditions of the health benefit plan or contract.
2. Prior authorization for emergency services shall not be required. All services necessary to evaluate and stabilize an emergency medical condition shall be considered covered emergency services.
3. For purposes of this section, unless the context otherwise requires:
a. “Emergency medical condition” means a medical condition that manifests itself by symptoms of sufficient severity, including but not limited to severe pain, that an ordinarily prudent person, possessing average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in one of the following:
(1) Placing the health of the individual, or with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy.
(2) Serious impairment to bodily function.
(3) Serious dysfunction of a bodily organ or part.
b. “Emergency services” means covered inpatient and outpatient health care services that are furnished by a health care provider who is qualified to provide the services that are needed to evaluate or stabilize an emergency medical condition.
99 Acts, ch 41, §3; 2017 Acts, ch 148, §69
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.17 - Continuity of care — terminal illness.

514C.17 Continuity of care — terminal illness.
1. Except as provided under subsection 2 or 3, if a carrier, as defined in section 513B.2, or a plan established pursuant to chapter 509A for public employees, terminates its contract with a participating health care provider, a covered individual who is undergoing a specified course of treatment for a terminal illness or a related condition, with the recommendation of the covered individual’s treating physician licensed under chapter 148 or treating physician assistant licensed under chapter 148C may continue to receive coverage for treatment received from the covered individual’s physician or physician assistant for the terminal illness or a related condition, for a period of up to ninety days. Payment for covered benefits and benefit levels shall be according to the terms and conditions of the contract.
2. A covered person who makes a change in health plans involuntarily may request that the new health plan cover services of the covered person’s treating physician licensed under chapter 148 or treating physician assistant licensed under chapter 148C who is not a participating health care provider under the new health plan, if the covered person is undergoing a specified course of treatment for a terminal illness or a related condition. Continuation of such coverage shall continue for up to ninety days. Payment for covered benefits and benefit levels shall be according to the terms and conditions of the contract.
3. Notwithstanding subsections 1 and 2, a carrier or a plan established under chapter 509A which terminates the contract of a participating health care provider for cause shall not be required to cover health care services provided by the health care provider to a covered person following the date of termination.
99 Acts, ch 41, §4; 2008 Acts, ch 1088, §132; 2017 Acts, ch 148, §70; 2022 Acts, ch 1066, §46
Subsections 1 and 2 amended
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.20 - Mandated coverage for dental care — anesthesia and certain hospital charges.

514C.20 Mandated coverage for dental care — anesthesia and certain hospital charges.
1. Notwithstanding section 514C.6, and subject to the terms and conditions of the policy or contract, a policy or contract providing for third-party payment or prepayment of health or medical expenses shall provide coverage for the administration of general anesthesia and hospital or ambulatory surgical center charges related to the provision of dental care services provided to any of the following covered individuals:
a. A child under five years of age upon a determination by a licensed dentist and the child’s treating physician licensed pursuant to chapter 148 or treating physician assistant licensed pursuant to chapter 148C, that such child requires necessary dental treatment in a hospital or ambulatory surgical center due to a dental condition or a developmental disability for which patient management in the dental office has proved to be ineffective.
b. Any individual upon a determination by a licensed dentist and the individual’s treating physician licensed pursuant to chapter 148 or treating physician assistant licensed pursuant to chapter 148C, that such individual has one or more medical conditions that would create significant or undue medical risk for the individual in the course of delivery of any necessary dental treatment or surgery if not rendered in a hospital or ambulatory surgical center.
2. Prior authorization of hospitalization or ambulatory surgical center for dental care procedures may be required in the same manner that prior authorization is required for hospitalization for other coverages under the contract or policy.
3. This section applies to the following classes of third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2000:
a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. Any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
e. A plan established pursuant to chapter 509A for public employees.
4. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
2000 Acts, ch 1193, §1; 2008 Acts, ch 1088, §134; 2017 Acts, ch 148, §73; 2022 Acts, ch 1066, §49
Subsection 1, paragraphs a and b amended
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.21 - Coverage for immunizations — mercury.

514C.21 Coverage for immunizations — mercury.
1. Third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2006, that provide reimbursement for immunizations shall provide reimbursement for immunizations containing no more than trace amounts of mercury at the acquisition cost rate for immunizations containing no more than trace amounts of mercury. For the purposes of this section, “trace amounts” means trace amounts as defined by the United States food and drug administration.
2. For the purposes of this section, “third-party payment provider contracts or policies” includes:
a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
2004 Acts, ch 1159, §2; 2017 Acts, ch 148, §74
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.23 - Human papilloma virus vaccinations — coverage.

514C.23 Human papilloma virus vaccinations — coverage.
1. Notwithstanding the uniformity of treatment requirements of section 514C.6, a contract, policy, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage benefits for any vaccination or immunization shall provide coverage benefits for a vaccination for human papilloma virus, including but not limited to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2009:
a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. An individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law.
e. A plan established pursuant to chapter 509A for public employees.
2. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
3. As used in this section, “human papilloma virus” means the human papilloma virus as defined by the centers for disease control and prevention of the United States department of health and human services.
4. The commissioner of insurance shall adopt rules pursuant to chapter 17A as necessary to administer this section.
2008 Acts, ch 1108, §1
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.24 - Cancer treatment — coverage.

514C.24 Cancer treatment — coverage.
1. Notwithstanding the uniformity of treatment requirements of section 514C.6, a contract, policy, or plan providing for third-party payment or prepayment for cancer treatment shall not discriminate between coverage benefits for prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells and intravenously administered or injected cancer medications that are covered, regardless of formulation or benefit category determination by the contract, policy, or plan.
2. The provisions of this section shall apply to all of the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2009:
a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. An individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law.
e. A plan established pursuant to chapter 509A for public employees.
3. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, long-term care, basic hospital, and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
4. The commissioner of insurance shall adopt rules pursuant to chapter 17A as necessary to administer this section.
2009 Acts, ch 179, §183
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.25 - Coverage for prosthetic devices.

514C.25 Coverage for prosthetic devices.
1. a. Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage benefits for medically necessary prosthetic devices when prescribed by a physician licensed under chapter 148 or physician assistant licensed under chapter 148C. Such coverage benefits for medically necessary prosthetic devices shall provide coverage for medically necessary prosthetic devices that, at a minimum, equals the coverage and payment for medically necessary prosthetic devices provided under the most recent federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. §1395k, 13951, and 1395m, and
42 C.F.R. §410.100
,
414.202
,
414.210
, and
414.228
, as applicable.
b. For the purposes of this section, “prosthetic device” means an artificial limb device to replace, in whole or in part, an arm or leg.
2. a. This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2009:
(1) Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
(2) An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
(3) An individual or group health maintenance organization contract regulated under chapter 514B.
(4) A plan established pursuant to chapter 509A for public employees.
b. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
3. Notwithstanding subsection 1, paragraph “a”, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that is issued for use in connection with a health savings account as authorized under Tit. XII of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. No. 108-173, may impose the same deductibles and out-of-pocket limits on the prosthetics coverage benefits required in this section that apply to substantially all health, medical, and surgical coverage benefits under the policy, contract, or plan.
2009 Acts, ch 89, §1; 2017 Acts, ch 148, §77; 2022 Acts, ch 1066, §50
Subsection 1, paragraph a amended
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.29 - Services provided by a doctor of chiropractic.

514C.29 Services provided by a doctor of chiropractic.
1. Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not impose a copayment or coinsurance amount on an insured for services provided by a doctor of chiropractic licensed pursuant to chapter 151 that is greater than the copayment or coinsurance amount imposed on the insured for services provided by a person engaged in the practice of medicine and surgery or osteopathic medicine and surgery under chapter 148 for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided.
2. This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2012:
a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. A plan established pursuant to chapter 509A for public employees.
3. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
2012 Acts, ch 1138, §36; 2017 Acts, ch 148, §81
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.30 - Services provided by a physical therapist, occupational therapist, or speech pathologist.

514C.30 Services provided by a physical therapist, occupational therapist, or speech pathologist.
1. Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not impose a copayment or coinsurance amount on an insured for services provided by a physical therapist licensed pursuant to chapter 148A, by an occupational therapist licensed pursuant to chapter 148B, or by a speech pathologist licensed pursuant to chapter 154F that is greater than the copayment or coinsurance amount imposed on the insured for services provided by a person engaged in the practice of medicine and surgery or osteopathic medicine and surgery under chapter 148 for the same or a similar diagnosed condition even if a different nomenclature is used to describe the condition for which the services are provided.
2. This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2015:
a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. A plan established pursuant to chapter 509A for public employees.
3. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
2015 Acts, ch 137, §101, 162, 163; 2017 Acts, ch 148, §82
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.33 - Services provided by provisionally licensed psychologists.

514C.33 Services provided by provisionally licensed psychologists.
1. Notwithstanding section 514C.6, a policy or contract providing for third-party payment or prepayment of health or medical expenses shall include a provision for the payment of necessary behavioral health services provided by a person who holds a provisional license to practice psychology pursuant to section 154B.6, and who practices under the supervision of a supervisor who meets the qualifications determined by the board of psychology by rule.
2. A policy or contract subject to this section shall not impose a practice or supervision restriction which is inconsistent with or more restrictive than the authority already granted by law, including the authority to provide supervision in person or remotely through electronic means as specified by rule of the board of psychology.
3. The requirements of this section apply to and supersede any conflicting requirements regarding services provided under a policy or contract which is delivered, issued for delivery, continued, or renewed in this state on or after June 1, 2018, and apply to and supersede any conflicting requirements regarding services contained in an existing policy or contract on the policy’s or contract’s anniversary or renewal date, whichever is later.
4. For the purposes of this section, third-party payment or prepayment includes an individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509, 514, or 514A, an individual or group health maintenance organization contract issued and regulated under chapter 514B, or a preferred provider organization contract regulated pursuant to chapter 514F.
5. Nothing in this section shall be interpreted to require an individual or group health maintenance organization or a preferred provider organization or arrangement to provide payment or prepayment for services provided by a provisionally licensed psychologist providing behavioral health services under the supervision of a supervisor as specified in this section, unless the supervisor has entered into a contract or other agreement to provide behavioral health services with the individual or group health maintenance organization or the preferred provider organization or arrangement.
2018 Acts, ch 1165, §138, 139; 2019 Acts, ch 59, §236, 240
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES › Section 514C.35 - Behavioral health services provided in a school — coverage.

514C.35 Behavioral health services provided in a school — coverage.
1. Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not deny coverage or payment for behavioral health services, including behavioral health services provided via telehealth, solely because the services are delivered in a school.
2. Nothing in this section shall be interpreted to do any of the following:
a. Require an insurer to pay for behavioral health services that are otherwise excluded from coverage under a policy, contract, or plan.
b. Require an insurer to pay for behavioral health services that are provided by an individual employed by or under contract with a school district or an educational service agency in a regular full-time or part-time position, or any other party that has not entered into a provider agreement with the insurer.
c. Prevent application of any other provision of a policy, contract, or plan.
3. This section applies to third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021, and to claims for reimbursement under such policies, contracts, or plans incurred on or after January 1, 2021.
4. For the purposes of this section:
a. “Behavioral health services” means services provided by a health care professional operating within the scope of the health care professional’s practice which address mental, emotional, medical, or behavioral conditions, illnesses, diseases, or problems.
b. “Educational service agency” means a governmental agency or government entity which is established and operated exclusively for the purpose of providing educational services to one or more educational institutions.
c. “Health care professional” means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law.
d. “School” means all of the following:
(1) Any school, other than a public school, that is accredited pursuant to section 256.11 for any and all levels for grades one through twelve.
(2) Any school directly supported in whole or in part by taxation.
(3) An area education agency established pursuant to chapter 273.
e. “School district” means a school district described in chapter 274.
f. “Telehealth” means the same as defined in section 514C.34.
2020 Acts, ch 1105, §5; 2020 Acts, ch 1121, §66, 70
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514D - ACCIDENT AND SICKNESS INSURANCE POLICIES › Section 514D.1 - Purpose.

514D.1 Purpose.
The purpose of this chapter is to provide reasonable standardization, simplification, and disclosure of the terms and coverages of individual accident and sickness insurance policies issued under chapter 514A and individual subscriber contracts issued under chapter 514, in order to facilitate public understanding and comparison and to eliminate provisions which may be misleading or unreasonably confusing in connection with the purchase of coverage or the settlement of claims.
[C81, §514D.1]
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514D - ACCIDENT AND SICKNESS INSURANCE POLICIES › Section 514D.2 - Definitions.

514D.2 Definitions.
As used in this chapter, unless the context otherwise requires:
1. “Accident and sickness insurance” means individual accident and sickness insurance within the meaning of section 514A.1. “Accident and sickness insurance” also means individual subscriber contracts for hospital service, or medical and surgical service, or individual pharmaceutical or optometric service issued under chapter 514, and for purposes of this chapter, corporations issuing contracts under chapter 514 are deemed to be engaged in the business of insurance.
2. “Form” means and includes policies, contracts, riders, endorsements and applications used in connection with the sale of accident and sickness insurance under chapter 514 or chapter 514A.
3. “Medicare” means the Health Insurance for the Aged Act, Tit. XVIII of the United States Social Security Act added by the amendment of 1965 as amended on or before July 1, 1980.
4. “Policy” means the entire contract between the insurer and the insured, including the policy riders, endorsements, and the application, if attached, and includes individual subscriber contracts issued under chapter 514.
[C81, §514D.2]
2013 Acts, ch 90, §154
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514D - ACCIDENT AND SICKNESS INSURANCE POLICIES › Section 514D.3 - Standards for policies established.

514D.3 Standards for policies established.
1. The commissioner shall issue rules to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content, and required disclosure for the sale of policies of individual accident and sickness insurance and individual subscriber contracts which shall be in addition to and in accordance with applicable laws of this state, including but not limited to sections 514A.1 through 514A.8 and sections 514A.10 through 514A.12. These rules may include but shall not be limited to any of the following subjects:
a. Terms of renewability.
b. Initial and subsequent conditions of eligibility.
c. Nonduplication of coverage provisions.
d. Coverage of dependents.
e. Coverage of persons eligible for Medicare by reason of age.
f. Preexisting conditions.
g. Termination of insurance.
h. Probationary periods.
i. Limitations.
j. Exceptions.
k. Reductions.
l. Elimination periods.
m. Requirements for replacement.
n. Recurrent conditions.
o. The definition of terms, including but not limited to the following: Hospital, accident, sickness, injury, physician, accidental means, total disability, partial disability, nervous disorder, guaranteed renewable, and noncancelable.
2. The commissioner may issue rules with respect to policies of individual accident and sickness insurance and individual subscriber contracts that specify prohibited policies or subscriber contracts, or prohibited policy or contract provisions which the commissioner finds to be unjust, unfair, or unfairly discriminatory to the policyholder or any person insured under the policy or any beneficiary. This subsection does not authorize the commissioner to prohibit a policy or policy provision or subscriber contract or contract provision which is specifically authorized by statute.
3. A rule issued by the commissioner under this section shall not apply to a conversion policy issued pursuant to a contractual conversion privilege under a group or individual policy of accident and sickness insurance when such group or individual contract contains provisions that are inconsistent with the requirements of this chapter or any rule issued under this chapter.
4. A rule issued by the commissioner under this section shall not apply to policies being issued to employees or members being added to a franchise plan, as defined in section 509.14, which is in existence on the effective date of the rule.
[C81, §514D.3]
2021 Acts, ch 80, §322
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514D - ACCIDENT AND SICKNESS INSURANCE POLICIES › Section 514D.4 - Standards for benefits established.

514D.4 Standards for benefits established.
1. The commissioner shall issue rules to establish minimum standards for benefits under each of the following categories of coverage contained in policies of individual accident and sickness insurance or subscriber contracts:
a. Basic hospital expense coverage.
b. Basic medical-surgical expense coverage.
c. Hospital confinement indemnity coverage.
d. Major medical expense coverage.
e. Disability income protection coverage.
f. Accident-only coverage.
g. Specified disease or specified accident coverage.
h. Medicare supplement coverage.
i. Limited benefit health coverage.
2. This section does not prohibit the issuance of a policy which combines two or more of the categories of coverage enumerated in paragraphs “a” through “f” of subsection 1. A category of coverage referred to in paragraph “g”, “h”, or “i” of subsection 1 shall not be combined in a policy or contract either with another category of coverage referred to in paragraph “g”, “h”, or “i” of subsection 1 or with a category of coverage referred to in any of paragraphs “a” through “f” of subsection 1 unless a rule issued by the commissioner specifically authorizes that combination of coverages.
3. The commissioner shall prescribe the method of identification of policies and contracts based upon coverages provided.
4. A policy of accident and sickness insurance or subscriber contract shall not be delivered or issued for delivery in this state unless the policy or contract meets the minimum standards prescribed under this section.
5. The commissioner may upon notice and hearing at any time after the initial filing or approval of any individual accident and sickness policy or subscriber contract form, withdraw approval or suspend further sale of the form if the benefits provided are unreasonable in relation to the premium charge. The commissioner shall establish reasonable and creditable anticipated minimum loss ratios for Medicare supplement and other accident and sickness insurance policies.
6. A rule issued by the commissioner under this section shall not apply to a conversion policy issued pursuant to a contractual conversion privilege under a group or individual policy of accident and sickness insurance when such group or individual contract contains provisions which are inconsistent with the requirements of this chapter or any rule issued under this chapter.
7. A rule issued by the commissioner under this section shall not apply to policies being issued to employees or members being added to a franchise plan, as defined in section 509.14, which is in existence on the effective date of the rule.
[C81, §514D.4; 81 Acts, ch 167, §2]
92 Acts, ch 1162, §34; 2021 Acts, ch 80, §323
Referred to in §508C.3, 514D.5
2023 Iowa Code › Title XIII - COMMERCE › Chapter 514D - ACCIDENT AND SICKNESS INSURANCE POLICIES › Section 514D.6 - Limitation on defenses.

514D.6 Limitation on defenses.
Notwithstanding section 514A.3, subsection 1, paragraph “b”, subparagraph 2, or any contrary provision of chapter 514, if the issuer of the policy of accident and sickness insurance or subscriber contract elects to use a simplified application form, with or without a question as to the applicant’s health at the time of application, but without any questions concerning the insured’s health history or medical treatment history, the policy or contract must cover any loss occurring after twelve months from the date of issue of the policy or contract from any preexisting condition not specifically excluded from coverage by terms of the policy or contract, and, except as so provided, the policy or contract shall not include wording that would permit a defense based upon preexisting conditions.
[C81, §514D.6]
2023 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 through 514A.8 and sections 514A.10 through 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]
2021 Acts, ch 80, §324
2023 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]
2023 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
2023 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