Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 34 - Nonprofit Health Service Corporations › Rule 191-34.2 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
For purposes of this chapter, the following definitions shall
				  apply:
"Commissioner"
means the commissioner of
				  insurance for the state of Iowa.
"Competitor"
means a corporation, business
				  entity, or person engaged in the business of contracting to provide health care
				  services to others, pay indemnity for health care services provided to others,
				  or provide administrative services relevant thereto in the state of
				  Iowa.
"Division"
means the insurance division of
				  Iowa.
"Employee"
is as defined by Iowa Code
				  section
				  8561..
"Health care services"
means services
				  included in the furnishing to any individual of medical or dental care, or
				  hospitalization, or incident to the furnishing of such care or hospitalization,
				  as well as the furnishing to any person of all other services for the purposes
				  of preventing, alleviating, curing or healing human illness, injury, or
				  physical disability.
"Immediate family member"
means an
				  individual within the first degree of consanguinity or affinity who resides in
				  the same household. With respect to determining the immediate family or spouse
				  of a provider, only those providers licensed and practicing in Iowa on a
				  regular basis shall be considered.
"Material financial interest"
means a vested
				  interest of at least 10 percent of the fair market value of the property or an
				  interest from which at least 10 percent of individual's gross income is
				  derived.
"Provider"
means any physician, hospital, or
				  person as defined in Iowa Code chapter 4 which is licensed or otherwise
				  authorized in the state of Iowa to furnish health care services.
"Relatedindustry"
means a commercial
				  enterprise whose goods or services are by design or function primarily for use
				  in the health care services industry. Related industry does not include
				  commercial enterprises whose goods and services are generic to business in
				  general, such as, but not limited to, utilities, food, cleaning, financial, or
				  legal services.
"Subscriber"
means an individual who enters
				  into a contract for hospital services, medical or surgical services, dental
				  services, pharmaceutical services, or optometric services with a corporation
				  subject to Iowa Code chapter 514. With respect to contracts providing benefits
				  to more than one individual, subscriber shall include each individual entitled
				  to receive benefits who has reached the legal age of majority. Subscriber also
				  includes all individuals entitled to receive services or payment for services
				  from a corporation subject to Iowa Code chapter 514 pursuant to the terms of a
				  contract or certificate issued by the corporation to an employer or group.
				  Subscriber also includes any individual eligible for medical assistance or
				  additional medical assistance as defined by Iowa Code chapter 249A and with
				  respect to whom the department of human services has entered into a contract
				  with the corporation subject to Iowa Code chapter 514.
"Subscriber director"
means a subscriber who
				  is a member of the board of directors of a corporation subject to Iowa Code
				  chapter 514 and who is not a provider, the spouse or an immediate family member
				  of a provider Subscriber director includes only those individuals nominated
				  pursuant to subrule 34.7(2). Subscriber director does not include any
				  individual who has a material financial interest or fiduciary interest in the
				  delivery of health care services or a related industry, an employee of an
				  institution which provides health care services, or the spouse or an immediate
				  family member of such an individual. A subscriber director of a hospital or
				  medical service corporation shall be a subscriber of the services of that
				  corporation. Proof of compliance with the requirements of this paragraph shall
				  be by affidavit.