1.All policies of group accident or health insurance or combination thereof issued in this
state shall contain in substance the following provisions:
a.The policy shall have a provision that a copy of the application, if any, of the
policyholder shall be attached to the policy when issued or shall be furnished to the
policyholder within thirty days after the policy is issued, that all statements made by the
policyholder or by the persons insured shall be deemed representations and not warranties,
and that no statement made by any person insured shall be used in any contest unless a copy
of the instrument containing the statement is or has been furnished to such person.
b.A provision that the company will issue to the policyholder for delivery to each
person insured under such policy an
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1. All policies of group accident or health insurance or combination thereof issued in this
state shall contain in substance the following provisions:
a. The policy shall have a provision that a copy of the application, if any, of the
policyholder shall be attached to the policy when issued or shall be furnished to the
policyholder within thirty days after the policy is issued, that all statements made by the
policyholder or by the persons insured shall be deemed representations and not warranties,
and that no statement made by any person insured shall be used in any contest unless a copy
of the instrument containing the statement is or has been furnished to such person.
b. A provision that the company will issue to the policyholder for delivery to each
person insured under such policy an individual certificate setting forth a statement as to
the insurance protection to which the person is entitled, to whom the insurance benefits
are payable, and such provisions of the policy as are, in the opinion of the commissioner of
insurance, necessary to inform the holder thereof as to the holder’s rights under the policy.
c. A provision that to the group or class thereof originally insured shall be added, from
time to time, all new persons eligible to insurance in such group or class.
d. A provision that if the insurance on a person or insurance on a person and the
person’s dependents covered by the policy ceases because of termination of employment
or of membership in the class, the person and the person’s dependents may continue their
accident or health insurance under the group policy.
e. A provision shall be made available to policyholders, under group policies covering
vision care services or procedures, for payment of necessary medical or surgical care and
treatmentprovidedbyanoptometristlicensedunderchapter154ifthecareandtreatmentare
provided within the scope of the optometrist’s license and if the policy would pay for the care
and treatment if the care and treatment were provided by a person engaged in the practice
of medicine or surgery or osteopathic medicine and surgery as licensed under chapter 148.
The policy shall provide that the policyholder may reject the coverage or provision if the
coverage or provision for services which may be provided by an optometrist is rejected for all
providers of similar vision care services as licensed under chapter 148 or 154. This paragraph
applies to group policies delivered or issued for delivery after July 1, 1983, and to existing
group policies on their next anniversary or renewal date, or upon expiration of the applicable
collective bargaining contract, if any, whichever is later. This paragraph does not apply to
blanket, short-term travel, accident-only, limited or specified disease, or individual or group
conversion policies, or policies designed only for issuance to persons for coverage under
Tit. XVIII of the Social Security Act, or any other similar coverage under a state or federal
government plan.
f. A provision shall be made available to policyholders under group policies covering
diagnosis and treatment of human ailments for payment or reimbursement for necessary
diagnosisortreatmentprovidedbyachiropractorlicensedunderchapter151, ifthediagnosis
or treatment is provided within the scope of the chiropractor’s license and if the policy would
pay or reimburse for the diagnosis or treatment by a person licensed under chapter 148 of
the human ailment, irrespective of and disregarding variances in terminology employed
by the various licensed professions in describing the human ailment or its diagnosis or its
treatment. Thepolicyshallprovidethatthepolicyholdermayrejectthecoverageorprovision
if the coverage or provision for diagnosis or treatment of a human ailment by a chiropractor
is rejected for all providers of diagnosis or treatment for similar human ailments licensed
under chapter 148 or 151. A policy of group health insurance may limit or make optional the
payment or reimbursement for lawful diagnostic or treatment service by all licensees under
chapters 148 and 151 on any rational basis which is not solely related to the license under or
the practices authorized by chapter 151 or is not dependent upon a method of classification,
categorization, or description based directly or indirectly upon differences in terminology
used by different licensees in describing human ailments or their diagnosis or treatment.
This paragraph applies to group policies delivered or issued for delivery after July 1, 1986,
and to existing group policies on their next anniversary or renewal date, or upon expiration
of the applicable collective bargaining contract, if any, whichever is later. This paragraph
does not apply to blanket, short-term travel, accident-only, limited or specified disease, or
individual or group conversion policies, or policies under Tit. XVIII of the Social Security
Act, or any other similar coverage under a state or federal government plan.
g. A provision shall be made available to policyholders, under group policies covering
hospital, medical, or surgical expenses, for payment of covered services determined to
be medically necessary provided by registered nurses certified by a national certifying
organization, which organization shall be identified by the Iowa board of nursing pursuant
to rules adopted by the board, if the services are within the practice of the profession of
a registered nurse as that practice is defined in section 152.1, under terms and conditions
agreed upon between the insurer and the policyholder, subject to utilization controls. This
paragraph shall not require payment for nursing services provided by a certified nurse
practicing in a hospital, nursing facility, health care institution, physician’s office, or other
noninstitutional setting if the certified nurse is an employee of the hospital, nursing facility,
health care institution, physician, or other health care facility or health care provider. This
paragraph applies to group policies delivered or issued for delivery in this state on or after
July 1, 1989, and to existing group policies on their next anniversary or renewal dates,
or upon expiration of the applicable collective bargaining contract, if any, whichever is
later. This paragraph does not apply to blanket, short-term travel, accident-only, limited or
specified disease, or individual or group conversion policies, policies rated on a community
basis, or policies designed only for issuance to persons for eligible coverage under Tit. XVIII
of the federal Social Security Act, or any other similar coverage under a state or federal
government plan.
h. A provision that the insurer will 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.
2. In addition to the provisions required in subsection 1, paragraphs “a” through “h”, the
commissionershallrequireprovisionsthroughtheadoptionofrulesimplementingthefederal
Health Insurance Portability and Accountability Act, Pub. L. No. 104-191.