§ 514.7 — Contracts — approval by commissioner — provisions to be available

Iowa § 514.7

• Jurisdiction: Iowa
• Title XIII: COMMERCE
• Ch. 514: NONPROFIT HEALTH SERVICE CORPORATIONS

Text

1. The contracts by any such corporation with the subscribers for health care service shall
at all times be subject to the approval of the commissioner of insurance. The commissioner
shall require that participating pharmacies be reimbursed by the pharmaceutical service
corporation at rates or prices equal to rates or prices charged nonsubscribers, unless the
commissioner determines otherwise to prevent loss to subscribers.
2. A provision shall be available in approved contracts with hospital and medical service
corporate subscribers under group subscriber contracts or plans covering vision care
services or procedures, for payment of necessary medical or surgical care and treatment
provided by an optometrist licensed under chapter 154, if the care and treatment are
provided within the scope of the optometrist’s license and if the subscriber contract would
pay for the care and treatment if it were provided by a person engaged in the practice
of medicine or surgery as licensed under chapter 148. The subscriber contract shall also
provide that the subscriber 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 subsection applies to group
subscriber contracts delivered after July 1, 1983, and to group subscriber contracts on their
anniversary or renewal date, or upon the expiration of the applicable collective bargaining
contract, if any, whichever is the later. This subsection does not apply to contracts designed
only for issuance to subscribers eligible for coverage under Tit. XVIII of the Social Security
Act, or any other similar coverage under a state or federal government plan.
3. A provision shall be made available in approved contracts with hospital and medical
subscribers under group subscriber contracts or plans covering diagnosis and treatment
of human ailments, for payment or reimbursement for necessary diagnosis or treatment
provided by a chiropractor licensed under chapter 151 if the diagnosis or treatment is
provided within the scope of the chiropractor’s license and if the subscriber contract would
pay or reimburse for the diagnosis or treatment of the human ailments, irrespective of
and disregarding variances in terminology employed by the various licensed professions
in describing the human ailments or their diagnosis or treatment, if it were provided by
a person licensed under chapter 148. The subscriber contract shall also provide that the
subscriber may reject the coverage or provision 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 group subscriber
contract 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 upon
differences in terminology used by different licensees in describing human ailments or their
diagnosis or treatment. This subsection applies to group subscriber contracts delivered after
July 1, 1986, and to group subscriber contracts on their anniversary or renewal date, or upon
the expiration of the applicable collective bargaining contract, if any, whichever is the later.
This subsection does not apply to contracts designed only for issuance to subscribers eligible
for coverage under Tit. XVIII of the Social Security Act, or any other similar coverage under
a state or federal government plan.
4. A provision shall be available in approved contracts with hospital and medical service
corporate subscribers under group subscriber contracts or plans covering medical and
surgical service, for payment of covered services determined to be medically necessary
provided by certified 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 corporation and subscriber group, subject to utilization controls. This subsection
shall not require payment for nursing services provided by a certified registered nurse
practicing in a hospital, nursing facility, health care institution, a physician’s office, or
other noninstitutional setting if the certified registered nurse is an employee of the hospital,
nursing facility, health care institution, physician, or other health care facility or health care

provider. This subsection applies to group subscriber contracts delivered in this state on or
after July 1, 1989, and to group subscriber contracts on their anniversary or renewal date, or
upon the expiration of the applicable collective bargaining contract, if any, whichever is the
later. This subsection does not apply to limited or specified disease or individual contracts
or contracts designed only for issuance to subscribers eligible for coverage under Tit. XVIII
of the federal Social Security Act, contracts which are rated on a community basis, or any
other similar coverage under a state or federal government plan.

Legislative History

[C39, §8895.07; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.7]