§ 514C.16 — Emergency room services

Iowa § 514C.16

• Jurisdiction: Iowa
• Title XIII: COMMERCE
• Ch. 514C: SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES

Text

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
§514C.16, SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES 16
furnishedoutsideanycontractualprovidernetworkorpreferredprovidernetwork. 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
arefurnishedbyahealthcareproviderwhoisqualifiedtoprovidetheservicesthatareneeded
to evaluate or stabilize an emergency medical condition.