1. Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy
or contract providing for third-party payment or prepayment of health or medical expenses
shall provide coverage benefits for the cost associated with equipment, supplies, and
self-management training and education for the treatment of all types of diabetes mellitus
when prescribed by a physician licensed under chapter 148 or a physician assistant licensed
under chapter 148C. Coverage benefits shall include coverage for the cost associated with
all of the following:
a. Equipment and supplies.
b. Payment for diabetes self-management training and education only under all of the
following conditions:
(1)The physician or physician assistant managing the individual’s diabetic condition
certifies that such s
Free access — add to your briefcase to read the full text and ask questions with AI
1. Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy
or contract providing for third-party payment or prepayment of health or medical expenses
shall provide coverage benefits for the cost associated with equipment, supplies, and
self-management training and education for the treatment of all types of diabetes mellitus
when prescribed by a physician licensed under chapter 148 or a physician assistant licensed
under chapter 148C. Coverage benefits shall include coverage for the cost associated with
all of the following:
a. Equipment and supplies.
b. Payment for diabetes self-management training and education only under all of the
following conditions:
(1) The physician or physician assistant managing the individual’s diabetic condition
certifies that such services are needed under a comprehensive plan of care related to the
17 SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES, §514C.19
individual’s diabetic condition to ensure therapy compliance or to provide the individual
with necessary skills and knowledge to participate in the management of the individual’s
condition.
(2) The diabetes self-management training and education program is certified by
the department of health and human services. The department shall consult with the
American diabetes association, Iowa affiliate, in developing the standards for certification
of diabetes education programs that cover at least ten hours of initial outpatient diabetes
self-management training within a continuous twelve-month period and up to two hours of
follow-up training for each subsequent year for each individual diagnosed by a physician or
physician assistant with any type of diabetes mellitus.
2. a. This section applies to the following classes of third-party payment provider
contractsorpoliciesthataredelivered,issuedfordelivery,continued,orrenewedinthisstate:
(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) Any other entity engaged in the business of insurance, risk transfer, or risk retention,
which is subject to the jurisdiction of the commissioner.
(5) 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.