This text of Iowa § 514D.4 (Standards for benefits established) is published on Counsel Stack Legal Research, covering Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
1.The commissioner shall issue rules to establish minimum standards for benefits under
each of the following categories of coverage contained in policies of individual accident and
sickness insurance or subscriber contracts:
a.Basic hospital expense coverage.
b.Basic medical-surgical expense coverage.
c.Hospital confinement indemnity coverage.
d.Major medical expense coverage.
e.Disability income protection coverage.
f.Accident-only coverage.
g.Specified disease or specified accident coverage.
h.Medicare supplement coverage.
i.Limited benefit health coverage.
2.This section does not prohibit the issuance of a policy which combines two or more
of the categories of coverage enumerated in paragraphs “a” through “f” of subsection 1.
A category of coverage referred to in paragraph “g
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1. The commissioner shall issue rules to establish minimum standards for benefits under
each of the following categories of coverage contained in policies of individual accident and
sickness insurance or subscriber contracts:
a. Basic hospital expense coverage.
b. Basic medical-surgical expense coverage.
c. Hospital confinement indemnity coverage.
d. Major medical expense coverage.
e. Disability income protection coverage.
f. Accident-only coverage.
g. Specified disease or specified accident coverage.
h. Medicare supplement coverage.
i. Limited benefit health coverage.
2. This section does not prohibit the issuance of a policy which combines two or more
of the categories of coverage enumerated in paragraphs “a” through “f” of subsection 1.
A category of coverage referred to in paragraph “g”, “h”, or “i” of subsection 1 shall not
be combined in a policy or contract either with another category of coverage referred to
in paragraph “g”, “h”, or “i” of subsection 1 or with a category of coverage referred to in
any of paragraphs “a” through “f” of subsection 1 unless a rule issued by the commissioner
specifically authorizes that combination of coverages.
3. The commissioner shall prescribe the method of identification of policies and contracts
based upon coverages provided.
4. Apolicyofaccidentandsicknessinsuranceorsubscribercontractshallnotbedelivered
or issued for delivery in this state unless the policy or contract meets the minimum standards
prescribed under this section.
5. The commissioner may upon notice and hearing at any time after the initial filing or
approvalofanyindividualaccidentandsicknesspolicyorsubscribercontractform,withdraw
approval or suspend further sale of the form if the benefits provided are unreasonable in
relation to the premium charge. The commissioner shall establish reasonable and creditable
3 ACCIDENT AND SICKNESS INSURANCE POLICIES, §514D.5
anticipated minimum loss ratios for Medicare supplement and other accident and sickness
insurance policies.
6. A rule issued by the commissioner under this section shall not apply to a conversion
policy issued pursuant to a contractual conversion privilege under a group or individual
policy of accident and sickness insurance when such group or individual contract contains
provisions which are inconsistent with the requirements of this chapter or any rule issued
under this chapter.
7. A rule issued by the commissioner under this section shall not apply to policies being
issuedtoemployeesormembersbeingaddedtoafranchiseplan, asdefinedinsection509.14,
which is in existence on the effective date of the rule.