§ 514D.5 — Disclosure, Medicare information, and advertising

Iowa § 514D.5

• Jurisdiction: Iowa
• Title XIII: COMMERCE
• Ch. 514D: ACCIDENT AND SICKNESS INSURANCE POLICIES

Text

1. Except as otherwise provided in subsection 3, in order to provide for full and fair
disclosure in the sale of individual accident and sickness insurance policies or subscriber
contracts a policy or contract shall not be delivered or issued for delivery in this state unless
the outline of coverage described in subsection 2 either accompanies the policy or contract or
is delivered to the applicant at the time application is made and unless an acknowledgment
of receipt or certificate of delivery of the outline is provided the insurer. In the event the
policy or contract is issued on a basis other than that applied for, the outline of coverage
properly describing the policy or contract must accompany the policy or contract when it
is delivered and must clearly state that it is not the policy or contract for which application
was made.
2. a. The commissioner shall prescribe the format and content of the outline of coverage
required by subsection 1. “Format” means style, arrangement, and overall appearance,
including such items as the size, color, and prominence of type and the arrangement of text
and captions. The outline of coverage shall include all of the following:
(1) A statement identifying the applicable category or categories of coverage provided by
the policy or contract as prescribed in section 514D.4.
(2) A description of the principal benefits and coverage provided in the policy or contract.
(3) A statement of the exceptions, reductions, and limitations contained in the policy or
contract.
(4) A statement of the renewal provisions including any reservation by the insurer of a
right to change premiums.
(5) A statement that the outline is a summary of the policy or contract issued or applied
for and that the policy or contract should be consulted to determine governing contractual
provisions.
b. If payment will not be made for services performed by a chiropractor acting within the
scope of the chiropractor’s license when those services would be compensable if performed
by a medical doctor, then a statement that services performed by a chiropractor are not
compensable shall be included in the outline of coverage.
3. The commissioner shall prescribe disclosure rules for Medicare supplement coverage
which are determined to be in the public interest and which are designed to adequately
inform the prospective insured of the need for and extent of coverage offered as Medicare
supplement coverage. For Medicare supplement coverage, the outline of coverage required
by subsection 2 shall be furnished to the prospective insured with the application form.
4. The commissioner shall further prescribe by rule a standard form for and the contents
of an informational brochure for persons eligible for Medicare by reason of age, which is
intendedtoimprovethebuyer’sabilitytoselectthemostappropriatecoverageandtoimprove
the buyer’s understanding of Medicare. Except in the case of direct response insurance
policies, the commissioner may require by rule that this informational brochure be provided
to prospective insureds eligible for Medicare concurrently with delivery of the outline of
coverage. With respect to direct response insurance policies, the commissioner may require
§514D.5, ACCIDENT AND SICKNESS INSURANCE POLICIES 4
by rule that this brochure must be provided to prospective insureds eligible for Medicare by
reason of age upon request, but not later than at the time of delivery of the policy or contract.
5. The commissioner shall adopt rules prohibiting the advertising of forms titled as
“nursing home” forms or inferring coverage for custodial care in a nursing facility as defined
in section 135C.1 unless such forms provide coverage for custodial care in a nursing facility
as defined in section 135C.1.

Legislative History

[C81, §514D.5]