§ 514K.2 — Health carrier disclosures — public internet sites

Iowa § 514K.2

• Jurisdiction: Iowa
• Title XIII: COMMERCE
• Ch. 514K: HEALTH CARE PLAN INFORMATION

Text

1. A carrier that provides small group health coverage pursuant to chapter 513B or
individual health coverage pursuant to chapter 513C and that offers for sale a policy,
contract, or plan that covers the essential health benefits required pursuant to section 1302
of the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148, and its
implementing regulations, shall provide to each of its enrollees at the time of enrollment, and
shall make available to prospective enrollees and enrollees, insurance producers licensed
under chapter 522B, and the general public, on the carrier’s internet site, all of the following
information in a clear and understandable form for use in comparing policies, contracts, and
plans, and coverage and premiums:
a. Any items or services, including prescription drugs, that have a coinsurance
requirement where the cost-sharing required depends on the cost of the item or service.
b. The specific prescription drugs available on the carrier’s formulary, the specific
prescription drugs covered when furnished by a physician or clinic, and any clinical
prerequisites or prior authorization requirements for coverage of the drugs.
c. How medications will specifically be included in or excluded from the deductible,
including a description of all out-of-pocket costs that may not apply to the deductible for a
prescription drug.
2. A carrier that provides a summary of benefits and coverage to its enrollees in
accordance with 26 C.F.R. §54.9815-2715, 29 C.F.R. §2590.715-2715, and 45 C.F.R. §147.200
is deemed to be in compliance with this section unless the commissioner of insurance
determines that these federal regulations, or the successors to any of these federal
regulations, fail to require the information required pursuant to this section in a clear and
understandable form.