General Assembly: 77 (1997 Regular GA) - Chapter 88 - Health benefit plans — point of service options


Published: 1997-04-30

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$20 per month, or Get a Day Pass for only USD$4.99.

CH.88 LAWS OF THE SEVENlY-SEVENTH G.A., 1997 SESSION

CHAPTER 88 HEALTH BENEFIT PlANS - POINT OF SERVICE OPTIONS

H.F.133

128

AN ACT relating to the offering of point of service plan options in certain health benefit plans.

Be It Enacted by the General Assembly of the State of Iowa:

Section 1. NEW SECTION. 514C.13 GROUP MANAGED CARE HEALTH PlANS - ALTERNATIVE OFFERS.

1. As used in this section, unless the context otherwise requires: a. "Carrier" means an entity that provides health benefit plans in this state. "Carrier"

includes an insurance company, group hospital or medical service corporation, health main- tenance organization, multiple employer welfare arrangement, and any other person pro- viding health benefit plans in this state subject to regulation by the commissioner of insur- ance.

b. "Health benefit plan" means a policy, certificate, or contract providing hospital or medical coverage, benefits, or services rendered by a health care provider. "Health benefit plan" does not include a group conversion plan, accident-only, specific-disease, short-term hospital or medical hospital confinement indemnity, credit, dental, vision, Medicare supple- ment, long-term care, or disability income insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, or automobile medical payment insurance.

c. "Health care provider" means a hospital licensed pursuant to chapter 135B, a person licensed under chapter 148, 148C, 149, 150, 150A, 151, or 154, or a person licensed as an advanced registered nurse practitioner under chapter 152.

d. "Indemnity plan" means a hospital or medical expense-incurred policy, certificate, or contract, major medical expense insurance, or hospital or medical service plan contract.

e. "Large employer" means a person actively engaged in business who, during at least fifty percent of the employer's working days during the preceding calendar year, employed more than fifty full-time equivalent employees.

f. "Limited provider network plan" means a managed care health plan which limits ac- cess to or coverage for services to selected health care providers who are under contract with the managed care health plan.

g. "Managed care health plan" means a health benefit plan that selects and contracts with health care providers; manages and coordinates health care delivery; monitors neces- sity, appropriateness, and quality of health care delivered by health care providers; and performs utilization review and cost control.

h. "Organized delivery system" means an organized delivery system as defined in section 513C.3.

i. "Point of service plan option" means a provision in a managed care health plan that permits insureds, enrollees, or subscribers access to health care from health care providers who have not contracted with the managed care health plan.

j. "Small employer" means a person actively engaged in business who, during at least fifty percent of the employer's working days during the preceding calendar year, employed not less than two and not more than fifty full-time equivalent employees.

2. A carrier or organized delivery system which offers to a small employer a limited provider network plan to provide health care services or benefits to the small employer's employees shall also offer to the small employer a point of service option to the limited provider network plan.

3. A carrier or organized delivery system which offers to a large employer a limited pro- vider network plan to provide health care seIVices or benefits to the large employer's employ- ees shall also offer to the large employer one or more of the following:

129 LAWS OF THE SEVENTY-SEVENTH G.A., 1997 SESSION CH.90

a. A point of service plan option to the limited provider network plan. The price of the point of service plan option shall be actuarially determined.

b. A managed care health plan that is not a limited provider network plan. c. An indemnity plan. 4. A large employer that offers a limited provider network plan to its employees shall also

offer to its employees one or more of the following: a. A point of service plan option to the limited provider network plan. b. A managed care health plan that is not a limited provider network plan. c. An indemnity plan.

Approved April 30, 1997

CHAPTER 89 NONPERPETUAL CARE CEMETERIES

S.F.21

AN ACf eliminating the requirement that a nonperpetual care cemetery post a sign indicating the cemetery is a nonperpetual care cemetery.

Be It Enacted by the General Assembly of the State of Iowa:

Section 1. Section 566A.5, subsection I, Code 1997, is amended by striking the subsec- tion.

Sec. 2. Section 566A.5, subsection 2, Code 1997, is amended to read as follows: a. LEach nonperpetual care cemetery shall aIse have printed or stamped at the head of all

of its contracts, deeds, statements,letterheads, and advertising material, the legend: "This is a nonperpetual care cemetery", and shall not sell any lot or interment space in the cemetery unless the purchaser of the lot or interment space is informed that the cemetery is a nonperpetual care cemetery.

Approved May I, 1997

CHAPTER 90 RUNAWAY CHILDREN

S.F.123

AN ACf relating to runaway children, by defining when a child is a chronic runaway, authorizing county runaway treatment plans, and providing for assessment and treatment procedures for chronic runaways.

Be It Enacted by the General Assembly of the State of Iowa:

Section 1. Section 232.2, Code 1997, is amended by adding the following new subsec- tion: