2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 509 - GROUP INSURANCE
509.3 - PROVISIONS AS PART OF ACCIDENT OR HEALTH POLICY.

        509.3  PROVISIONS AS PART OF ACCIDENT OR HEALTH
      POLICY.
         1.  All policies of group accident or health insurance or
      combination thereof issued in this state shall contain in substance
      the following provisions:
         a.  The policy shall have a provision that a copy of the
      application, if any, of the policyholder shall be attached to the
      policy when issued or shall be furnished to the policyholder within
      thirty days after the policy is issued, that all statements made by
      the policyholder or by the persons insured shall be deemed
      representations and not warranties, and that no statement made by any
      person insured shall be used in any contest unless a copy of the
      instrument containing the statement is or has been furnished to such
      person.
         b.  A provision that the company will issue to the
      policyholder for delivery to each person insured under such policy an
      individual certificate setting forth a statement as to the insurance
      protection to which the person is entitled, to whom the insurance
      benefits are payable, and such provisions of the policy as are, in
      the opinion of the commissioner of insurance, necessary to inform the
      holder thereof as to the holder's rights under the policy.
         c.  A provision that to the group or class thereof originally
      insured shall be added, from time to time, all new persons eligible
      to insurance in such group or class.
         d.  A provision that if the insurance on a person or insurance
      on a person and the person's dependents covered by the policy ceases
      because of termination of employment or of membership in the class,
      the person and the person's dependents may continue their accident or
      health insurance under the group policy and may subsequently apply
      for a converted policy without evidence of insurability, as provided
      in chapter 509B.{
         e.  A provision shall be made available to policyholders,
      under group policies covering vision care services or procedures, for
      payment of necessary medical or surgical care and treatment provided
      by an optometrist licensed under chapter 154 if the care and
      treatment are provided within the scope of the optometrist's license
      and if the policy would pay for the care and treatment if the care
      and treatment were provided by a person engaged in the practice of
      medicine or surgery or osteopathic medicine and surgery as licensed
      under chapter 148.  The policy shall provide that the policyholder
      may reject the coverage or provision if the coverage or provision for
      services which may be provided by an optometrist is rejected for all
      providers of similar vision care services as licensed under chapter
      148 or 154.  This paragraph applies to group policies delivered or
      issued for delivery after July 1, 1983, and to existing group
      policies on their next anniversary or renewal date, or upon
      expiration of the applicable collective bargaining contract, if any,
      whichever is later.  This paragraph does not apply to blanket,
      short-term travel, accident-only, limited or specified disease, or
      individual or group conversion policies, or policies designed only
      for issuance to persons for coverage under Tit. XVIII of the Social
      Security Act, or any other similar coverage under a state or federal
      government plan.
         f.  A provision shall be made available to policyholders under
      group policies covering diagnosis and treatment of human ailments for
      payment or reimbursement for necessary diagnosis or treatment
      provided by a chiropractor licensed under chapter 151, if the
      diagnosis or treatment is provided within the scope of the
      chiropractor's license and if the policy would pay or reimburse for
      the diagnosis or treatment by a person licensed under chapter 148 of
      the human ailment, irrespective of and disregarding variances in
      terminology employed by the various licensed professions in
      describing the human ailment or its diagnosis or its treatment.  The
      policy shall provide that the policyholder may reject the coverage or
      provision if the coverage or provision for diagnosis or treatment of
      a human ailment by a chiropractor is rejected for all providers of
      diagnosis or treatment for similar human ailments licensed under
      chapter 148 or 151.  A policy of group health insurance may limit or
      make optional the payment or reimbursement for lawful diagnostic or
      treatment service by all licensees under chapters 148 and 151 on any
      rational basis which is not solely related to the license under or
      the practices authorized by chapter 151 or is not dependent upon a
      method of classification, categorization, or description based
      directly or indirectly upon differences in terminology used by
      different licensees in describing human ailments or their diagnosis
      or treatment.  This paragraph applies to group policies delivered or
      issued for delivery after July 1, 1986, and to existing group
      policies on their next anniversary or renewal date, or upon
      expiration of the applicable collective bargaining contract, if any,
      whichever is later.  This paragraph does not apply to blanket,
      short-term travel, accident-only, limited or specified disease, or
      individual or group conversion policies, or policies under Tit. XVIII
      of the Social Security Act, or any other similar coverage under a
      state or federal government plan.
         g.  A provision shall be made available to policyholders,
      under group policies covering hospital, medical, or surgical
      expenses, for payment of covered services determined to be medically
      necessary provided by registered nurses certified by a national
      certifying organization, which organization shall be identified by
      the Iowa board of nursing pursuant to rules adopted by the board, if
      the services are within the practice of the profession of a
      registered nurse as that practice is defined in section 152.1, under
      terms and conditions agreed upon between the insurer and the
      policyholder, subject to utilization controls.  This paragraph shall
      not require payment for nursing services provided by a certified
      nurse practicing in a hospital, nursing facility, health care
      institution, physician's office, or other noninstitutional setting if
      the certified nurse is an employee of the hospital, nursing facility,
      health care institution, physician, or other health care facility or
      health care provider.  This paragraph applies to group policies
      delivered or issued for delivery in this state on or after July 1,
      1989, and to existing group policies on their next anniversary or
      renewal dates, or upon expiration of the applicable collective
      bargaining contract, if any, whichever is later.  This paragraph does
      not apply to blanket, short-term travel, accident-only, limited or
      specified disease, or individual or group conversion policies,
      policies rated on a community basis, or policies designed only for
      issuance to persons for eligible coverage under Tit. XVIII of the
      federal Social Security Act, or any other similar coverage under a
      state or federal government plan.
         h.  A provision that the insurer will permit continuation of
      existing coverage or reenrollment in previously existing coverage for
      an individual who meets the requirements of section 513B.2,
      subsection 14, paragraph "a", "b", "c", "d", or
      "e", and who is an unmarried child of an insured or enrollee who
      so elects, at least through the policy anniversary date on or after
      the date the child marries, ceases to be a resident of this state, or
      attains the age of twenty-five years old, whichever occurs first, or
      so long as the unmarried child maintains full-time status as a
      student in an accredited institution of postsecondary education.
         2.  In addition to the provisions required in subsection 1,
      paragraphs "a" through "h", the commissioner shall require
      provisions through the adoption of rules implementing the federal
      Health Insurance Portability and Accountability Act, Pub. L. No.
      104-191.  

         Section History: Early Form

         [C24, 27, 31, § 8677, 8678; C35, § 8684-e4, -e6; C39, § 8684.04,
      8684.06; C46, § 509.4, 509.6; C50, 54, 58, 62, 66, 71, 73, 75, 77,
      79, 81, § 509.3] 

         Section History: Recent Form

         83 Acts, ch 166, § 1; 84 Acts, ch 1290, § 1; 86 Acts, ch 1124, §
      8; 86 Acts, ch 1180, § 2; 89 Acts, ch 164, § 2; 97 Acts, ch 103, §1;
      99 Acts, ch 75, §2; 2005 Acts, ch 70, §7; 2008 Acts, ch 1088, § 125;
      2008 Acts, ch 1188, § 38, 43; 2009 Acts, ch 118, §7, 11
         Referred to in § 509.10, 509.14, 514.21, 514.23 

         Footnotes

         {Section 509B.4, providing for the conversion of group policies,
      repealed by 2006 Acts, ch 1117, §127; corrective legislation is
      pending
         2009 amendment to subsection 1, paragraph h applies to policies,
      contracts, or plans of accident and health insurance delivered,
      issued for delivery, continued, or renewed in this state on or after
      July 1, 2009; 2009 Acts, ch 118, §11