2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514B - HEALTH MAINTENANCE ORGANIZATIONS
514B.9 - EVIDENCE OF COVERAGE.

        514B.9  EVIDENCE OF COVERAGE.
         Every enrollee shall receive an evidence of coverage and any
      amendments.  If the enrollee obtains coverage through an insurance
      policy or a contract issued by a corporation authorized under chapter
      514, the insurer or the corporation shall issue the evidence of
      coverage.  No evidence of coverage or amendment shall be issued or
      delivered to any person in this state until a copy of the form of the
      evidence of coverage or amendment has been filed with and approved by
      the commissioner.
         An evidence of coverage shall contain a clear and complete
      statement of:
         1.  The health care services and the insurance or other benefits,
      if any, to which the enrollee is entitled in the total context of the
      organizational structure of the health maintenance organization.
         2.  Any limitations on the services or benefits to be provided,
      including any deductible or coinsurance charges permitted under
      section 514B.5, subsection 3.
         3.  The manner in which information is available on the method of
      obtaining health care services.
         4.  The total amount of payment for health care services and
      indemnity or service benefits, if any, which the enrollee is
      obligated to pay with respect to individual contracts, or an
      indication whether the plan offered through the health maintenance
      organization is contributory or noncontributory with respect to group
      contracts.
         5.  The health maintenance organization's method for resolving
      enrollee complaints.
         6.  The mechanism by which enrollees shall be allowed to
      participate in matters of policy and operation.
         A copy of the form of the evidence of coverage to be used in this
      state and any amendment shall be subject to the filing and approval
      requirements of this section unless it is subject to the jurisdiction
      of the commissioner under the laws governing health insurance or
      corporations authorized under chapter 514 in which event the filing
      and approval provisions of such laws apply.  To the extent, however,
      that those provisions are less strict than those provided under this
      section, then the requirements of this section shall apply.
         Enrollees shall be entitled to receive the most recent annual
      statement of the financial condition of the health maintenance
      organization in which they are enrolled, which statement shall
      include a balance sheet and summary of receipts and disbursements.
      

         [C75, 77, 79, 81, § 514B.9]
         Referred to in § 514B.11