2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514E - IOWA COMPREHENSIVE HEALTH INSURANCE ASSOCIATION
514E.7 - POLICIES -- ELIGIBLE PERSONS -- DEPENDENT COVERAGE -- PREEXISTING CONDITIONS.

        514E.7  POLICIES -- ELIGIBLE PERSONS -- DEPENDENT
      COVERAGE -- PREEXISTING CONDITIONS.
         1. a.  An individual who is and continues to be a resident is
      eligible for plan coverage if evidence is provided of any of the
      following:
         (1)  A notice of rejection or refusal to issue substantially
      similar insurance for health reasons by one carrier or organized
      delivery system.
         (2)  A refusal by a carrier or organized delivery system to issue
      insurance except at a rate exceeding the plan rate.
         (3)  That the individual is a federally defined eligible
      individual.
         (4)  That the individual has a health condition that is
      established by the association's board of directors, with the
      approval of the commissioner, to be eligible for plan coverage.
         (5)  That the individual has coverage under a basic or standard
      health benefit plan under chapter 513C.
         b.  A rejection or refusal by a carrier or organized delivery
      system offering only stoploss, excess of loss, or reinsurance
      coverage with respect to an applicant under subparagraphs (1) and (2)
      is not sufficient evidence for purposes of this subsection.
         c.  The association shall rescind coverage for an individual
      who no longer resides in the state.
         2. a.  An association policy shall provide that coverage of a
      dependent unmarried person terminates when the person becomes
      nineteen years of age or, if the person is enrolled full time in an
      accredited educational institution, terminates at twenty-five years
      of age.  The policy shall also provide in substance that attainment
      of the limiting age does not operate to terminate coverage when the
      person is and continues to be both of the following:
         (1)  Incapable of self-sustaining employment by reason of mental
      retardation or physical disability.
         (2)  Primarily dependent for support and maintenance upon the
      person in whose name the contract is issued.
         b.  Proof of incapacity and dependency must be furnished to
      the carrier within one hundred twenty days of the person's attainment
      of the limiting age, and subsequently as may be required by the
      carrier, but not more frequently than annually after the two-year
      period following the person's attainment of the limiting age.
         3.  An association policy that provides coverage for a family
      member of the person in whose name the contract is issued shall also
      provide, as to the family member's coverage, that the health
      insurance benefits applicable for children include the coverage
      required under section 514C.1.
         4. a.  A preexisting condition exclusion shall not apply to a
      federally defined eligible individual.
         b.  Plan coverage shall not impose any preexisting condition
      exclusion as follows:
         (1)  In the case of a child who is adopted or placed for adoption
      before attaining eighteen years of age and who, as of the last day of
      the thirty-day period beginning on the date of the adoption or
      placement for adoption, is covered under creditable coverage.  This
      subparagraph shall not apply to coverage before the date of such
      adoption or placement for adoption.
         (2)  In the case of an individual who, as of the last day of the
      thirty-day period beginning with the date of birth, is covered under
      creditable coverage.
         (3)  Relating to pregnancy as a preexisting condition.
         (4)  In the case of an individual transferring to an association
      policy from a basic or standard health benefit plan under chapter
      513C beginning on or after January 1, 2005.
         c.  Plan coverage shall exclude charges or expenses incurred
      during the first six months following the effective date of coverage
      for preexisting conditions.  Such preexisting condition exclusions
      shall be waived to the extent that similar exclusions, if any, have
      been satisfied under any prior health insurance coverage which was
      involuntarily terminated, provided both of the following apply:
         (1)  Application for association coverage is made no later than
      sixty-three days following such involuntary termination and, in such
      case, coverage under the plan is effective from the date on which
      such prior coverage was terminated.
         (2)  The applicant is not eligible for continuation rights that
      would provide coverage substantially similar to plan coverage.
         d.  This subsection does not prohibit preexisting conditions
      coverage in an association policy that is more favorable to the
      insured than that specified in this subsection.
         e.  If the association policy contains a waiting period for
      preexisting conditions, an insured may retain any existing coverage
      the insured has under an insurance plan that has coverage equivalent
      to the association policy for the duration of the waiting period
      only.
         5.  An individual is not eligible for coverage by the association
      if any of the following apply:
         a.  The individual is at the time of application eligible for
      health care benefits under chapter 249A.
         b.  The individual has terminated coverage by the association
      within the past twelve months, except that this paragraph does not
      apply to an applicant who is a federally eligible individual.
         c.  The individual is an inmate of a public institution,
      except that this paragraph does not apply to an applicant who is a
      federally defined eligible individual.
         d.  The individual premiums are paid for or reimbursed under
      any government sponsored program or by any government agency or
      health care provider, except as an otherwise qualifying full-time
      employee, or dependent of the employee, of a government agency or
      health care provider.
         e.  The individual, on the effective date of the coverage
      applied for, has not been rejected for, already has, or will have
      coverage similar to an association policy as an insured or covered
      dependent.  This paragraph does not apply to an applicant who is a
      federally eligible individual.
         f.  The individual is eligible for Medicare based upon age.
         6.  The association is not required to make plan coverage
      available to an individual who is covered or is eligible for any
      continued group coverage under Internal Revenue Code § 4980B, the
      federal Employee Retirement Income Security Act of 1974, codified at
      29 U.S.C. § 1001 et seq., the federal Public Health Service Act of
      July 1, 1944, codified at 42 U.S.C. § 201 et seq., or any continued
      group coverage required by the state.  For purposes of this
      subsection, an individual who would have been eligible for such
      continuation of group coverage, but is not eligible solely because
      the individual or other responsible party failed to make the required
      election of coverage during the applicable time period, or terminated
      such coverage prior to the end of such applicable time period, shall
      be deemed to be eligible for such group coverage until the date on
      which the individual's continuing group coverage would have expired
      had an election been made or a termination not occurred.  

         86 Acts, ch 1156, § 7; 90 Acts, ch 1163, §1--3; 96 Acts, ch 1129,
      § 113; 97 Acts, ch 103, § 52, 53; 98 Acts, ch 1100, § 71; 2004 Acts,
      ch 1110, §48, 49; 2004 Acts, ch 1158, §15--17; 2005 Acts, ch 70, §17,
      51; 2006 Acts, ch 1117, §64; 2008 Acts, ch 1123, § 27