Text: H04101                            Text: H04103
Text: H04100 - H04199                   Text: H Index
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House Amendment 4102

Amendment Text

PAG LIN
  1  1    Amend House File 247, as amended, passed, and
  1  2 reprinted by the House, as follows:
  1  3    #1.  Page 1, by inserting before line 1 the
  1  4 following:
  1  5    "Sec.    .  Section 87.4, Code 1995, is amended by
  1  6 adding the following new unnumbered paragraph:
  1  7    NEW UNNUMBERED PARAGRAPH.  The workers'
  1  8 compensation premium written on a municipality which
  1  9 is a member of an insurance pool which provides
  1 10 workers' compensation insurance coverage to a
  1 11 statewide group of municipalities, as defined in
  1 12 section 670.1, shall not be considered in the
  1 13 determination of any assessments levied pursuant to an
  1 14 agreement established under section 515A.15."
  1 15    #2.  Page 1, by inserting after line 5 the
  1 16 following:
  1 17    "Sec.    .  NEW SECTION.  505.22  CERTAIN RELIGIOUS
  1 18 ORGANIZATION ACTIVITIES EXEMPT FROM REGULATION.
  1 19    A religious organization which, through its
  1 20 publication to subscribers, solicits funds for the
  1 21 payment of medical expenses of other subscribers,
  1 22 shall not be considered to be engaging in the business
  1 23 of insurance for purposes of this chapter or any other
  1 24 provision of Title XIII, and shall not be subject to
  1 25 the jurisdiction of the commissioner of insurance, if
  1 26 all of the following apply:
  1 27    1.  The religious publication is provided by a
  1 28 nonprofit charitable organization described in section
  1 29 501(c)(3) of the Internal Revenue Code.
  1 30    2.  Participation is limited to subscribers who are
  1 31 members of the same denomination or religion.
  1 32    3.  The publication is registered with the United
  1 33 States postal service and acts as an organizational
  1 34 clearinghouse for information between subscribers who
  1 35 have financial, physical, or medical needs, and
  1 36 subscribers who choose to assist with those needs,
  1 37 matching subscribers with the present ability to pay
  1 38 with subscribers with a present financial or medical
  1 39 need.
  1 40    4.  The organization, through its publication,
  1 41 provides for the payment for subscriber financial or
  1 42 medical needs through direct payments from one
  1 43 subscriber to another.
  1 44    5.  The organization, through its publication,
  1 45 suggests amounts to contribute that are voluntary
  1 46 among the subscribers, with no assumption of risk or
  1 47 promise to pay either among the subscribers or between
  1 48 the subscribers and the publication."
  1 49    #3.  Page 2, by inserting after line 2 the
  1 50 following:
  2  1    "Sec.    .  Section 507B.4, subsection 7, Code
  2  2 1995, is amended by adding the following new
  2  3 paragraph:
  2  4    NEW PARAGRAPH.  c.  Making or permitting any
  2  5 discrimination in the sale of insurance solely on the
  2  6 basis of domestic abuse as defined in section 236.2."
  2  7    #4.  Page 5, by inserting after line 9 the
  2  8 following:
  2  9    "Sec.    .  NEW SECTION.  514C.8  COORDINATION OF
  2 10 HEALTH CARE BENEFITS WITH STATE MEDICAL ASSISTANCE.
  2 11    1.  An insurer, health maintenance organization, or
  2 12 hospital and medical service plan providing health
  2 13 care coverage to individuals in this state shall not
  2 14 consider the availability of or eligibility for
  2 15 medical assistance under Title XIX of the federal
  2 16 Social Security Act and chapter 249A, when determining
  2 17 eligibility of the individual for coverage or
  2 18 calculating payments to the individual under the
  2 19 health care coverage plan.
  2 20    2.  The state acquires the rights of an individual
  2 21 to payment from an insurer, health maintenance
  2 22 organization, or hospital or medical service plan to
  2 23 the extent payment for covered expenses is made
  2 24 pursuant to chapter 249A for health care items or
  2 25 services provided to the individual.  Upon
  2 26 presentation of proof that payment was made pursuant
  2 27 to chapter 249A for covered expenses, the insurer,
  2 28 health maintenance organization, or hospital or
  2 29 medical service plan shall make payment to the state
  2 30 medical assistance program to the extent of the
  2 31 coverage provided in the policy or contract.
  2 32    3.  An insurer shall not impose requirements on the
  2 33 state with respect to the assignment of rights
  2 34 pursuant to this section that are different from the
  2 35 requirements applicable to an agent or assignee of a
  2 36 covered individual.
  2 37    4.  For purposes of this section, "insurer" means
  2 38 an entity which offers a health benefit plan,
  2 39 including a group health plan under the federal
  2 40 Employee Retirement Income Security Act of 1974.
  2 41    Sec.    .  NEW SECTION.  514C.9  MEDICAL SUPPORT &endash;
  2 42 INSURANCE REQUIREMENTS.
  2 43    1.  An insurer shall not deny coverage or
  2 44 enrollment of a child under the health plan of the
  2 45 obligor upon any of the following grounds:
  2 46    a.  The child is born out of wedlock.
  2 47    b.  The child is not claimed as a dependent on the
  2 48 obligor's federal income tax return.
  2 49    c.  The child does not reside with the obligor or
  2 50 in the insurer's service area.  This section shall not
  3  1 be construed to require a health maintenance
  3  2 organization regulated under chapter 514B to provide
  3  3 any services or benefits for treatment outside of the
  3  4 geographic area described in its certificate of
  3  5 authority which would not be provided to a member
  3  6 outside of that geographic area pursuant to the terms
  3  7 of the health maintenance organizations contract.
  3  8    2.  An insurer of an obligor providing health care
  3  9 coverage to the child for which the obligor is legally
  3 10 responsible to provide support shall do all of the
  3 11 following:
  3 12    a.  Provide information to the obligee or other
  3 13 legal custodian of the child as necessary for the
  3 14 child to obtain benefits through the coverage of the
  3 15 insurer.
  3 16    b.  Allow the obligee or other legal custodian of
  3 17 the child, or the provider with the approval of the
  3 18 obligee or other legal custodian of the child, to
  3 19 submit claims for covered services without the
  3 20 approval of the obligor.
  3 21    c.  Make payment on a claim submitted in paragraph
  3 22 "b" directly to the obligee or other legal custodian
  3 23 of the child, the provider, or the state medical
  3 24 assistance agency for claims submitted by the obligee
  3 25 or other legal custodian of the child, by the provider
  3 26 with the approval of the obligee or other legal
  3 27 custodian of the child, or by the state medical
  3 28 assistance agency.
  3 29    3.  If an obligor is required by a court order or
  3 30 administrative order to provide health coverage for a
  3 31 child and the obligor is eligible for dependent health
  3 32 coverage, the insurer shall do all of the following:
  3 33    a.  Allow the obligor to enroll under dependent
  3 34 coverage a child who is eligible for coverage pursuant
  3 35 to the applicable terms and conditions of the health
  3 36 benefit plan and the standard enrollment guidelines of
  3 37 the insurer without regard to an enrollment season
  3 38 restriction.
  3 39    b.  Enroll a child who is eligible for coverage
  3 40 under the applicable terms and conditions of the
  3 41 health benefit plan and the standard enrollment
  3 42 guidelines of the insurer, without regard to any time
  3 43 of enrollment restriction, under dependent coverage
  3 44 upon application by the obligee or other legal
  3 45 custodian of the child or by the department of human
  3 46 services in the event an obligor required by a court
  3 47 order or administrative order fails to apply for
  3 48 coverage for the child.
  3 49    c.  Maintain coverage and not cancel the child's
  3 50 enrollment unless the insurer obtains satisfactory
  4  1 written evidence of any of the following:
  4  2    (1)  The court order or administrative order is no
  4  3 longer in effect.
  4  4    (2)  The child is eligible for or will enroll in
  4  5 comparable health coverage through an insurer which
  4  6 shall take effect not later than the effective date of
  4  7 the cancellation of enrollment of the original
  4  8 coverage.
  4  9    (3)  The employer has eliminated dependent health
  4 10 coverage for its employees.
  4 11    (4)  The obligor is no longer paying the required
  4 12 premium because the employer no longer owes the
  4 13 obligor compensation, or because the obligor's
  4 14 employment has terminated and the obligor has not
  4 15 elected to continue coverage.
  4 16    4.  A group health plan shall establish reasonable
  4 17 procedures to determine whether a child is covered
  4 18 under a qualified medical child support order issued
  4 19 pursuant to chapter 252E.  The procedures shall be in
  4 20 writing, provide for prompt notice of each person
  4 21 specified in the medical child support order as
  4 22 eligible to receive benefits under the group health
  4 23 plan upon receipt by the plan of the medical child
  4 24 support order, and allow an obligee or other legal
  4 25 custodian of the child under chapter 252E to designate
  4 26 a representative for receipt of copies of notices in
  4 27 regard to the medical child support order that are
  4 28 sent to the obligee or other legal custodian of the
  4 29 child and the department of human services' child
  4 30 support recovery unit.
  4 31    5.  For purposes of this section, unless the
  4 32 context otherwise requires:
  4 33    a.  "Child" means a person, other than an obligee's
  4 34 spouse or former spouse, who is recognized under a
  4 35 qualified medical child support order as having a
  4 36 right to enrollment under a group health plan as the
  4 37 obligor's dependent.
  4 38    b.  "Court order" or "administrative order" means a
  4 39 ruling by a court or administrative agency in regard
  4 40 to the support an obligor shall provide to the
  4 41 obligor's child.
  4 42    c.  "Insurer" means an entity which offers a health
  4 43 benefit plan.
  4 44    d.  "Obligee" means an obligee as defined in
  4 45 section 252E.1.
  4 46    e.  "Obligor" means an obligor as defined in
  4 47 section 252E.1.
  4 48    f.  "Qualified medical child support order" means a
  4 49 child support order which creates or recognizes a
  4 50 child's right to receive health benefits for which the
  5  1 child is eligible under a group health benefit plan,
  5  2 describes or determines the type of coverage to be
  5  3 provided, specifies the length of time for which the
  5  4 order applies, and specifies the plan to which the
  5  5 order applies.
  5  6    Sec.    .  NEW SECTION.  514C.10  COVERAGE FOR
  5  7 ADOPTED CHILD.
  5  8    1.  DEFINITIONS.  For purposes of this section,
  5  9 unless the context otherwise requires:
  5 10    a.  "Child" means, with respect to an adoption or a
  5 11 placement for adoption of a child, an individual who
  5 12 has not attained age eighteen as of the date of the
  5 13 issuance of a final adoption decree, or upon an
  5 14 interlocutory adoption decree becoming a final
  5 15 adoption decree, as provided in chapter 600, or as of
  5 16 the date of the placement for adoption.
  5 17    b.  "Placement for adoption" means the assumption
  5 18 and retention of a legal obligation for the total or
  5 19 partial support of the child in anticipation of the
  5 20 adoption of the child.  The child's placement with a
  5 21 person terminates upon the termination of such legal
  5 22 obligation.
  5 23    2.  COVERAGE REQUIRED.  A policy or contract
  5 24 providing for third-party payment or prepayment of
  5 25 health or medical expenses shall provide coverage
  5 26 benefits to a dependent child adopted by, or placed
  5 27 for adoption with, an insured or enrollee under the
  5 28 same terms and conditions as apply to a biological,
  5 29 dependent child of the insured or enrollee.  The
  5 30 issuer of the policy or contract shall not restrict
  5 31 coverage under the policy or contract for a dependent
  5 32 child adopted by, or placed for adoption with, the
  5 33 insured or enrollee solely on the basis of a
  5 34 preexisting condition of such dependent child at the
  5 35 time that the child would otherwise become eligible
  5 36 for coverage under the plan, if the adoption or
  5 37 placement occurs while the insured or enrollee is
  5 38 eligible for coverage under the policy or contract.
  5 39 This section applies to the following classes of
  5 40 third-party payment provider contracts or policies
  5 41 delivered, issued for delivery, continued, or renewed
  5 42 in this state on or after July 1, 1995:
  5 43    a.  Individual or group accident and sickness
  5 44 insurance providing coverage on an expense-incurred
  5 45 basis.
  5 46    b.  An individual or group hospital or medical
  5 47 service contract issued pursuant to chapter 509, 514,
  5 48 or 514A.
  5 49    c.  An individual or group health maintenance
  5 50 organization contract regulated under chapter 514B.
  6  1    d.  An individual or group Medicare supplemental
  6  2 policy, unless coverage pursuant to such policy is
  6  3 preempted by federal law.
  6  4    e.  An organized delivery system licensed by the
  6  5 director of public health."
  6  6    #5.  Page 8, by striking lines 6 through 18 and
  6  7 inserting the following:
  6  8    "Sec.    .  Section 515A.15, Code 1995, is amended
  6  9 to read as follows:
  6 10    515A.15  ASSIGNED RISKS.
  6 11    Agreements may shall be made among insurers with
  6 12 respect to the equitable apportionment among them of
  6 13 insurance which may be afforded applicants who are in
  6 14 good faith entitled to but who are unable to procure
  6 15 such insurance through ordinary methods and such
  6 16 insurers may agree among themselves on the use of
  6 17 reasonable rate modifications for such insurance, such
  6 18 the agreements and rate modifications to be subject to
  6 19 the approval of the commissioner.
  6 20    For purposes of this section, "insurer" includes,
  6 21 in addition to insurers defined pursuant to section
  6 22 515A.2, a self-insurance association formed on or
  6 23 after July 1, 1995, pursuant to section 87.4 except
  6 24 for an association comprised of cities or counties, or
  6 25 both, or an association comprised of community
  6 26 colleges as defined in section 260C.2, which have
  6 27 entered into an agreement pursuant to chapter 28E for
  6 28 the purpose of establishing a self-insured program for
  6 29 the payment of workers' compensation benefits."
  6 30    #6.  Page 16, lines 2 and 3, by striking the words
  6 31 "REFUSED &endash; ADMINISTRATIVE PENALTY" and inserting the
  6 32 following:  "SUSPENSION".
  6 33    #7.  Page 16, by striking lines 7 through 20 and
  6 34 inserting the following:  "this chapter".
  6 35    #8.  Page 24, lines 19 and 20, by striking the
  6 36 words "REFUSED &endash; ADMINISTRATIVE PENALTY" and
  6 37 inserting the following:  "SUSPENSION".
  6 38    #9.  By striking page 24, line 24, through page 25,
  6 39 line 2, and inserting the following:  "with this
  6 40 chapter".
  6 41    #10.  Page 25, by striking lines 3 through 8 and
  6 42 inserting the following:
  6 43    "Sec.    .  Section 521.1, Code 1995, is amended to
  6 44 read as follows:
  6 45    521.1  DEFINITIONS.
  6 46    "Company" or "companies" when used in this chapter
  6 47 means a company or association organized under chapter
  6 48 508, 511, 515, 518, 518A, or 520, except county
  6 49 mutuals and includes a mutual insurance holding
  6 50 company organized pursuant to section 521A.14."
  7  1    #11.  Page 25, by inserting after line 26 the
  7  2 following:
  7  3    "Sec.    .  NEW SECTION.  521A.14  MUTUAL INSURANCE
  7  4 HOLDING COMPANIES.
  7  5    1.  a.  A domestic mutual insurance company upon
  7  6 approval of the commissioner, may reorganize by
  7  7 forming an insurance holding company based upon a
  7  8 mutual plan and continuing the corporate existence of
  7  9 the reorganizing insurance company as a stock
  7 10 insurance company.  The commissioner, after a public
  7 11 hearing as provided in section 521A.3, subsection 4,
  7 12 paragraph "b", if satisfied that the interests of the
  7 13 policyholders are properly protected and that the plan
  7 14 of reorganization is fair and equitable to the
  7 15 policyholders, may approve the proposed plan of
  7 16 reorganization and may require as a condition of
  7 17 approval such modifications of the proposed plan of
  7 18 reorganization as the commissioner finds necessary for
  7 19 the protection of the policyholder's interests.  The
  7 20 commissioner may retain consultants as provided in
  7 21 section 521A.3, subsection 4, paragraph "c".  A
  7 22 reorganization pursuant to this section is subject to
  7 23 section 521A.3, subsections 1, 2, and 3.  The
  7 24 commissioner shall retain jurisdiction over a mutual
  7 25 insurance holding company organized pursuant to this
  7 26 section to assure that policyholder interests are
  7 27 protected.
  7 28    b.  All of the initial shares of the capital stock
  7 29 of the reorganized insurance company shall be issued
  7 30 to the mutual insurance holding company.  The
  7 31 membership interests of the policyholders of the
  7 32 reorganized insurance company shall become membership
  7 33 interests in the mutual insurance holding company.
  7 34 Policyholders of the reorganized insurance company
  7 35 shall be members of the mutual insurance holding
  7 36 company in accordance with the articles of
  7 37 incorporation and bylaws of the mutual insurance
  7 38 holding company.  The mutual insurance holding company
  7 39 shall at all times own a majority of the voting shares
  7 40 of the capital stock of the reorganized insurance
  7 41 company.
  7 42    2.  a.  A domestic mutual insurance company, upon
  7 43 the approval of the commissioner, may reorganize by
  7 44 merging its policyholders membership interests into a
  7 45 mutual insurance holding company formed pursuant to
  7 46 subsection 1 and continuing the corporate existence of
  7 47 the reorganizing insurance company as a stock
  7 48 insurance company subsidiary of the mutual insurance
  7 49 holding company.  The commissioner, after a public
  7 50 hearing as provided in section 521A.3, subsection 4,
  8  1 paragraph "b", if satisfied that the interest of the
  8  2 policyholders are properly protected and that the
  8  3 merger is fair and equitable to the policyholders, may
  8  4 approve the proposed merger and may require as a
  8  5 condition of approval such modifications of the
  8  6 proposed merger as the commissioner finds necessary
  8  7 for the protection of the policyholder's interests.
  8  8 The commissioner may retain consultants as provided in
  8  9 section 521A.3, subsection 4, paragraph "c".  A merger
  8 10 pursuant to this section is subject to section 521A.3,
  8 11 subsections 1, 2, and 3.  The commissioner shall
  8 12 retain jurisdiction over the mutual insurance holding
  8 13 company organized pursuant to this section to assure
  8 14 that policyholder interests are protected.
  8 15    b.  All of the initial shares of the capital stock
  8 16 of the reorganized insurance company shall be issued
  8 17 to the mutual insurance holding company.  The
  8 18 membership interests of the policyholders of the
  8 19 reorganized insurance company shall become membership
  8 20 interests in the mutual insurance holding company.
  8 21 Policyholders of the reorganized insurance company
  8 22 shall be members of the mutual insurance holding
  8 23 company in accordance with the articles of
  8 24 incorporation and bylaws of the mutual insurance
  8 25 holding company.  The mutual insurance holding company
  8 26 shall at all times own a majority of the voting shares
  8 27 of the capital stock of the reorganized insurance
  8 28 company.  A merger of policyholder's membership
  8 29 interests in a mutual insurance company into a mutual
  8 30 insurance holding company shall be deemed to be a
  8 31 merger of insurance companies pursuant to chapter 521
  8 32 and chapter 521 is also applicable.
  8 33    3.  A mutual insurance holding company resulting
  8 34 from the reorganization of a domestic mutual insurance
  8 35 company organized under chapter 491 shall be
  8 36 incorporated pursuant to chapter 491.  This
  8 37 requirement shall supersede any conflicting provisions
  8 38 of section 491.1.  The articles of incorporation and
  8 39 any amendments to such articles of the mutual
  8 40 insurance holding company shall be subject to approval
  8 41 of the commissioner and the attorney general in the
  8 42 same manner as those of an insurance company.
  8 43    4.  A mutual insurance holding company is deemed to
  8 44 be an insurer subject to chapter 507C and shall
  8 45 automatically be a party to any proceeding under
  8 46 chapter 507C involving an insurance company which as a
  8 47 result of a reorganization pursuant to subsection 1 or
  8 48 2 is a subsidiary of the mutual insurance holding
  8 49 company.  In any proceeding under chapter 507C
  8 50 involving the reorganized insurance company, the
  9  1 assets of the mutual insurance holding company are
  9  2 deemed to be assets of the estate of the reorganized
  9  3 insurance company for purposes of satisfying the
  9  4 claims of the reorganized insurance company's policy-
  9  5 holders.  A mutual insurance holding company shall not
  9  6 dissolve or liquidate without the approval of the
  9  7 commissioner or as ordered by the district court
  9  8 pursuant to chapter 507C.
  9  9    5.  a.  Chapters 508B and 515G are not applicable
  9 10 to a reorganization or merger pursuant to this
  9 11 section.
  9 12    b.  Chapter 508B is applicable to demutualization
  9 13 of a mutual insurance holding company which resulted
  9 14 from the reorganization of a domestic mutual life
  9 15 insurance company organized under chapter 508 as if it
  9 16 were a mutual life insurance company.
  9 17    c.  Chapter 515G is applicable to demutualization
  9 18 of a mutual insurance holding company which resulted
  9 19 from the reorganization of a domestic mutual property
  9 20 and casualty insurance company organized under chapter
  9 21 515 as if it were a mutual property and casualty
  9 22 insurance company.
  9 23    6.  A membership interest in a domestic mutual
  9 24 insurance holding company shall not constitute a
  9 25 security as defined in section 502.102."
  9 26    #12.  Page 27, by inserting after line 1 the
  9 27 following:
  9 28    "Sec.    .  The Code editor is directed to codify
  9 29 new section 521A.14, as enacted in this Act, as a
  9 30 separate division of chapter 521A."
  9 31    #13.  Title page, by striking line 4 and inserting
  9 32 the following:  "contracts, providing for coordination
  9 33 of health care benefits with state medical assistance
  9 34 and for continuation of health care benefits pursuant
  9 35 to court-ordered medical child support and for
  9 36 coverage for an adopted child,".
  9 37    #14.  By renumbering, relettering, or redesignating
  9 38 and correcting internal references as necessary.  
  9 39 HF 247S
  9 40 mj/cc/26
     

Text: H04101                            Text: H04103
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