Text: S03365 Text: S03367 Text: S03300 - S03399 Text: S Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Amend House File 247, as amended, passed, and 1 2 reprinted by the House, as follows: 1 3 #1. Page 5, by inserting after line 9 the 1 4 following: 1 5 "Sec. . NEW SECTION. 514C.8 COORDINATION OF 1 6 HEALTH CARE BENEFITS WITH STATE MEDICAL ASSISTANCE. 1 7 1. An insurer, health maintenance organization, or 1 8 hospital and medical service plan providing health 1 9 care coverage to individuals in this state shall not 1 10 consider the availability of or eligibility for 1 11 medical assistance under Title XIX of the federal 1 12 Social Security Act and chapter 249A, when determining 1 13 eligibility of the individual for coverage or 1 14 calculating payments to the individual under the 1 15 health care coverage plan. 1 16 2. The state acquires the rights of an individual 1 17 to payment from an insurer, health maintenance 1 18 organization, or hospital or medical service plan to 1 19 the extent payment for covered expenses is made 1 20 pursuant to chapter 249A for health care items or 1 21 services provided to the individual. Upon 1 22 presentation of proof that payment was made pursuant 1 23 to chapter 249A for covered expenses, the insurer, 1 24 health maintenance organization, or hospital or 1 25 medical service plan shall make payment to the state 1 26 medical assistance program to the extent of the 1 27 coverage provided in the policy or contract. 1 28 3. An insurer shall not impose requirements on the 1 29 state with respect to the assignment of rights 1 30 pursuant to this section that are different from the 1 31 requirements applicable to an agent or assignee of a 1 32 covered individual. 1 33 4. For purposes of this section, "insurer" means 1 34 an entity which offers a health benefit plan, 1 35 including a group health plan under the federal 1 36 Employee Retirement Income Security Act of 1974. 1 37 Sec. . NEW SECTION. 514C.9 MEDICAL SUPPORT &endash; 1 38 INSURANCE REQUIREMENTS. 1 39 1. An insurer shall not deny coverage or 1 40 enrollment of a child under the health plan of the 1 41 obligor upon any of the following grounds: 1 42 a. The child is born out of wedlock. 1 43 b. The child is not claimed as a dependent on the 1 44 obligor's federal income tax return. 1 45 c. The child does not reside with the obligor or 1 46 in the insurer's service area. This section shall not 1 47 be construed to require a health maintenance 1 48 organization regulated under chapter 514B to provide 1 49 any services or benefits for treatment outside of the 1 50 geographic area described in its certificate of 2 1 authority which would not be provided to a member 2 2 outside of that geographic area pursuant to the terms 2 3 of the health maintenance organizations contract. 2 4 2. An insurer of an obligor providing health care 2 5 coverage to the child for which the obligor is legally 2 6 responsible to provide support shall do all of the 2 7 following: 2 8 a. Provide information to the obligee or other 2 9 legal custodian of the child as necessary for the 2 10 child to obtain benefits through the coverage of the 2 11 insurer. 2 12 b. Allow the obligee or other legal custodian of 2 13 the child, or the provider with the approval of the 2 14 obligee or other legal custodian of the child, to 2 15 submit claims for covered services without the 2 16 approval of the obligor. 2 17 c. Make payment on a claim submitted in paragraph 2 18 "b" directly to the obligee or other legal custodian 2 19 of the child, the provider, or the state medical 2 20 assistance agency for claims submitted by the obligee 2 21 or other legal custodian of the child, by the provider 2 22 with the approval of the obligee or other legal 2 23 custodian of the child, or by the state medical 2 24 assistance agency. 2 25 3. If an obligor is required by a court order or 2 26 administrative order to provide health coverage for a 2 27 child and the obligor is eligible for dependent health 2 28 coverage, the insurer shall do all of the following: 2 29 a. Allow the obligor to enroll under dependent 2 30 coverage a child who is eligible for coverage pursuant 2 31 to the applicable terms and conditions of the health 2 32 benefit plan and the standard enrollment guidelines of 2 33 the insurer without regard to an enrollment season 2 34 restriction. 2 35 b. Enroll a child who is eligible for coverage 2 36 under the applicable terms and conditions of the 2 37 health benefit plan and the standard enrollment 2 38 guidelines of the insurer, without regard to any time 2 39 of enrollment restriction, under dependent coverage 2 40 upon application by the obligee or other legal 2 41 custodian of the child or by the department of human 2 42 services in the event an obligor required by a court 2 43 order or administrative order fails to apply for 2 44 coverage for the child. 2 45 c. Maintain coverage and not cancel the child's 2 46 enrollment unless the insurer obtains satisfactory 2 47 written evidence of any of the following: 2 48 (1) The court order or administrative order is no 2 49 longer in effect. 2 50 (2) The child is eligible for or will enroll in 3 1 comparable health coverage through an insurer which 3 2 shall take effect not later than the effective date of 3 3 the cancellation of enrollment of the original 3 4 coverage. 3 5 (3) The employer has eliminated dependent health 3 6 coverage for its employees. 3 7 (4) The obligor is no longer paying the required 3 8 premium because the employer no longer owes the 3 9 obligor compensation, or because the obligor's 3 10 employment has terminated and the obligor has not 3 11 elected to continue coverage. 3 12 4. A group health plan shall establish reasonable 3 13 procedures to determine whether a child is covered 3 14 under a qualified medical child support order issued 3 15 pursuant to chapter 252E. The procedures shall be in 3 16 writing, provide for prompt notice of each person 3 17 specified in the medical child support order as 3 18 eligible to receive benefits under the group health 3 19 plan upon receipt by the plan of the medical child 3 20 support order, and allow an obligee or other legal 3 21 custodian of the child under chapter 252E to designate 3 22 a representative for receipt of copies of notices in 3 23 regard to the medical child support order that are 3 24 sent to the obligee or other legal custodian of the 3 25 child and the department of human services' child 3 26 support recovery unit. 3 27 5. For purposes of this section, unless the 3 28 context otherwise requires: 3 29 a. "Child" means a person, other than an obligee's 3 30 spouse or former spouse, who is recognized under a 3 31 qualified medical child support order as having a 3 32 right to enrollment under a group health plan as the 3 33 obligor's dependent. 3 34 b. "Court order" or "administrative order" means a 3 35 ruling by a court or administrative agency in regard 3 36 to the support an obligor shall provide to the 3 37 obligor's child. 3 38 c. "Insurer" means an entity which offers a health 3 39 benefit plan. 3 40 d. "Obligee" means an obligee as defined in 3 41 section 252E.1. 3 42 e. "Obligor" means an obligor as defined in 3 43 section 252E.1. 3 44 f. "Qualified medical child support order" means a 3 45 child support order which creates or recognizes a 3 46 child's right to receive health benefits for which the 3 47 child is eligible under a group health benefit plan, 3 48 describes or determines the type of coverage to be 3 49 provided, specifies the length of time for which the 3 50 order applies, and specifies the plan to which the 4 1 order applies. 4 2 Sec. . NEW SECTION. 514C.10 COVERAGE FOR 4 3 ADOPTED CHILD. 4 4 1. DEFINITIONS. For purposes of this section, 4 5 unless the context otherwise requires: 4 6 a. "Child" means, with respect to an adoption or a 4 7 placement for adoption of a child, an individual who 4 8 has not attained age eighteen as of the date of the 4 9 issuance of a final adoption decree, or upon an 4 10 interlocutory adoption decree becoming a final 4 11 adoption decree, as provided in chapter 600, or as of 4 12 the date of the placement for adoption. 4 13 b. "Placement for adoption" means the assumption 4 14 and retention of a legal obligation for the total or 4 15 partial support of the child in anticipation of the 4 16 adoption of the child. The child's placement with a 4 17 person terminates upon the termination of such legal 4 18 obligation. 4 19 2. COVERAGE REQUIRED. A policy or contract 4 20 providing for third-party payment or prepayment of 4 21 health or medical expenses shall provide coverage 4 22 benefits to a dependent child adopted by, or placed 4 23 for adoption with, an insured or enrollee under the 4 24 same terms and conditions as apply to a biological, 4 25 dependent child of the insured or enrollee. The 4 26 issuer of the policy or contract shall not restrict 4 27 coverage under the policy or contract for a dependent 4 28 child adopted by, or placed for adoption with, the 4 29 insured or enrollee solely on the basis of a 4 30 preexisting condition of such dependent child at the 4 31 time that the child would otherwise become eligible 4 32 for coverage under the plan, if the adoption or 4 33 placement occurs while the insured or enrollee is 4 34 eligible for coverage under the policy or contract. 4 35 This section applies to the following classes of 4 36 third-party payment provider contracts or policies 4 37 delivered, issued for delivery, continued, or renewed 4 38 in this state on or after July 1, 1995: 4 39 a. Individual or group accident and sickness 4 40 insurance providing coverage on an expense-incurred 4 41 basis. 4 42 b. An individual or group hospital or medical 4 43 service contract issued pursuant to chapter 509, 514, 4 44 or 514A. 4 45 c. An individual or group health maintenance 4 46 organization contract regulated under chapter 514B. 4 47 d. An individual or group Medicare supplemental 4 48 policy, unless coverage pursuant to such policy is 4 49 preempted by federal law. 4 50 e. An organized delivery system licensed by the 5 1 director of public health." 5 2 #2. Page 25, by striking lines 3 through 8 and 5 3 inserting the following: 5 4 "Sec. . Section 521.1, Code 1995, is amended to 5 5 read as follows: 5 6 521.1 DEFINITIONS. 5 7 "Company" or "companies" when used in this chapter 5 8 means a company or association organized under chapter 5 9 508, 511, 515, 518, 518A, or 520,except county5 10mutualsand includes a mutual insurance holding 5 11 company organized pursuant to section 521A.14." 5 12 #3. Page 25, by inserting after line 26 the 5 13 following: 5 14 "Sec. . NEW SECTION. 521A.14 MUTUAL INSURANCE 5 15 HOLDING COMPANIES. 5 16 1. a. A domestic mutual insurance company upon 5 17 approval of the commissioner, may reorganize by 5 18 forming an insurance holding company based upon a 5 19 mutual plan and continuing the corporate existence of 5 20 the reorganizing insurance company as a stock 5 21 insurance company. The commissioner, after a public 5 22 hearing as provided in section 521A.3, subsection 4, 5 23 paragraph "b", if satisfied that the interests of the 5 24 policyholders are properly protected and that the plan 5 25 of reorganization is fair and equitable to the 5 26 policyholders, may approve the proposed plan of 5 27 reorganization and may require as a condition of 5 28 approval such modifications of the proposed plan of 5 29 reorganization as the commissioner finds necessary for 5 30 the protection of the policyholder's interests. The 5 31 commissioner may retain consultants as provided in 5 32 section 521A.3, subsection 4, paragraph "c". A 5 33 reorganization pursuant to this section is subject to 5 34 section 521A.3, subsections 1, 2, and 3. The 5 35 commissioner shall retain jurisdiction over a mutual 5 36 insurance holding company organized pursuant to this 5 37 section to assure that policyholder interests are 5 38 protected. 5 39 b. All of the initial shares of the capital stock 5 40 of the reorganized insurance company shall be issued 5 41 to the mutual insurance holding company. The 5 42 membership interests of the policyholders of the 5 43 reorganized insurance company shall become membership 5 44 interests in the mutual insurance holding company. 5 45 Policyholders of the reorganized insurance company 5 46 shall be members of the mutual insurance holding 5 47 company in accordance with the articles of 5 48 incorporation and bylaws of the mutual insurance 5 49 holding company. The mutual insurance holding company 5 50 shall at all times own a majority of the voting shares 6 1 of the capital stock of the reorganized insurance 6 2 company. 6 3 2. a. A domestic mutual insurance company, upon 6 4 the approval of the commissioner, may reorganize by 6 5 merging its policyholders membership interests into a 6 6 mutual insurance holding company formed pursuant to 6 7 subsection 1 and continuing the corporate existence of 6 8 the reorganizing insurance company as a stock 6 9 insurance company subsidiary of the mutual insurance 6 10 holding company. The commissioner, after a public 6 11 hearing as provided in section 521A.3, subsection 4, 6 12 paragraph "b", if satisfied that the interest of the 6 13 policyholders are properly protected and that the 6 14 merger is fair and equitable to the policyholders, may 6 15 approve the proposed merger and may require as a 6 16 condition of approval such modifications of the 6 17 proposed merger as the commissioner finds necessary 6 18 for the protection of the policyholder's interests. 6 19 The commissioner may retain consultants as provided in 6 20 section 521A.3, subsection 4, paragraph "c". A merger 6 21 pursuant to this section is subject to section 521A.3, 6 22 subsections 1, 2, and 3. The commissioner shall 6 23 retain jurisdiction over the mutual insurance holding 6 24 company organized pursuant to this section to assure 6 25 that policyholder interests are protected. 6 26 b. All of the initial shares of the capital stock 6 27 of the reorganized insurance company shall be issued 6 28 to the mutual insurance holding company. The 6 29 membership interests of the policyholders of the 6 30 reorganized insurance company shall become membership 6 31 interests in the mutual insurance holding company. 6 32 Policyholders of the reorganized insurance company 6 33 shall be members of the mutual insurance holding 6 34 company in accordance with the articles of 6 35 incorporation and bylaws of the mutual insurance 6 36 holding company. The mutual insurance holding company 6 37 shall at all times own a majority of the voting shares 6 38 of the capital stock of the reorganized insurance 6 39 company. A merger of policyholder's membership 6 40 interests in a mutual insurance company into a mutual 6 41 insurance holding company shall be deemed to be a 6 42 merger of insurance companies pursuant to chapter 521 6 43 and chapter 521 is also applicable. 6 44 3. A mutual insurance holding company resulting 6 45 from the reorganization of a domestic mutual insurance 6 46 company organized under chapter 491 shall be 6 47 incorporated pursuant to chapter 491. This 6 48 requirement shall supersede any conflicting provisions 6 49 of section 491.1. The articles of incorporation and 6 50 any amendments to such articles of the mutual 7 1 insurance holding company shall be subject to approval 7 2 of the commissioner and the attorney general in the 7 3 same manner as those of an insurance company. 7 4 4. A mutual insurance holding company is deemed to 7 5 be an insurer subject to chapter 507C and shall 7 6 automatically be a party to any proceeding under 7 7 chapter 507C involving an insurance company which as a 7 8 result of a reorganization pursuant to subsection 1 or 7 9 2 is a subsidiary of the mutual insurance holding 7 10 company. In any proceeding under chapter 507C 7 11 involving the reorganized insurance company, the 7 12 assets of the mutual insurance holding company are 7 13 deemed to be assets of the estate of the reorganized 7 14 insurance company for purposes of satisfying the 7 15 claims of the reorganized insurance company's policy- 7 16 holders. A mutual insurance holding company shall not 7 17 dissolve or liquidate without the approval of the 7 18 commissioner or as ordered by the district court 7 19 pursuant to chapter 507C. 7 20 5. a. Chapters 508B and 515G are not applicable 7 21 to a reorganization or merger pursuant to this 7 22 section. 7 23 b. Chapter 508B is applicable to demutualization 7 24 of a mutual insurance holding company which resulted 7 25 from the reorganization of a domestic mutual life 7 26 insurance company organized under chapter 508 as if it 7 27 were a mutual life insurance company. 7 28 c. Chapter 515G is applicable to demutualization 7 29 of a mutual insurance holding company which resulted 7 30 from the reorganization of a domestic mutual property 7 31 and casualty insurance company organized under chapter 7 32 515 as if it were a mutual property and casualty 7 33 insurance company. 7 34 6. A membership interest in a domestic mutual 7 35 insurance holding company shall not constitute a 7 36 security as defined in section 502.102." 7 37 #4. Page 27, by inserting after line 1 the 7 38 following: 7 39 "Sec. . The Code editor is directed to codify 7 40 new section 521A.14, as enacted in this Act, as a 7 41 separate division of chapter 521A." 7 42 #5. Title page, line 4, by inserting after the 7 43 word "contracts," the following: "providing for 7 44 coordination of health care benefits with state 7 45 medical assistance and for continuation of health care 7 46 benefits pursuant to court-ordered medical child 7 47 support and for coverage for an adopted child,". 7 48 #6. Renumber as necessary. 7 49 7 50 8 1 8 2 COMMITTEE ON COMMERCE 8 3 PATRICK J. DELUHERY, Chairperson 8 4 HF 247.302 76 8 5 mj/cf
Text: S03365 Text: S03367 Text: S03300 - S03399 Text: S Index Bills and Amendments: General Index Bill History: General Index
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