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House Journal: Page 1955: Wednesday, April 26, 1995

38   an entity which offers a health benefit plan,
39   including a group health plan under the federal
40   Employee Retirement Income Security Act of 1974.
41     Sec. ___.  NEW SECTION.  514C.9  MEDICAL SUPPORT --
42   INSURANCE REQUIREMENTS.
43     1.  An insurer shall not deny coverage or
44   enrollment of a child under the health plan of the
45   obligor upon any of the following grounds:
46     a.  The child is born out of wedlock.
47     b.  The child is not claimed as a dependent on the
48   obligor's federal income tax return.
49     c.  The child does not reside with the obligor or
50   in the insurer's service area.  This section shall not

Page   3

 1   be construed to require a health maintenance
 2   organization regulated under chapter 514B to provide
 3   any services or benefits for treatment outside of the
 4   geographic area described in its certificate of
 5   authority which would not be provided to a member
 6   outside of that geographic area pursuant to the terms
 7   of the health maintenance organizations contract.
 8     2.  An insurer of an obligor providing health care
 9   coverage to the child for which the obligor is legally
10   responsible to provide support shall do all of the
11   following:
12     a.  Provide information to the obligee or other
13   legal custodian of the child as necessary for the
14   child to obtain benefits through the coverage of the
15   insurer.
16     b.  Allow the obligee or other legal custodian of
17   the child, or the provider with the approval of the
18   obligee or other legal custodian of the child, to
19   submit claims for covered services without the
20   approval of the obligor.
21     c.  Make payment on a claim submitted in paragraph
22   "b" directly to the obligee or other legal custodian
23   of the child, the provider, or the state medical
24   assistance agency for claims submitted by the obligee
25   or other legal custodian of the child, by the provider
26   with the approval of the obligee or other legal
27   custodian of the child, or by the state medical
28   assistance agency.
29     3.  If an obligor is required by a court order or
30   administrative order to provide health coverage for a
31   child and the obligor is eligible for dependent health
32   coverage, the insurer shall do all of the following:
33     a.  Allow the obligor to enroll under dependent
34   coverage a child who is eligible for coverage pursuant
35   to the applicable terms and conditions of the health
36   benefit plan and the standard enrollment guidelines of
37   the insurer without regard to an enrollment season
38   restriction.

Iowa General Assembly

Index: House Journal (76th General Assembly: Session 1)

© 1995 Cornell College and League of Women Voters of Iowa

Comments? hjourn@legis.iowa.gov.

Last update: Sun Jan 14 21:05:02 CST 1996
URL: /DOCS/GA/76GA/Session.1/HJournal/01900/01955.html
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