Text: HF00132 Text: HF00134 Text: HF00100 - HF00199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 HOUSE FILE 133
1 2
1 3 AN ACT
1 4 RELATING TO THE OFFERING OF POINT OF SERVICE PLAN OPTIONS
1 5 IN CERTAIN HEALTH BENEFIT PLANS.
1 6
1 7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 8
1 9 Section 1. NEW SECTION. 514C.13 GROUP MANAGED CARE
1 10 HEALTH PLANS – ALTERNATIVE OFFERS.
1 11 1. As used in this section, unless the context otherwise
1 12 requires:
1 13 a. "Carrier" means an entity that provides health benefit
1 14 plans in this state. "Carrier" includes an insurance company,
1 15 group hospital or medical service corporation, health
1 16 maintenance organization, multiple employer welfare
1 17 arrangement, and any other person providing health benefit
1 18 plans in this state subject to regulation by the commissioner
1 19 of insurance.
1 20 b. "Health benefit plan" means a policy, certificate, or
1 21 contract providing hospital or medical coverage, benefits, or
1 22 services rendered by a health care provider. "Health benefit
1 23 plan" does not include a group conversion plan, accident-only,
1 24 specific-disease, short-term hospital or medical hospital
1 25 confinement indemnity, credit, dental, vision, Medicare
1 26 supplement, long-term care, or disability income insurance,
1 27 coverage issued as a supplement to liability insurance,
1 28 workers' compensation or similar insurance, or automobile
1 29 medical payment insurance.
1 30 c. "Health care provider" means a hospital licensed
1 31 pursuant to chapter 135B, a person licensed under chapter 148,
1 32 148C, 149, 150, 150A, 151, or 154, or a person licensed as an
1 33 advanced registered nurse practitioner under chapter 152.
1 34 d. "Indemnity plan" means a hospital or medical expense-
1 35 incurred policy, certificate, or contract, major medical
2 1 expense insurance, or hospital or medical service plan
2 2 contract.
2 3 e. "Large employer" means a person actively engaged in
2 4 business who, during at least fifty percent of the employer's
2 5 working days during the preceding calendar year, employed more
2 6 than fifty full-time equivalent employees.
2 7 f. "Limited provider network plan" means a managed care
2 8 health plan which limits access to or coverage for services to
2 9 selected health care providers who are under contract with the
2 10 managed care health plan.
2 11 g. "Managed care health plan" means a health benefit plan
2 12 that selects and contracts with health care providers; manages
2 13 and coordinates health care delivery; monitors necessity,
2 14 appropriateness, and quality of health care delivered by
2 15 health care providers; and performs utilization review and
2 16 cost control.
2 17 h. "Organized delivery system" means an organized delivery
2 18 system as defined in section 513C.3.
2 19 i. "Point of service plan option" means a provision in a
2 20 managed care health plan that permits insureds, enrollees, or
2 21 subscribers access to health care from health care providers
2 22 who have not contracted with the managed care health plan.
2 23 j. "Small employer" means a person actively engaged in
2 24 business who, during at least fifty percent of the employer's
2 25 working days during the preceding calendar year, employed not
2 26 less than two and not more than fifty full-time equivalent
2 27 employees.
2 28 2. A carrier or organized delivery system which offers to
2 29 a small employer a limited provider network plan to provide
2 30 health care services or benefits to the small employer's
2 31 employees shall also offer to the small employer a point of
2 32 service option to the limited provider network plan.
2 33 3. A carrier or organized delivery system which offers to
2 34 a large employer a limited provider network plan to provide
2 35 health care services or benefits to the large employer's
3 1 employees shall also offer to the large employer one or more
3 2 of the following:
3 3 a. A point of service plan option to the limited provider
3 4 network plan. The price of the point of service plan option
3 5 shall be actuarially determined.
3 6 b. A managed care health plan that is not a limited
3 7 provider network plan.
3 8 c. An indemnity plan.
3 9 4. A large employer that offers a limited provider network
3 10 plan to its employees shall also offer to its employees one or
3 11 more of the following:
3 12 a. A point of service plan option to the limited provider
3 13 network plan.
3 14 b. A managed care health plan that is not a limited
3 15 provider network plan.
3 16 c. An indemnity plan.
3 17
3 18
3 19
3 20 RON J. CORBETT
3 21 Speaker of the House
3 22
3 23
3 24
3 25 MARY E. KRAMER
3 26 President of the Senate
3 27
3 28 I hereby certify that this bill originated in the House and
3 29 is known as House File 133, Seventy-seventh General Assembly.
3 30
3 31
3 32
3 33 ELIZABETH ISAACSON
3 34 Chief Clerk of the House
3 35 Approved , 1997
4 1
4 2
4 3
4 4 TERRY E. BRANSTAD
4 5 Governor
Text: HF00132 Text: HF00134 Text: HF00100 - HF00199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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