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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