House Journal: Page 330: Wednesday, February 16, 2000
37 physical tolerance or by physical symptoms when the
38 alcohol or drug is withdrawn.
39 2. This section shall not apply to accident-only,
40 specific disease, short-term hospital or medical,
41 hospital confinement indemnity, credit, dental,
42 vision, Medicare supplement, long-term care, basic
43 hospital and medical-surgical expense coverage as
44 defined by the commissioner, disability income
45 insurance coverage, coverage issued as a supplement to
46 liability insurance, workers' compensation or similar
47 insurance, automobile medical payment insurance, or
48 individual accident or sickness policies issued
49 pursuant to chapter 513C.
50 3. a third-party payor may manage the benefits
Page 2
1 provided through common methods including, but not
2 limited to, providing payment of benefits or providing
3 care and treatment under a capitated payment system,
4 prospective reimbursement rate system, utilization
5 control system, incentive system for the use of least
6 restrictive and least costly levels of care, a
7 preferred provider contract limiting choice of
8 specific provider, or any other system, method, or
9 organization designed to ensure services are medically
10 necessary and clinically appropriate.
11 4. a group policy or contract covered under this
12 section, at a minimum, shall provide for thirty
13 inpatient and sixty outpatient days annually. The
14 policy or contract may also include deductibles,
15 coinsurance, or copayments if such deductibles,
16 coinsurance, or copayments are applicable to other
17 medical or surgical services coverage under the policy
18 or contract. It is not a violation of this section if
19 the policy or contract excludes entirely from coverage
20 benefits the cost of providing the following:
21 a. Marital, family, educational, developmental, or
22 training services.
23 b. Care that is substantially custodial in nature.
24 c. Services and supplies that are not medically
25 necessary or clinically appropriate.
26 d. Experimental treatments.
27 5. The commissioner, by rule, shall increase the
28 mental health and substance abuse lifetime limit in
29 the individual market guaranteed standard product to
30 one hundred thousand dollars.
31 6. a group policy is exempt from this section upon
32 submitting to the commissioner evidence demonstrating
33 a premium increase for the policy term in excess of
34 three percent as a result of the requirements of this
35 section.
© 2000 Cornell College and
League of Women Voters of Iowa
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