Text: SSB01122 Text: SSB01124 Text: SSB01100 - SSB01199 Text: SSB Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 87.11, unnumbered paragraph 1, Code 1 2 2001, is amended to read as follows: 1 3 When an employer coming under this chapter furnishes 1 4 satisfactory proofs to the insurance commissioner of such 1 5 employer's solvency and financial ability to pay the 1 6 compensation and benefits as by law provided and to make such 1 7 payments to the parties when entitled thereto, or when such 1 8 employer deposits with the insurance commissioner security 1 9 satisfactory to the insurance commissioner and the workers' 1 10 compensation commissioner as guaranty for the payment of such 1 11 compensation, such employer shall be relieved of the 1 12 provisions of this chapter requiring insurance; but such 1 13 employer shall, from time to time, furnish such additional 1 14 proof of solvency and financial ability to pay as may be 1 15 required by such insurance commissioner or workers' 1 16 compensation commissioner. A political subdivision, including 1 17 a city, county, community college, or school corporation, that 1 18 is self-insured for workers' compensation is not required to 1 19 submit a plan or program to the insurance commissioner for 1 20 review and approval. 1 21 Sec. 2. NEW SECTION. 321.276 INTENTIONAL VEHICLE 1 22 COLLISION. 1 23 1. It is unlawful to cause or attempt to cause a vehicle 1 24 collision that is likely to result in bodily injury, or to 1 25 aid, abet, or conspire with any person to knowingly cause or 1 26 participate in or attempt to cause a vehicle collision that is 1 27 likely to result in bodily injury. 1 28 2. A person guilty of a violation of subsection 1 commits 1 29 a class "D" felony. 1 30 Sec. 3. Section 505.11, Code 2001, is amended to read as 1 31 follows: 1 32 505.11 REFUNDS. 1 33 Whenever it appears to the satisfaction of the commissioner 1 34 of insurance that because of error, mistake, or erroneous 1 35 interpretation of statute that a foreign or domestic insurance 2 1 corporation has paid to the state of Iowa taxes, fines, 2 2 penalties, or license fees in excess of the amount legally 2 3 chargeable against it, the commissioner of insurance shall 2 4 have power to refund to such corporation any such excess by 2 5 applying the amountthereofof the excess payment toward the 2 6 payment of taxes, fines, penalties, or license fees already 2 7 due or which mayhereafterbecome due, until such excess 2 8 payments have been fully refunded.The commissioner shall2 9certify to the department of revenue and finance the amount of2 10any such credit to be applied to future taxes due and notify2 11the insurance company affected of the amount thereof.2 12 Sec. 4. Section 507.10, subsection 2, Code 2001, is 2 13 amended to read as follows: 2 14 2. FILING OF EXAMINATION REPORT. No later than sixty days 2 15 following completion of the examination, the examiner in 2 16 charge shall file with the division a verified written report 2 17 of examinationunder oath. Upon receipt of the verified 2 18 report and after administrative review, the division shall 2 19 transmit the report to the company examined, together with a 2 20 notice which shall afford the company examined a reasonable 2 21 opportunity of not more than thirty days to make a written 2 22 submission or rebuttal with respect to any matters contained 2 23 in the examination report. 2 24 Sec. 5. Section 507B.4, subsection 9, paragraphs b and e, 2 25 Code 2001, are amended by striking the paragraphs. 2 26 Sec. 6. Section 507B.4, subsection 9, paragraph f, Code 2 27 2001, is amended to read as follows: 2 28 f. Not attempting in good faith to effectuate prompt, 2 29 fair, and equitable settlements of claims in which liability 2 30 has become reasonably clear, or failing to include interest on 2 31 the payment of claims when required under section 511.38 or 2 32 subsection 10B. 2 33 Sec. 7. Section 507B.4, subsection 9, Code 2001, is 2 34 amended by adding the following new paragraph: 2 35 NEW PARAGRAPH. o. Failing to comply with the procedures 3 1 for auditing claims submitted by health care providers as set 3 2 forth by rule of the commissioner. 3 3 Sec. 8. Section 507B.4, Code 2001, is amended by adding 3 4 the following new subsection: 3 5 NEW SUBSECTION. 10B. PAYMENT OF INTEREST. Failure of an 3 6 insurer to pay interest at the rate of ten percent per annum 3 7 on all health insurance claims that the insurer fails to 3 8 timely accept and pay pursuant to section 507B.4A, subsection 3 9 1, paragraph "e". Interest shall accrue commencing on the 3 10 thirty-first day after receipt of all properly completed proof 3 11 of loss forms. 3 12 For purposes of this subsection, "insurer" means an entity 3 13 providing a plan of health insurance, health care benefits, or 3 14 health care services, or an entity subject to the jurisdiction 3 15 of the commissioner performing utilization review, including 3 16 an insurance company offering sickness and accident plans, a 3 17 health maintenance organization, a nonprofit health service 3 18 corporation, a plan established pursuant to chapter 509A for 3 19 public employees, or any other entity providing a plan of 3 20 health insurance, health care benefits, or health care 3 21 services. 3 22 Sec. 9. NEW SECTION. 507B.4A DUTY TO PROMPTLY 3 23 INVESTIGATE CLAIMS AND RESPOND TO INQUIRIES. 3 24 1. A person shall promptly respond to inquiries from the 3 25 commissioner, a policyholder, or a claimant. A person shall 3 26 promptly take action to investigate and settle a claim. A 3 27 person's actions are deemed untimely if that person fails to 3 28 do any of the following: 3 29 a. Provide all forms necessary to file a claim within ten 3 30 days of receipt of notification of a claim. 3 31 b. Acknowledge a completed proof of loss or other claim 3 32 form within ten days of its receipt by the person. 3 33 c. Initiate investigation of a claim within ten days of 3 34 receipt of a completed proof of loss or claim form. 3 35 d. Provide a substantive reply to an inquiry from the 4 1 commissioner, a policyholder, or a claimant within thirty days 4 2 of receipt of the inquiry, unless good cause exists for delay. 4 3 e. Either accept and pay or deny a clean claim within 4 4 thirty days of receipt of all reasonably completed proof of 4 5 loss or claim forms. If a person needs additional time to 4 6 determine whether a claim should be accepted or denied, the 4 7 person shall notify the claimant of the additional time needed 4 8 within thirty days of receipt of settlement information or 4 9 proof of loss or claim forms. The notice shall state the 4 10 reason the additional time is needed and the amount of 4 11 additional time needed to process the claim. 4 12 2. For purposes of this section, "clean claim" means a 4 13 claim that the insurer has received all reasonably necessary 4 14 information and no particular circumstance exists requiring 4 15 special treatment that prevents prompt payment from being 4 16 made. 4 17 Sec. 10. Section 507B.6, subsection 1, Code 2001, is 4 18 amended to read as follows: 4 19 1. Whenever the commissionershall have reason to believe4 20 believes that anysuchperson has been engaged or is engaging 4 21 in this state in any unfair method of competition or any 4 22 unfair or deceptive act or practice whether or not defined in 4 23 section 507B.4, 507B.4A, or 507B.5 and that a proceeding by 4 24 the commissioner in respecttheretoto such method of 4 25 competition or unfair or deceptive act or practice would beto4 26the interest ofin the public interest, the commissioner shall 4 27 issue and serve upon such person a statement of the charges in 4 28 that respect and a notice of a hearingthereonon such charges 4 29 to be held at a time and place fixed in the notice, which 4 30 shall not be less than ten days after the date of the service 4 31thereofof such notice. 4 32 Sec. 11. Section 507B.7, subsection 1, Code 2001, is 4 33 amended to read as follows: 4 34 1. If, after such hearing, the commissionershall4 35determinedetermines that the person charged has engaged in an 5 1 unfair method of competition or an unfair or deceptive act or 5 2 practice, the commissioner shall reduce the findings to 5 3 writing and shall issue and cause to be served upon the person 5 4 charged with the violation a copy of such findings, an order 5 5 requiring such person to cease and desist from engaging in 5 6 such method of competition, act or practice and if the act or 5 7 practice is a violation of section 507B.4, 507B.4A, or 507B.5, 5 8 the commissioner may at the commissioner's discretion order 5 9 any one or more of the following: 5 10 a. Payment of a civil penalty of not more than one 5 11 thousand dollars for each act or violation, but not to exceed 5 12 an aggregate of ten thousand dollars, unless the person knew 5 13 or reasonably should have known the person was in violation of 5 14 section 507B.4, 507B.4A, or 507B.5, in which case the penalty 5 15 shall be not more than five thousand dollars for each act or 5 16 violation, but not to exceed an aggregate penalty of fifty 5 17 thousand dollars in any one six-month period.The5 18commissioner shall, ifIf the commissioner findsthe5 19violationsthat a violation of section 507B.4, 507B.4A, or 5 20 507B.5werewas directed, encouraged, condoned, ignored, or 5 21 ratified by the employer of the person or by an insurer, the 5 22 commissioner shall also assess a fine to the employer or 5 23 insurer. 5 24 b. Suspension or revocation of the license of a person as 5 25 defined in section 507B.2, subsection 1, if the person knew or 5 26 reasonably should have known the person was in violation of 5 27 section 507B.4, 507B.4A, orsection507B.5. 5 28 c. Payment of interest at the rate of ten percent per 5 29 annum if the commissioner finds that the insurer failed to pay 5 30 interest as required under section 507B.4, subsection 10B. 5 31 Sec. 12. Section 507B.12, unnumbered paragraph 1, Code 5 32 2001, is amended to read as follows: 5 33 The commissioner may, after notice and hearing, promulgate 5 34 reasonable rules, as are necessary or proper to identify 5 35 specific methods of competition or acts or practices which are 6 1 prohibited by section 507B.4, 507B.4A, or 507B.5, but the 6 2 rules shall not enlarge upon or extend the provisions of such 6 3 sections. Such rules shall be subject to review in accordance 6 4 with chapter 17A. 6 5 Sec. 13. Section 511.4, Code 2001, is amended to read as 6 6 follows: 6 7 511.4 ADVERTISEMENTS – WHO DEEMED AGENT. 6 8 The provisions of sections515.122515.123 to 515.126 shall 6 9 apply to life insurance companies and associations. 6 10 Sec. 14. Section 513B.2, subsections 3 and 20, Code 2001, 6 11 are amended to read as follows: 6 12 3. "Basic health benefit plan" means a planwhich is6 13offeredestablished by the board of the small employer health 6 14 reinsurance program pursuant to section513B.14513B.13, 6 15 subsection 8, paragraph "a". 6 16 20. "Standard health benefit plan" means a planwhich is6 17offeredestablished by the board of the small employer health 6 18 reinsurance program pursuant to section513B.14513B.13, 6 19 subsection 8, paragraph "a". 6 20 Sec. 15. Section 513B.4, subsection 1, paragraphs d and e, 6 21 Code 2001, are amended by striking the paragraphs. 6 22 Sec. 16. Section 513B.4, subsection 2, Code 2001, is 6 23 amended by striking the subsection. 6 24 Sec. 17. Section 513B.10, subsection 1, paragraph a, Code 6 25 2001, is amended to read as follows: 6 26 a. A carrier or an organized delivery system that offers 6 27 health insurance coverage in the small group market shall 6 28 accept every small employer that applies for health insurance 6 29 coverage and shall accept for enrollment under such coverage 6 30 every eligible individual who applies for enrollment during 6 31 the period in which the individual first becomes eligible to 6 32 enroll under the terms of the health insurance coverage and 6 33 shall not place any restriction which is inconsistent with 6 34 eligibility rules established under this chapter.A carrier6 35or organized delivery system shall offer health insurance7 1coverage which constitutes a basic health benefit plan and7 2which constitutes a standard health benefit plan.7 3 Sec. 18. Section 513B.10, subsection 3, Code 2001, is 7 4 amended by striking the subsection. 7 5 Sec. 19. Section 513B.13, subsection 3, paragraph c, Code 7 6 2001, is amended by striking the paragraph. 7 7 Sec. 20. Section 513B.13, subsection 3, paragraph d, Code 7 8 2001, is amended to read as follows: 7 9 d.Subsequent membersMembers shall be appointed for terms 7 10 of three years. A board member's term shall continue until 7 11 the member's successor is appointed. 7 12 Sec. 21. Section 513B.13, subsections 4 and 5, Code 2001, 7 13 are amended to read as follows: 7 14 4. The board, within one hundred eighty days after the7 15initial appointments, shallmay submit a plan of operation to 7 16 the commissioner. The commissioner, after notice and hearing, 7 17 may approvethea plan of operation if the commissioner 7 18 determines that the plan is suitable to assure the fair, 7 19 reasonable, and equitable administration of the program, and 7 20 provides for the sharing of program gains and losses on an 7 21 equitable and proportionate basis in accordance with the 7 22 provisions of this section.TheA plan of operation is 7 23 effective upon written approval of the commissioner.After7 24the initial plan of operation is submitted and approved by the7 25commissioner, the7 26 5. The board may submit to the commissioner any amendments 7 27 to the plan necessary or suitable to assure the fair, 7 28 reasonable, and equitable administration of the program. 7 295. If the board fails to submit a plan of operation within7 30one hundred eighty days after the board's appointment, the7 31commissioner, after notice and hearing, shall establish and7 32adopt a temporary plan of operation.The commissionershall7 33 may amend or rescind a plan adopted pursuant tothis7 34subsection at the time a plan is submitted by the board and7 35approved by the commissionersubsection 4. 8 1 Sec. 22. Section 513B.13, subsection 8, paragraph a, Code 8 2 2001, is amended to read as follows: 8 3 a.With respect to a basic health benefit plan or a8 4standard health benefit plan, the program shall reinsure the8 5level of coverage provided and, with respect to other plans,8 6theThe program shall reinsure up to the level of coverage 8 7 provided in either a basic health benefit plan or standard 8 8 health benefit plan established by the board. 8 9 Sec. 23. Section 513B.13, subsection 13, Code 2001, is 8 10 amended by striking the subsection. 8 11 Sec. 24. Section 514E.1, subsection 15, paragraph a, Code 8 12 2001, is amended to read as follows: 8 13 a. "Health insurance coverage" means health insurance 8 14 coverage offered to individuals, but does not include short-8 15term limited duration insurance. 8 16 Sec. 25. NEW SECTION. 514J.3A NOTICE. 8 17 When a claim is denied in whole or in part based on medical 8 18 necessity, the carrier or organized delivery system shall 8 19 provide a notice in writing to the enrollee of the internal 8 20 appeal mechanism provided under the carrier or organized 8 21 delivery system's plan or policy. 8 22 At the time of a coverage decision, the carrier or 8 23 organized delivery system shall notify the enrollee in writing 8 24 of the right to have the coverage decision reviewed under the 8 25 external review process. 8 26 Sec. 26. Section 514J.4, subsection 1, Code 2001, is 8 27 amended by striking the subsection. 8 28 Sec. 27. Section 514J.5, Code 2001, is amended to read as 8 29 follows: 8 30 514J.5 CERTIFICATION OF REQUEST – ELIGIBILITY. 8 31 1. The commissioner shall have two business days from 8 32 receipt of a request for an external review to certify the 8 33 request. The commissioner shall certify the request if all of 8 34 the following criteria are satisfied: 8 35 a. The enrollee was covered by the carrier or organized 9 1 delivery system at the time the service or treatment was 9 2 proposed or received. 9 3 b. The enrollee has been denied coverage based on a 9 4 determination by the carrier or organized delivery system that 9 5 the proposed or received service or treatment does not meet 9 6 the definition of medical necessity as defined in the 9 7enrollee's evidence of coveragecarrier's or organized 9 8 delivery system's plan or policy. 9 9 c. The enrollee, or the enrollee's treating health care 9 10 provider acting on behalf of the enrollee, has exhausted all 9 11 internal appeal mechanisms provided under the carrier's or the 9 12 organized delivery system'scontractplan or policy. 9 13 d. The written request for external review was filed 9 14 within sixty days of receipt of the coverage decision. 9 15 2. The commissioner shall notify the enrollee, or the 9 16 enrollee's treating health care provider acting on behalf of 9 17 the enrollee, and the carrier or organized delivery system in 9 18 writing of thedecisioncertification. 9 19 3. The carrier or organized delivery system has three 9 20 business days to contestthe eligibility of the request for9 21external review with the commissionerthe commissioner's 9 22 certification decision. If the commissioner finds that the 9 23 request for external review is not eligible forfull review9 24 certification, the commissioner, within two business days, 9 25 shall notify the enrollee, or the enrollee's treating health 9 26 care provider acting on behalf of the enrollee, in writing of 9 27 the reasons that the request for external review is not 9 28 eligible forfull reviewcertification. 9 29 4. If the commissioner finds that the request for external 9 30 review is eligible for certification, notwithstanding the 9 31 contest by the carrier or organized delivery system, the 9 32 commissioner shall notify the carrier or organized delivery 9 33 system in writing of the reasons for upholding the 9 34 certification. 9 35 Sec. 28. Section 514J.7, Code 2001, is amended by striking 10 1 the section and inserting in lieu thereof the following: 10 2 514J.7 EXTERNAL REVIEW. 10 3 The external review process shall meet the following 10 4 criteria: 10 5 1. The carrier or organized delivery system, within three 10 6 business days of a receipt of an eligible request for an 10 7 external review from the commissioner, or within three 10 8 business days of receipt of the commissioner's denial of the 10 9 carrier's or organized delivery system's contest of the 10 10 certification of the request under section 514J.5, subsection 10 11 3, whichever is later, shall do all of the following: 10 12 a. Select an independent review entity from the list 10 13 certified by the commissioner. The independent review entity 10 14 shall be an expert in the treatment of the medical condition 10 15 under review. The independent review entity shall not be a 10 16 subsidiary of, or owned or controlled by, the carrier or 10 17 organized delivery system, or owned or controlled by a trade 10 18 association of carriers or organized delivery systems of which 10 19 the carrier or organized delivery system is a member. 10 20 b. Notify the enrollee, and the enrollee's treating health 10 21 care provider, of the name, address, and telephone number of 10 22 the independent review entity and of the enrollee's and 10 23 treating health care provider's right to submit additional 10 24 information. 10 25 c. Notify the selected independent review entity by 10 26 facsimile that the carrier or organized delivery system has 10 27 chosen it to do the independent review and provide sufficient 10 28 descriptive information to identify the type of experts needed 10 29 to conduct the review and a detailed description and necessary 10 30 documentation of the treatment of the medical condition to be 10 31 reviewed. 10 32 d. Provide to the commissioner by facsimile a copy of the 10 33 notices sent to the enrollee and to the selected independent 10 34 review entity. 10 35 2. The independent review entity, within three business 11 1 days of receipt of the notice, shall select a person to 11 2 perform the external review and shall provide notice to the 11 3 enrollee of a brief description of the person including the 11 4 reasons the person selected is an expert in the treatment of 11 5 the medical condition under review. The independent review 11 6 entity does not need to disclose the name of the person. A 11 7 copy of the notice shall be sent by facsimile to the 11 8 commissioner. If the independent review entity does not have 11 9 a person who is an expert in the treatment of the medical 11 10 condition under review and certified by the commissioner to 11 11 conduct an independent review, the independent review entity 11 12 may either decline the review request or may request from the 11 13 commissioner additional time to have such an expert certified. 11 14 The independent review entity shall notify the commissioner by 11 15 facsimile of its choice between these options within three 11 16 business days of receipt of the notice from the carrier or 11 17 organized delivery system. The commissioner shall provide a 11 18 notice to the enrollee of the independent review entity's 11 19 decision and of the commissioner's decision as to how to 11 20 proceed with the external review process within three business 11 21 days of receipt of the independent review entity's decision. 11 22 3. The enrollee, or the enrollee's treating health care 11 23 provider acting on behalf of the enrollee, may object to the 11 24 independent review entity selected by the carrier or organized 11 25 delivery system or to the person selected as the reviewer by 11 26 the independent review entity by notifying the commissioner 11 27 within ten days of the mailing of the notice by the 11 28 independent review entity. The commissioner shall have two 11 29 business days from receipt of the objection to consider the 11 30 reasons set forth in support of the objection to approve or 11 31 deny the objection, to select an independent review entity if 11 32 necessary, and to provide notice of the commissioner's 11 33 decision to the enrollee, the enrollee's treating health care 11 34 provider, and the carrier or organized delivery system. 11 35 4. The carrier or organized delivery system, within 12 1 fifteen days of the mailing of the notice by the independent 12 2 review entity, or within three business days of a receipt of 12 3 notice by the commissioner following an objection by the 12 4 enrollee, whichever is later, shall do all of the following: 12 5 a. Provide to the independent review entity any 12 6 information submitted to the carrier or organized delivery 12 7 system by the enrollee or the enrollee's treating health care 12 8 provider in support of the request for coverage of a service 12 9 or treatment under the carrier's or organized delivery 12 10 system's appeal procedures. 12 11 b. Provide to the independent review entity any other 12 12 relevant documents used by the carrier or organized delivery 12 13 system in determining whether the proposed service or 12 14 treatment should have been provided. 12 15 c. Provide to the commissioner a confirmation that the 12 16 information required in paragraphs "a" and "b" has been 12 17 provided to the independent review entity, including the date 12 18 the information was provided. 12 19 5. The enrollee, or the enrollee's treating health care 12 20 provider, may provide to the independent review entity any 12 21 information submitted under any internal appeal mechanisms 12 22 provided under the carrier's or organized delivery system's 12 23 evidence of coverage, and other newly discovered relevant 12 24 information. The enrollee shall have ten business days from 12 25 the mailing date of the notification of the person selected as 12 26 the reviewer by the independent review entity to provide this 12 27 information. The independent review entity may reasonably 12 28 decide whether to consider any information provided by the 12 29 enrollee or the enrollee's treating health care provider after 12 30 the ten-day period. 12 31 6. The independent review entity shall notify the enrollee 12 32 and the enrollee's treating health care provider of any 12 33 additional medical information required to conduct the review 12 34 within five business days of receipt of the documentation 12 35 required under subsection 4. The enrollee or the enrollee's 13 1 treating health care provider shall provide the requested 13 2 information to the independent review entity within five days 13 3 after receipt of the notification requesting additional 13 4 medical information. The independent review entity may 13 5 reasonably decide whether to consider any information provided 13 6 by the enrollee or the enrollee's treating health care 13 7 provider after the five-day period. The independent review 13 8 entity shall notify the commissioner and the carrier or 13 9 organized delivery system of this request. 13 10 7. The independent review entity shall submit its external 13 11 review decision as soon as possible, but not later than thirty 13 12 days from the date the independent review entity received the 13 13 information required under subsection 4 from the carrier or 13 14 organized delivery system. The independent review entity, for 13 15 good cause, may request an extension of time from the 13 16 commissioner. The independent review entity's external review 13 17 decision shall be mailed to the enrollee or the treating 13 18 health care provider acting on behalf of the enrollee, the 13 19 carrier or organized delivery system, and the commissioner. 13 20 8. The confidentiality of any medical records submitted 13 21 shall be maintained pursuant to applicable state and federal 13 22 laws. 13 23 Sec. 29. NEW SECTION. 514J.15 PENALTIES. 13 24 A carrier who fails to comply with this chapter or with 13 25 rules adopted pursuant to this chapter is subject to the 13 26 penalties provided under chapter 507B. 13 27 Sec. 30. Section 515.35, subsection 4, paragraph n, 13 28 subparagraph (1), Code 2001, is amended to read as follows: 13 29 (1) A company organized under this chapter may invest up 13 30 totwofive percent of its admitted assets in securities or 13 31 property of any kind, without restrictions or limitations 13 32 except those imposed on business corporations in general. 13 33 Sec. 31. Section 515B.1, subsection 2, Code 2001, is 13 34 amended to read as follows: 13 35 2. Mortgage guaranty, financial guaranty, residual value, 14 1 or other forms of insurance offering protection against 14 2 investment risks. 14 3 Sec. 32. Section 515B.5, subsection 1, paragraph b, Code 14 4 2001, is amended to read as follows: 14 5 b. Be obligated to pay covered claims subject to a 14 6 limitation as established by the rights, duties, and 14 7 obligations under the policy of the insolvent insurer. 14 8 However, the association is not obligated to pay a claimant an 14 9 amount in excess of the obligation under the policy of the 14 10 insolvent insurer, regardless of whether such claim is based 14 11 on contract or tort. 14 12 Sec. 33. Section 515B.16, Code 2001, is amended by 14 13 striking the section and inserting in lieu thereof the 14 14 following: 14 15 515B.16 ACTIONS AGAINST THE ASSOCIATION. 14 16 Any action against the association shall be brought against 14 17 the association in the association's own name. The Polk 14 18 county district court shall have exclusive jurisdiction and 14 19 venue of such actions. Service of the original notice in 14 20 actions against the association may be made on any officer of 14 21 the association or upon the commissioner of insurance on 14 22 behalf of the association. The commissioner shall promptly 14 23 transmit any notice so served upon the commissioner to the 14 24 association. 14 25 Sec. 34. NEW SECTION. 515F.4A REASONABLENESS OF BENEFITS 14 26 IN RELATION TO PREMIUM CHARGE. 14 27 Benefits provided by credit personal property insurance 14 28 policies shall be reasonable in relation to the premium 14 29 charged. This requirement is satisfied if the premium rate 14 30 charged develops or may reasonably be expected to develop a 14 31 loss ratio of not less than sixty-five percent to afford a 14 32 reasonable allowance for actual and expected loss experience 14 33 including a reasonable catastrophe provision, general and 14 34 administrative expenses, reasonable acquisition expenses, 14 35 reasonable creditor compensation, investment income, premium 15 1 taxes, licenses, fees, assessments, and reasonable insurer 15 2 profit. 15 3 Sec. 35. Section 518.23, subsection 4, Code 2001, is 15 4 amended to read as follows: 15 5 4. NOTICE. Service of notice under subsection 2 or 3 may 15 6 bemade in person, or by mailing such notice by certified mail15 7deposited in the post office and directeddelivered in person 15 8 or mailed to the insured at the insured's post office address 15 9 as given in or upon the policy, or to such other address as 15 10 the insured shall have given to the association in writing. A 15 11 post office departmentreceipt of certified or registered mail15 12 certificate of mailing shall be deemed proof of receipt of 15 13 suchnoticemailing. If in either case the cash payments 15 14 exceed the amount properly chargeable, the excess shall be 15 15 refunded to the insured upon the surrender of the policy to 15 16 the association at its home office. 15 17 Sec. 36. Section 518A.29, subsection 4, Code 2001, is 15 18 amended to read as follows: 15 19 4. NOTICE. Service of notice under subsection 2 or 3 may 15 20 bemade in person, or by mailing such notice by certified mail15 21deposited in the post office and directeddelivered in person 15 22 or mailed to the insured at the insured's post office address 15 23 as given in or upon the policy, or to such other address as 15 24 the insured shall have given to the association in writing. A 15 25 post office departmentreceipt of certified or registered mail15 26 certificate of mailing shall be deemed proof of receipt of 15 27 suchnoticemailing. If in either case the cash payments 15 28 exceed the amount properly chargeable, the excess shall be 15 29 refunded upon the surrender of the policy to the association 15 30 at its home office. 15 31 Sec. 37. Section 707.6A, subsection 2, Code 2001, is 15 32 amended by adding the following new paragraph: 15 33 NEW PARAGRAPH. c. Causing or attempting to cause a 15 34 vehicle collision likely to result in bodily injury, or 15 35 aiding, abetting, or conspiring to cause or attempt to cause a 16 1 collision, in violation of section 321.276. 16 2 Sec. 38. Section 515.122, Code 2001, is repealed. 16 3 Sec. 39. Sections 432.12, 513B.14, 513B.16, 513B.17A, 16 4 513B.18, and 513B.31 through 513B.43, Code 2001, are repealed. 16 5 Sec. 40. EFFECTIVE DATE. Sections 14 through 23 and 16 6 section 39 of this Act take effect January 1, 2002. 16 7 EXPLANATION 16 8 This bill makes changes to various insurance-related 16 9 provisions throughout the Code. 16 10 The bill amends Code section 87.11 to provide that a 16 11 political subdivision, including a city, county, community 16 12 college, or school corporation, that is self-insured for 16 13 workers' compensation is not required to submit a plan or 16 14 program to the commissioner of insurance (the commissioner) 16 15 for review and approval. The current Code language requires 16 16 employers to furnish certain proof of solvency and ability to 16 17 pay to be exempted from workers' compensation insurance 16 18 requirements. 16 19 The bill creates new Code section 321.276, which punishes 16 20 intentional vehicle collisions likely to result in bodily 16 21 injury as a class "D" felony. Attempts to cause vehicle 16 22 collisions or aiding, abetting, or conspiring to knowingly 16 23 cause such collisions are also punishable as class "D" 16 24 felonies. If a death unintentionally results from such a 16 25 violation, the act is punishable as a class "C" felony under 16 26 Code section 707.6A. 16 27 The bill deletes the requirement in Code section 505.11 for 16 28 the commissioner to certify to the department of revenue and 16 29 finance the amount of credit to be applied on future taxes due 16 30 from a company that has overpaid amounts due to the state, and 16 31 to notify the company of the amount. The current Code 16 32 language gives the commissioner the power to refund the 16 33 overpayment or apply it to current or future amounts due. 16 34 Code section 507.10 is amended regarding the filing by the 16 35 examiner of a verified written report of examination, to 17 1 delete the words "under oath". 17 2 The bill deletes certain acts designated in Code section 17 3 507B.4 as unfair claim settlement practices: failing to 17 4 acknowledge and act reasonably promptly upon communications 17 5 with respect to claims arising under insurance policies, and 17 6 failing to affirm or deny coverage of claims within a 17 7 reasonable time after proof of loss statements have been 17 8 completed. The bill amends another unfair claim settlement 17 9 practice to expressly include a reference to another Code 17 10 subsection added by this bill, and adds an additional unfair 17 11 claim settlement practice relating to the audit of health care 17 12 claims. 17 13 The bill adds an unfair practice relating to the payment of 17 14 interest on health insurance claims an insurer fails to accept 17 15 timely. 17 16 The bill adds new Code section 507B.4A, specifying certain 17 17 actions that are within a person's duty to respond timely to 17 18 inquiries from the commissioner, a policyholder, or a 17 19 claimant; and to investigate and settle a claim timely. 17 20 Several other Code sections are amended in the bill to include 17 21 a reference to this new Code section. 17 22 The bill corrects certain Code references in Code sections 17 23 511.4 and 513B.2 due to Code section repeals made by the bill. 17 24 The bill strikes paragraphs in Code section 513B.4 related 17 25 to certain outdated restrictions on premiums, and strikes a 17 26 subsection pertaining to premium rates variances for certain 17 27 plans. 17 28 The bill deletes the requirement in Code section 513B.10 17 29 for a carrier or organized delivery system to offer health 17 30 insurance coverage which constitutes a basic health benefit 17 31 plan and a standard health benefit plan. The bill also 17 32 deletes a subsection of Code section 513B.10 dealing with such 17 33 plans. 17 34 The bill strikes a paragraph from Code section 513B.13 17 35 dealing with initial appointments to the board for the small 18 1 employer carrier reinsurance program. The bill also updates 18 2 other language in the section. 18 3 Changes to Code chapter 513B, regarding small group health 18 4 coverage in sections 14 through 23 of the bill are effective 18 5 January 1, 2002. 18 6 The bill modifies the language used in Code section 514E.1 18 7 for the definition of "health insurance coverage". 18 8 The bill adds new Code section 514J.3A, which requires 18 9 notice of the availability of the internal appeal mechanism to 18 10 be provided when a claim is denied, and notice of the external 18 11 review process when a coverage decision is made. The bill 18 12 also deletes a subsection of Code section 514J.4 that was 18 13 moved to new Code section 514J.3A. 18 14 The bill amends terms used in Code section 514J.5 relating 18 15 to certification of a request for external review, and adds a 18 16 paragraph relating to written notification of reasons for 18 17 certification. 18 18 The bill strikes the existing Code section 514J.7, relating 18 19 to criteria for the external review process, and inserts a new 18 20 criteria section that reorganizes certain current provisions 18 21 and contains more details regarding the process. 18 22 The bill adds language to Code section 514J.12 to address 18 23 the standard of review when a health care claim has been 18 24 denied under a property or casualty insurance policy. 18 25 The bill adds new Code section 514J.15 to provide that a 18 26 carrier who fails to comply with the provisions of Code 18 27 chapter 514J, relating to the external review process, or 18 28 related rules adopted pursuant to the chapter, is subject to 18 29 penalties provided under Code chapter 507B, relating to 18 30 insurance trade practices. 18 31 The bill amends Code section 515.35, to permit investments 18 32 of up to 5 percent of the admitted assets of an insurance 18 33 company other than a life insurance company, instead of 2 18 34 percent. 18 35 The bill adds residual value as a type of insurance 19 1 coverage excluded from the scope of Code chapter 515B, the 19 2 insurance guaranty association chapter. 19 3 The bill amends Code section 515B.5 to specify that the 19 4 insurance guaranty association is not obligated to pay an 19 5 amount in excess of the policy limitations of the insolvent 19 6 insurer, regardless of whether the claim is based in contract 19 7 or tort. 19 8 The bill strikes current Code section 515B.16 regarding 19 9 actions against the insurance guaranty association, and 19 10 inserts revised language, including a provision that specifies 19 11 that Polk county district court has exclusive jurisdiction and 19 12 venue of such actions. 19 13 The bill creates new Code section 515F.4A to provide a 19 14 standard for judging the reasonableness of premiums charged to 19 15 benefits provided under a casualty insurance policy. 19 16 The bill amends Code sections 518.23 and 518A.29 by 19 17 deleting references to certified or registered mail, and 19 18 specifying that a certificate of mailing constitutes proof of 19 19 receipt of cancellation or nonrenewal of policies by a county 19 20 mutual insurance association or a state mutual insurance 19 21 association, respectively. 19 22 The bill repeals Code section 515.122, relating to required 19 23 components of advertising by agents for insurance other than 19 24 life insurance, effective July 1, 2001. 19 25 Effective January 1, 2002, the bill also repeals Code 19 26 section 432.12, regarding the premium tax credit for employer- 19 27 sponsored health plan premium credit; Code section 513B.14, 19 28 regarding basic and standard health benefit plan standards; 19 29 Code sections 513B.16 and 513B.18, applicability provisions 19 30 relating to basic and standard health benefit plans; Code 19 31 section 513B.17A, regarding adoption of rules relating to 19 32 restoration of small group health coverage; and Code sections 19 33 513B.31 through 513B.43, relating to basic benefit coverage 19 34 for small groups. 19 35 LSB 1073DP 79 20 1 jj/cls/14
Text: SSB01122 Text: SSB01124 Text: SSB01100 - SSB01199 Text: SSB Index Bills and Amendments: General Index Bill History: General Index
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