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514E.1 Definitions.

As used in this chapter, unless the context otherwise re- quires:

1. "Association" means the Iowa comprehensive health asociation established by section 514E.2.

2. "Association policy" means an individual or group policy issued by the association that provides the coverage specified in section 514E.4.

3. "Carrier" means an insurer providing accident and sick- ness insurance under chapter 509, 514 or 514A and includes a health maintenance organization established under chapter 514B if payments received by the health maintenance organization are considered premiums pursuant to section 514B.31 and are taxed under chapter 432. "Carrier" also includes a corporation which becomes a mutual insurer pursuant to section 514.23 and any other person as defined in section 4.1, subsection 20, who is or may become liable for the tax imposed by chapter 432.

4. "Commissioner" means the commissioner of insurance.

5. "Eligible expenses" means the usual, customary and reaonable charges for the health care services specified in section 514E.4.

6. "Health care facility" means a health care facility as defined in section 135C.1, subsection 6, a hospital as defined in section 135B.1, subsection 1, or a community mental health center established under chapter 230A.

7. "Health care services" means services, the coverage of which is authorized under chapter 509, chapter 514, chapter 514A, or chapter 514B as limited by sections 514E.4 and 514E.5, and includes services for the purposes of preventing, alleviating, curing, or healing human illness, injury or physical disability.

8. "Health insurance" means accident and sickness insurance authorized by chapter 509, 514 or 514A.

9. "Health insurance trust fund" means the fund created in section 514E.3.

10. "Insured" means an individual who is provided qualified comprehensive health insurance under an association policy, which policy may include dependents and other covered persons.

11. "Medicaid" means the federal-state assistance program established under Title XIX of the federal Social Security Act.

12. "Medicare" means the federal government health insurance program established under Title XVIII of the Social Security Act.

13. "Policy" means a contract, policy, or plan of health insurance.

14. "Policy year" means a consecutive twelve-month period during which a policy provides or obligates the carrier to provide health insurance.

Section History: Recent form

86 Acts, ch 1156, § 1; 89 Acts, ch 304, §1003

Internal References

Referred to in § 514E.2

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Last update: Mon Jan 27 16:05:08 CST 1997
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