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514E.6 Policies, deductible and coinsurance requirements---limitations---lifetime benefit limit.

1. Except as provided in subsection 3, an association policy offered in accordance with this chapter shall include a deductible. Deductibles of five hundred dollars and one thousand dollars on a per person per calendar year basis shall be offered. The board may authorize deductibles in other amounts. The deductibles must be applied to the first five hundred dollars, one thousand dollars, or other authorized amount of eligible expenses incurred by the covered person.

2. Except as provided in subsection 3, a mandatory coinsurance requirement shall be imposed at the rate of twenty percent of eligible expenses in excess of the mandatory deductible.

3. The maximum aggregate out-of-pocket payments for eligible expenses by the insured in the form of deductibles and coinsurance shall not exceed in a policy year:

a. One thousand five hundred dollars for an individual five-hundred-dollar deductible policy.

b. Two thousand dollars for an individual one-thousand- dollar deductible policy.

c. Three thousand dollars for a family five-hundred-dollar deductible policy.

d. Four thousand dollars for a family one-thousand-dollar deductible policy.

e. An amount authorized by the board for any other de- ductible policy.

4. For a family policy, the maximum annual deductible under the policy shall be the deductible chosen for a maximum of two individuals under the policy.

5. Eligible expenses incurred by a covered person in the last three months of a calendar year, and applied toward a deductible, shall also be applied toward the deductible amount in the next calendar year.

6. The lifetime benefit per covered person is two hundred fifty thousand dollars.

7. The association shall, in addition to other policies, offer Medicare supplement policies designed to supplement Medicare and provide coverage of at least fifty percent of the deductible and eighty percent of the covered expenses in section 514E.4. Medicare supplement plans are subject to the same limitations on premiums, deductibility, and annual out- of-pocket expenses as other association policies.

Section History: Recent form

86 Acts, ch 1156, § 6

Internal References

Referred to in § 514E.4

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