1. The commissioner shall adopt by rule the form and level of coverage of the basic health benefit plan and the standard health benefit plan to be made available by a small employer carrier pursuant to section 513B.10. The commissioner's rules shall include the benefit levels, cost-sharing levels, exclusions, and limitations for the basic health benefit plan and the standard health benefit plan, and shall define for purposes of this subchapter, a basic health benefit plan and a standard health benefit plan which contain benefit and cost- sharing levels that are consistent with the basic method of operation and the benefit plans of health maintenance organizations, including any restrictions imposed by federal law.
2. The commissioner's rules may include cost containment features such as the following:
a. Utilization review of health care services, including review of medical necessity of hospital and physician services.
b. Case management.
c. Selective contracting with hospitals, physicians, and other health care providers.
d. Reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions.
e. Other managed care provisions.
92 Acts, ch 1167, § 15
Referred to in § 513B.2
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