1. The commissioner may, based upon reasonable actuarial evidence as to cost-effectiveness, determine any of the following:
a. What benefits or direct pay requirements must be minimally included in a basic benefit coverage policy or subscription contract.
b. What otherwise mandated benefits or direct pay requirements may be exempted from coverage by a basic benefit coverage policy or subscription contract.
c. What cost containment procedures must be minimally included in a basic benefit coverage policy or subscription contract.
d. What cost containment procedures otherwise restricted may be utilized by a basic benefit coverage policy or subscription contract.
2. The commissioner may retain a consultant to assist in the analysis of any benefit or requirement, and may convene an advisory panel to assist the commissioner in the review of evidence and practices by the health care and insurance industries.
3. The commissioner may assess a fee against health insurers, hospital service plans, and health maintenance organizations issuing or issuing for delivery in this state basic benefit coverage policies or subscription contracts to defray consulting fees and expenses incurred by the commissioner under this section.
4. The commissioner may also require medical professional societies or providers associations requesting the inclusion of a benefit or requirement in a basic benefit coverage policy or subscription contract to contribute on a proportionate and reasonable basis to the payment of the commissioner's consultants and expenses under this section as a condition of reviewing a benefit or requirement impacting upon such medical professionals or providers.
91 Acts, ch 244, §17
CS91, § 514H.7
93 Acts, ch 80, § 20
CS93, § 513B.37
Referred to in § 513B.32, 513B.38
Previous Section 513B.36
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