514.7 - CONTRACTS -- APPROVAL BY COMMISSIONER -- PROVISIONS TO BE AVAILABLE.

        514.7  CONTRACTS -- APPROVAL BY COMMISSIONER --      PROVISIONS TO BE AVAILABLE.         1.  The contracts by any such corporation with the subscribers for      health care service shall at all times be subject to the approval of      the commissioner of insurance.  The commissioner shall require that      participating pharmacies be reimbursed by the pharmaceutical service      corporation at rates or prices equal to rates or prices charged      nonsubscribers, unless the commissioner determines otherwise to      prevent loss to subscribers.         2.  A provision shall be available in approved contracts with      hospital and medical service corporate subscribers under group      subscriber contracts or plans covering vision care services or      procedures, for payment of necessary medical or surgical care and      treatment provided by an optometrist licensed under chapter 154, if      the care and treatment are provided within the scope of the      optometrist's license and if the subscriber contract would pay for      the care and treatment if it were provided by a person engaged in the      practice of medicine or surgery as licensed under chapter 148.  The      subscriber contract shall also provide that the subscriber may reject      the coverage or provision if the coverage or provision for services      which may be provided by an optometrist is rejected for all providers      of similar vision care services as licensed under chapter 148 or 154.      This subsection applies to group subscriber contracts delivered after      July 1, 1983, and to group subscriber contracts on their anniversary      or renewal date, or upon the expiration of the applicable collective      bargaining contract, if any, whichever is the later.  This subsection      does not apply to contracts designed only for issuance to subscribers      eligible for coverage under Title XVIII of the Social Security Act,      or any other similar coverage under a state or federal government      plan.         3.  A provision shall be made available in approved contracts with      hospital and medical subscribers under group subscriber contracts or      plans covering diagnosis and treatment of human ailments, for payment      or reimbursement for necessary diagnosis or treatment provided by a      chiropractor licensed under chapter 151 if the diagnosis or treatment      is provided within the scope of the chiropractor's license and if the      subscriber contract would pay or reimburse for the diagnosis or      treatment of the human ailments, irrespective of and disregarding      variances in terminology employed by the various licensed professions      in describing the human ailments or their diagnosis or treatment, if      it were provided by a person licensed under chapter 148.  The      subscriber contract shall also provide that the subscriber may reject      the coverage or provision if the coverage or provision for diagnosis      or treatment of a human ailment by a chiropractor is rejected for all      providers of diagnosis or treatment for similar human ailments      licensed under chapter 148 or 151.  A group subscriber contract may      limit or make optional the payment or reimbursement for lawful      diagnostic or treatment service by all licensees under chapters 148      and 151 on any rational basis which is not solely related to the      license under or the practices authorized by chapter 151 or is not      dependent upon a method of classification, categorization, or      description based upon differences in terminology used by different      licensees in describing human ailments or their diagnosis or      treatment.  This subsection applies to group subscriber contracts      delivered after July 1, 1986, and to group subscriber contracts on      their anniversary or renewal date, or upon the expiration of the      applicable collective bargaining contract, if any, whichever is the      later.  This subsection does not apply to contracts designed only for      issuance to subscribers eligible for coverage under Title XVIII of      the Social Security Act, or any other similar coverage under a state      or federal government plan.         4.  A provision shall be available in approved contracts with      hospital and medical service corporate subscribers under group      subscriber contracts or plans covering medical and surgical service,      for payment of covered services determined to be medically necessary      provided by certified registered nurses certified by a national      certifying organization, which organization shall be identified by      the Iowa board of nursing pursuant to rules adopted by the board, if      the services are within the practice of the profession of a      registered nurse as that practice is defined in section 152.1, under      terms and conditions agreed upon between the corporation and      subscriber group, subject to utilization controls.  This subsection      shall not require payment for nursing services provided by a      certified registered nurse practicing in a hospital, nursing      facility, health care institution, a physician's office, or other      noninstitutional setting if the certified registered nurse is an      employee of the hospital, nursing facility, health care institution,      physician, or other health care facility or health care provider.      This subsection applies to group subscriber contracts delivered in      this state on or after July 1, 1989, and to group subscriber      contracts on their anniversary or renewal date, or upon the      expiration of the applicable collective bargaining contract, if any,      whichever is the later.  This subsection does not apply to limited or      specified disease or individual contracts or contracts designed only      for issuance to subscribers eligible for coverage under Title XVIII      of the federal Social Security Act, contracts which are rated on a      community basis, or any other similar coverage under a state or      federal government plan.  
         Section History: Early Form
         [C39, § 8895.07; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79,      81, § 514.7] 
         Section History: Recent Form
         83 Acts, ch 166, § 2; 84 Acts, ch 1122, § 6; 84 Acts, ch 1290, §      2; 86 Acts, ch 1180, § 5; 89 Acts, ch 164, § 3; 99 Acts, ch 75, §3;      2000 Acts, ch 1058, §46; 2008 Acts, ch 1088, § 126         Referred to in § 514.21, 514.23