Terms Used In Iowa Code > Chapter 513C - Individual Health Insurance Market Reform

• Actuarial certification: means a written statement by a member of the American academy of actuaries or other individual acceptable to the commissioner that an individual carrier is in compliance with the provisions of section 513C. See Iowa Code 513C.3
• Actuary: means a person who is a member in good standing of the American academy of actuaries. See Iowa Code 510.1B
• affiliated: means any entity or person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, a specified entity or person. See Iowa Code 513C.3
• Basic or standard health benefit plan: means the core group of health benefits developed pursuant to section 513C. See Iowa Code 513C.3
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Block of business: means all the individuals insured under the same individual health benefit plan. See Iowa Code 513C.3
• Board: means the engineering and land surveying examining board provided by this chapter. See Iowa Code 542B.2
• Carrier: means any entity that provides individual health benefit plans in this state. See Iowa Code 513C.3
• Commission: means the real estate commission as established by chapter 543B. See Iowa Code 543C.1
• Commissioner: means the commissioner of insurance. See Iowa Code 513C.3
• Contract: means the same as defined in section 554D. See Iowa Code 554E.1
• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Dependent: A person dependent for support upon another.
• Eligible individual: means an individual who is a resident of this state and who either has qualifying existing coverage or has had qualifying existing coverage within the immediately preceding thirty days, or an individual who has had a qualifying event occur within the immediately preceding thirty days. See Iowa Code 513C.3
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• Filed rate: means , for a rating period related to each block of business, the rate charged to all individuals with similar rating characteristics for individual health benefit plans. See Iowa Code 513C.3
• following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
• Fraud: Intentional deception resulting in injury to another.
• Individual health benefit plan: means any hospital or medical expense incurred policy or certificate, hospital or medical service plan, or health maintenance organization subscriber contract sold to an individual, or any discretionary group trust or association policy, whether issued within or outside of the state, providing hospital or medical expense incurred coverage to individuals residing within this state. See Iowa Code 513C.3
• Insurer: means a person duly licensed in this state as an insurance company pursuant to this subtitle. See Iowa Code 510.1B
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• person: means individual, corporation, limited liability company, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity. See Iowa Code 4.1
• Premium: means all moneys paid by an individual and eligible dependents as a condition of receiving coverage from a carrier or an organized delivery system, including any fees or other contributions associated with an individual health benefit plan. See Iowa Code 513C.3
• Qualifying event: means any of the following:
   a. See Iowa Code 513C.3
• qualifying previous coverage: means benefits or coverage provided under any of the following:
   (1) Any group health insurance that provides benefits similar to or exceeding benefits provided under the standard health benefit plan, provided that such policy has been in effect for a period of at least one year. See Iowa Code 513C.3
• Rating characteristics: means demographic characteristics of individuals which are considered by the carrier in the determination of premium rates for the individuals and which are approved by the commissioner. See Iowa Code 513C.3
• Rating period: means the period for which premium rates established by a carrier are in effect. See Iowa Code 513C.3
• Restricted network provision: means a provision of an individual health benefit plan that conditions the payment of benefits, in whole or in part, on the use of health care providers that have entered into a contractual arrangement with the carrier to provide health care services to covered individuals. See Iowa Code 513C.3
• Sale: means any sale, offer for sale, or attempt to sell or lease any land, to the public in this state, for cash or on credit. See Iowa Code 543C.1
• state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
• year: means twelve consecutive months. See Iowa Code 4.1