Terms Used In Iowa Code > Chapter 513B - Small Group Health Coverage

• Account: means the same as defined in section 554. See Iowa Code 554E.1
• Actuarial certification: means a written statement by a member of the American academy of actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with the provisions of section 513B. See Iowa Code 513B.2
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Base premium rate: means , for each class of business as to a rating period, the lowest premium rate charged or which could have been charged under a rating system for that class of business, by the small employer carrier to small employers for health insurance plans with the same or similar coverage. See Iowa Code 513B.2
• Basic health benefit plan: means a plan established by the board of the small employer health reinsurance program pursuant to section 513B. See Iowa Code 513B.2
• 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}
• Board: means the engineering and land surveying examining board provided by this chapter. See Iowa Code 542B.2
• Carrier: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services. See Iowa Code 513B.2
• Case characteristics: means demographic or other relevant characteristics of a small employer, as determined by a small employer carrier, which are considered by the insurer in the determination of premium rates for the small employer. See Iowa Code 513B.2
• Child: includes child by adoption. See Iowa Code 4.1
• Class of business: means all or a distinct grouping of small employers as shown on the records of the small employer carrier. See Iowa Code 513B.2
• Commissioner: means the commissioner of insurance. See Iowa Code 513B.2
• 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.
• Creditable coverage: means health benefits or coverage provided to an individual under any of the following:
   a. See Iowa Code 513B.2
• Dependent: A person dependent for support upon another.
• Division: means the division of insurance. See Iowa Code 513B.2
• Eligible employee: means an employee who works on a full-time basis and has a normal workweek of thirty or more hours. See Iowa Code 513B.2
• 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}
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Ex officio: Literally, by virtue of one's office.
• 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.
• Group health insurance coverage: means health insurance coverage offered in connection with a group health plan. See Iowa Code 513B.2
• Group health plan: means an employee welfare benefit plan as defined in section 3(1) of the federal Employee Retirement Income Security Act of 1974, to the extent that the plan provides medical care including items and services paid for as medical care to employees or their dependents as defined under the terms of the plan directly or through insurance, reimbursement, or otherwise. See Iowa Code 513B.2
• Health insurance coverage: means benefits consisting of health care provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as health care under a hospital or health service policy or certificate, hospital or health service plan contract, or health maintenance organization contract offered by a carrier. See Iowa Code 513B.2
• Index rate: means , for each class of business for small employers, the average of the applicable base premium rate and the corresponding highest premium rate. See Iowa Code 513B.2
• 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.
• Late enrollee: means an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period for which such individual is entitled to enroll under the terms of the health benefit plan, provided the initial enrollment period is a period of at least thirty days. See Iowa Code 513B.2
• medical care: means amounts paid for any of the following:
   (1) The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting a structure or function of the body. See Iowa Code 513B.2
• Money: means the same as defined in section 554. See Iowa Code 554E.1
• month: means a calendar month, and the word "year" and the abbreviation "A. See Iowa Code 4.1
• New business premium rate: means , for each class of business as to a rating period, the lowest premium rate charged or offered by the small employer carrier to small employers for newly issued health insurance coverages with the same or similar coverage. See Iowa Code 513B.2
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• 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
• Rating period: means the calendar period for which premium rates established by a small employer carrier are assumed to be in effect, as determined by the small employer carrier. See Iowa Code 513B.2
• Record: means the same as defined in section 554D. See Iowa Code 554E.1
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Rule: includes "regulation". See Iowa Code 4.1
• Small employer: means a person actively engaged in business who, on at least fifty percent of the employer's working days during the preceding year, employed at least one and not more than fifty full-time equivalent eligible employees. See Iowa Code 513B.2
• Small employer carrier: means any carrier which offers health benefit plans covering the employees of a small employer. See Iowa Code 513B.2
• Standard health benefit plan: means a plan established by the board of the small employer health reinsurance program pursuant to section 513B. See Iowa Code 513B.2
• 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
• Underwrite: means the authority to accept or reject risk on behalf of the insurer. See Iowa Code 510.1B
• United States: includes all the states. See Iowa Code 4.1
• year: means twelve consecutive months. See Iowa Code 4.1