1. A carrier or an agent shall not do either of the following:

 a. Encourage or direct individuals to refrain from filing an application for coverage with the carrier because of the health status, claims experience, industry, occupation, or geographic location of the individuals.
 b. Encourage or direct individuals to seek coverage from another carrier because of the health status, claims experience, industry, occupation, or geographic location of the individuals.

Terms Used In Iowa Code 513C.9

  • Basic or standard health benefit plan: means the core group of health benefits developed pursuant to section 513C. 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
  • Contract: means the same as defined in section 554D. See Iowa Code 554E.1
  • Contract: A legal written agreement that becomes binding when signed.
  • 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
  • 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
  • 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
  • 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
 2. Subsection 1, paragraph “a”, shall not apply with respect to information provided by a carrier or an agent to an individual regarding the established geographic service area of the carrier or the restricted network provision of the carrier.
 3. A carrier shall not, directly or indirectly, enter into any contract, agreement, or arrangement with an agent that provides for, or results in, the compensation paid to an agent for a sale of a basic or standard health benefit plan to vary because of the health status or permitted rating characteristics of the individual or the individual’s dependents.
 4. Notwithstanding subsection 3, a commission shall be paid to an agent related to the sale of a basic or standard health benefit plan under this chapter. A commission paid pursuant to this subsection shall not be considered by the board for purposes of section 513C.10, subsection 5.
 5. Subsection 3 does not apply with respect to the compensation paid to an agent on the basis of percentage of premium, provided that the percentage shall not vary because of the health status or other permitted rating characteristics of the individual or the individual’s dependents.
 6. Denial by a carrier of an application for coverage from an individual shall be in writing and shall state the reason or reasons for the denial.
 7. A violation of this section by a carrier or an agent is an unfair trade practice under chapter 507B.
 8. If a carrier enters into a contract, agreement, or other arrangement with a third-party administrator to provide administrative, marketing, or other services related to the offering of individual health benefit plans in this state, the third-party administrator is subject to this section as if it were a carrier.