1. The commissioner shall issue rules to establish minimum standards for benefits under each of the following categories of coverage contained in policies of individual accident and sickness insurance or subscriber contracts:

 a. Basic hospital expense coverage.
 b. Basic medical-surgical expense coverage.
 c. Hospital confinement indemnity coverage.
 d. Major medical expense coverage.
 e. Disability income protection coverage.
 f. Accident-only coverage.
 g. Specified disease or specified accident coverage.
 h. Medicare supplement coverage.
 i. Limited benefit health coverage.

Terms Used In Iowa Code 514D.4

  • Accident and sickness insurance: means individual accident and sickness insurance within the meaning of section 514A. See Iowa Code 514D.2
  • Commissioner: means the commissioner of insurance. See Iowa Code 510.1B
  • 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
  • Form: means and includes policies, contracts, riders, endorsements and applications used in connection with the sale of accident and sickness insurance under chapter 514 or chapter 514A. See Iowa Code 514D.2
  • Medicare: means the Health Insurance for the Aged Act, Tit. See Iowa Code 514D.2
  • Policy: means the entire contract between the insurer and the insured, including the policy riders, endorsements, and the application, if attached, and includes individual subscriber contracts issued under chapter 514. See Iowa Code 514D.2
  • Rule: includes "regulation". See Iowa Code 4.1
  • 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. This section does not prohibit the issuance of a policy which combines two or more of the categories of coverage enumerated in paragraphs “a” through “f” of subsection 1. A category of coverage referred to in paragraph “g”, “h”, or “i” of subsection 1 shall not be combined in a policy or contract either with another category of coverage referred to in paragraph “g”, “h”, or “i” of subsection 1 or with a category of coverage referred to in any of paragraphs “a” through “f” of subsection 1 unless a rule issued by the commissioner specifically authorizes that combination of coverages.
 3. The commissioner shall prescribe the method of identification of policies and contracts based upon coverages provided.
 4. A policy of accident and sickness insurance or subscriber contract shall not be delivered or issued for delivery in this state unless the policy or contract meets the minimum standards prescribed under this section.
 5. The commissioner may upon notice and hearing at any time after the initial filing or approval of any individual accident and sickness policy or subscriber contract form, withdraw approval or suspend further sale of the form if the benefits provided are unreasonable in relation to the premium charge. The commissioner shall establish reasonable and creditable anticipated minimum loss ratios for Medicare supplement and other accident and sickness insurance policies.
 6. A rule issued by the commissioner under this section shall not apply to a conversion policy issued pursuant to a contractual conversion privilege under a group or individual policy of accident and sickness insurance when such group or individual contract contains provisions which are inconsistent with the requirements of this chapter or any rule issued under this chapter.
 7. A rule issued by the commissioner under this section shall not apply to policies being issued to employees or members being added to a franchise plan, as defined in section 509.14, which is in existence on the effective date of the rule.
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