Terms Used In Iowa Code > Chapter 514C - Special Health and Accident Insurance Coverages

• Account: means the same as defined in section 554. See Iowa Code 554E.1
• Applied behavior analysis: means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior. See Iowa Code 514C.31
• Applied behavioral analysis: means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior or to prevent loss of attained skill or function, including the use of direct observation, measurement, and functional analysis of the relations between environment and behavior. See Iowa Code 514C.28
• Autism service provider: means a person, or group providing treatment of autism spectrum disorder. See Iowa Code 514C.28
• Autism spectrum disorder: means a mental health condition that meets the diagnostic criteria for such disorder as published in the most recent edition of the diagnostic and statistical manual of mental disorders as published by the American psychiatric association. See Iowa Code 514C.28
• Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
• Board: means the engineering and land surveying examining board provided by this chapter. See Iowa Code 542B.2
• Carrier: includes an insurance company, group hospital or medical service corporation, health maintenance organization, multiple employer welfare arrangement, and any other person providing health benefit plans in this state subject to regulation by the commissioner of insurance. See Iowa Code 514C.13
• Child: includes child by adoption. See Iowa Code 4.1
• 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.
• 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.
• Diagnostic assessment of autism spectrum disorder: means medically necessary assessment, evaluations, or tests performed by a licensed physician, licensed physician assistant, licensed psychologist, or licensed registered nurse practitioner to diagnose whether an individual has autism spectrum disorder. See Iowa Code 514C.28
• Electronic: means the same as defined in section 554D. See Iowa Code 554E.1
• 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.
• 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
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health benefit plan: means a policy, certificate, or contract providing hospital or medical coverage, benefits, or services rendered by a health care provider. See Iowa Code 514C.13
• Health care provider: means a hospital licensed pursuant to chapter 135B, a person licensed under chapter 148, 148C, 149, 151, or 154, or a person licensed as an advanced registered nurse practitioner under chapter 152. See Iowa Code 514C.13
• human papilloma virus: means the human papilloma virus as defined by the centers for disease control and prevention of the United States department of health and human services. See Iowa Code 514C.23
• Indemnity plan: means a hospital or medical expense-incurred policy, certificate, or contract, major medical expense insurance, or hospital or medical service plan contract. See Iowa Code 514C.13
• 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.
• Large employer: means a person actively engaged in business who, during at least fifty percent of the employer's working days during the preceding calendar year, employed more than fifty full-time equivalent employees. See Iowa Code 514C.13
• licensed physician: includes persons licensed under chapter 148, and "policy of accident and sickness insurance" includes individual policies or contracts issued pursuant to chapter 514, 514A, or 514B, and group policies as defined in section 509B. See Iowa Code 514C.3
• Limited provider network plan: means a managed care health plan which limits access to or coverage for services to selected health care providers who are under contract with the managed care health plan. See Iowa Code 514C.13
• Managed care health plan: means a health benefit plan that selects and contracts with health care providers; manages and coordinates health care delivery; monitors necessity, appropriateness, and quality of health care delivered by health care providers; and performs utilization review and cost control. See Iowa Code 514C.13
• minimum mammography examination coverage: means benefits which are better than or equal to the following minimum requirements:
   a. See Iowa Code 514C.4
• 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.
• Oversight: Committee review of the activities of a Federal agency or program.
• 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
• Pharmacy care: means medications prescribed by a licensed physician, licensed physician assistant, or licensed registered nurse practitioner and any assessment, evaluation, or test prescribed or ordered by a licensed physician, licensed physician assistant, or licensed registered nurse practitioner to determine the need for or effectiveness of such medications. See Iowa Code 514C.28
• Point of service plan option: means a provision in a managed care health plan that permits insureds, enrollees, or subscribers access to health care from health care providers who have not contracted with the managed care health plan. See Iowa Code 514C.13
• Practitioner: means any of the following:
   (1) A physician licensed pursuant to chapter 148. See Iowa Code 514C.31
• Psychiatric care: means direct or consultative services provided by a licensed physician who specializes in psychiatry. See Iowa Code 514C.28
• Psychological care: means direct or consultative services provided by a licensed psychologist. See Iowa Code 514C.28
• Rehabilitative care: means professional services and treatment programs, including applied behavioral analysis, provided by an autism service provider to produce socially significant improvement in human behavior or to prevent loss of attained skill or function. See Iowa Code 514C.28
• Rule: includes "regulation". See Iowa Code 4.1
• Small employer: means a person actively engaged in business who, during at least fifty percent of the employer's working days during the preceding calendar year, employed at least one and not more than fifty full-time equivalent employees. See Iowa Code 514C.13
• 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
• Therapeutic care: means services provided by a licensed speech pathologist, licensed occupational therapist, or licensed physical therapist. See Iowa Code 514C.28
• Treatment of autism spectrum disorder: means treatment that is identified in a treatment plan and includes medically necessary pharmacy care, psychiatric care, psychological care, rehabilitative care, and therapeutic care that is one of the following:
   (1) Prescribed, ordered, or provided by a licensed physician, licensed physician assistant, licensed psychologist, licensed social worker, or licensed registered nurse practitioner. See Iowa Code 514C.28
• Treatment plan: means a plan for the treatment of autism spectrum disorder developed by a licensed physician or licensed psychologist pursuant to a comprehensive evaluation or reevaluation performed in consultation with the patient and the patient's representative. See Iowa Code 514C.28
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• United States: includes all the states. See Iowa Code 4.1
• year: means twelve consecutive months. See Iowa Code 4.1