Iowa Admin. Code r. 191-73.9

Current through Register Vol. 47, No. 13, December 25, 2024

Rule 191-73.9 - Health insurance purchasing cooperative-product offerings-exemptions

(1) A HIPC shall offer at least one indemnity plan which provides an unrestricted choice of a physician. However, the indemnity plan may require an appropriate utilization review, preauthorization of treatments, or other reasonable cost and utilization oversight.

(2) All small employer group carriers participating in a HIPC shall offer a basic and a standard benefit plan.

(3) A HIPC is not required but may offer an employer-choice managed health care plan. The HIPC may also offer other indemnity plans.

(4) A HIPC cannot offer insurance from a risk retention group not chartered in the state nor a carrier not admitted in the state.

(5) A HIPC shall retain agents who are licensed pursuant to Iowa law if the HIPC markets the products of the HIPC through agents or sales representatives. Alternatively, if the HIPC does not use sales agents or representatives, the HIPC must demonstrate to the satisfaction of the commissioner that the alternative will provide consumer service meeting the same standards as that required of agents.

(6) A participating health plan is not required to be offered outside of the HIPC but may be offered through other distribution or marketing channels. An entity may not be licensed as a HIPC if it offers only one health plan or the products of only one carrier, or related carriers.

Iowa Admin. Code r. 191-73.9