§ 509.3

509.3 Provisions as part of accident or health policy. 1. All policies of group accident or health insurance or combination thereof issued in this state shall contain in substance the following provisions: a. The policy shall have a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued or shall be furnished to thepolicyholder within thirty days after the policy is issued, that all statements made by thepolicyholder or by the persons insured shall be deemed representations and not warranties,and that no statement made by any person insured shall be used in any contest unless a copyof the instrument containing the statement is or has been furnished to such person. b. A provision that the company will issue to the policyholder for delivery to each person insured under such policy an individual certificate setting forth a statement as tothe insurance protection to which the person is entitled, to whom the insurance benefitsare payable, and such provisions of the policy as are, in the opinion of the commissioner ofinsurance, necessary to inform the holder thereof as to the holder’s rights under the policy. c.

ce benefitsare payable, and such provisions of the policy as are, in the opinion of the commissioner ofinsurance, necessary to inform the holder thereof as to the holder’s rights under the policy. c. A provision that to the group or class thereof originally insured shall be added, from time to time, all new persons eligible to insurance in such group or class. d. A provision that if the insurance on a person or insurance on a person and the person’s dependents covered by the policy ceases because of termination of employmentor of membership in the class, the person and the person’s dependents may continue theiraccident or health insurance under the group policy. e. A provision shall be made available to policyholders, under group policies covering vision care services or procedures, for payment of necessary medical or surgical care andtreatment provided by an optometrist licensed under chapter 154 if the care and treatment areprovided within the scope of the optometrist’s license and if the policy would pay for the careand treatment if the care and treatment were provided by a person engaged in the practiceof medicine or surgery or osteopathic medicine and surgery as licensed

and if the policy would pay for the careand treatment if the care and treatment were provided by a person engaged in the practiceof medicine or surgery or osteopathic medicine and surgery as licensed under chapter 148.The policy shall provide that the policyholder may reject the coverage or provision if thecoverage or provision for services which may be provided by an optometrist is rejected for allproviders of similar vision care services as licensed under chapter 148 or 154. This paragraphapplies to group policies delivered or issued for delivery after July 1, 1983, and to existinggroup policies on their next anniversary or renewal date, or upon expiration of the applicablecollective bargaining contract, if any, whichever is later. This paragraph does not apply toblanket, short-term travel, accident-only, limited or specified disease, or individual or groupconversion policies, or policies designed only for issuance to persons for coverage underTit. XVIII of the Social Security Act, or any other similar coverage under a state or federalgovernment plan. f. A provision shall be made available to policyholders under group policies covering diagnosis and treatment of human ailments

or any other similar coverage under a state or federalgovernment plan. f. A provision shall be made available to policyholders under group policies covering diagnosis and treatment of human ailments for payment or reimbursement for necessarydiagnosis or treatment provided by a chiropractor licensed under chapter 151, if thediagnosis or treatment is provided within the scope of the chiropractor’s license and ifthe policy would pay or reimburse for the diagnosis or treatment by a person licensedunder chapter 148 of the human ailment, irrespective of and disregarding variances interminology employed by the various licensed professions in describing the human ailmentor its diagnosis or its treatment. The policy shall provide that the policyholder may rejectthe coverage or provision if the coverage or provision for diagnosis or treatment of a humanailment by a chiropractor is rejected for all providers of diagnosis or treatment for similarhuman ailments licensed under chapter 148 or 151. A policy of group health insurance maylimit or make optional the payment or reimbursement for lawful diagnostic or treatmentservice by all licensees under chapters 148 and 151 on any rational basis

. A policy of group health insurance maylimit or make optional the payment or reimbursement for lawful diagnostic or treatmentservice by all licensees under chapters 148 and 151 on any rational basis which is not solelyrelated to the license under or the practices authorized by chapter 151 or is not dependentupon a method of classification, categorization, or description based directly or indirectlyupon differences in terminology used by different licensees in describing human ailments ortheir diagnosis or treatment. This paragraph applies to group policies delivered or issued fordelivery after July 1, 1986, and to existing group policies on their next anniversary or renewaldate, or upon expiration of the applicable collective bargaining contract, if any, whichever is Sat Dec 23 00:41:40 2023 Iowa Code 2024, Section 509.3 (22, 0) §509.3, GROUP INSURANCE 2 later. This paragraph does not apply to blanket, short-term travel, accident-only, limited orspecified disease, or individual or group conversion policies, or policies under Tit. XVIII ofthe Social Security Act, or any other similar coverage under a state or federal governmentplan. g.

ited orspecified disease, or individual or group conversion policies, or policies under Tit. XVIII ofthe Social Security Act, or any other similar coverage under a state or federal governmentplan. g. A provision shall be made available to policyholders, under group policies covering hospital, medical, or surgical expenses, for payment of covered services determined tobe medically necessary provided by registered nurses certified by a national certifyingorganization, which organization shall be identified by the Iowa board of nursing pursuantto rules adopted by the board, if the services are within the practice of the profession ofa registered nurse as that practice is defined in section 152.1, under terms and conditionsagreed upon between the insurer and the policyholder, subject to utilization controls. Thisparagraph shall not require payment for nursing services provided by a certified nursepracticing in a hospital, nursing facility, health care institution, physician’s office, or othernoninstitutional setting if the certified nurse is an employee of the hospital, nursing facility,health care institution, physician, or other health care facility or health care provider.

ce, or othernoninstitutional setting if the certified nurse is an employee of the hospital, nursing facility,health care institution, physician, or other health care facility or health care provider. Thisparagraph applies to group policies delivered or issued for delivery in this state on or afterJuly 1, 1989, and to existing group policies on their next anniversary or renewal dates,or upon expiration of the applicable collective bargaining contract, if any, whichever islater. This paragraph does not apply to blanket, short-term travel, accident-only, limited orspecified disease, or individual or group conversion policies, policies rated on a communitybasis, or policies designed only for issuance to persons for eligible coverage under Tit. XVIIIof the federal Social Security Act, or any other similar coverage under a state or federalgovernment plan. h. A provision that the insurer will permit continuation of existing coverage or reenrollment in previously existing coverage for an individual who meets the requirementsof section 513B.2, subsection 14, paragraph 'a', 'b', 'c', 'd', or 'e', and who is an unmarriedchild of an insured or enrollee who so elects, at least through the

individual who meets the requirementsof section 513B.2, subsection 14, paragraph 'a', 'b', 'c', 'd', or 'e', and who is an unmarriedchild of an insured or enrollee who so elects, at least through the policy anniversary date onor after the date the child marries, ceases to be a resident of this state, or attains the age oftwenty-five years old, whichever occurs first, or so long as the unmarried child maintainsfull-time status as a student in an accredited institution of postsecondary education. 2. In addition to the provisions required in subsection 1, paragraphs 'a' through 'h', the commissioner shall require provisions through the adoption of rules implementing the federalHealth Insurance Portability and Accountability Act, Pub. L. No. 104-191. [C24, 27, 31, §8677, 8678; C35, §8684-e4, -e6; C39, §8684.04, 8684.06; C46, §509.4, 509.6; C50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §509.3] 83 Acts, ch 166, §1; 84 Acts, ch 1290, §1; 86 Acts, ch 1124, §8; 86 Acts, ch 1180, §2; 89 Acts, ch 164, §2; 97 Acts, ch 103, §1; 99 Acts, ch 75, §2; 2005 Acts, ch 70, §7; 2008 Acts, ch 1088,§125; 2008 Acts, ch 1188, §38, 43; 2009 Acts, ch 118, §7, 11; 2012 Acts, ch 1021, §98 Referred to in

cts, ch 164, §2; 97 Acts, ch 103, §1; 99 Acts, ch 75, §2; 2005 Acts, ch 70, §7; 2008 Acts, ch 1088,§125; 2008 Acts, ch 1188, §38, 43; 2009 Acts, ch 118, §7, 11; 2012 Acts, ch 1021, §98 Referred to in §509.10, 509.14, 514.21, 514.23 Sat Dec 23 00:41:40 2023 Iowa Code 2024, Section 509.3 (22, 0)