514.7 Contracts — approval by commissioner — provisions to be available. 1. The contracts by any such corporation with the subscribers for health care service shall at all times be subject to the approval of the commissioner of insurance. The commissionershall require that participating pharmacies be reimbursed by the pharmaceutical servicecorporation at rates or prices equal to rates or prices charged nonsubscribers, unless thecommissioner determines otherwise to prevent loss to subscribers. 2. A provision shall be available in approved contracts with hospital and medical service corporate subscribers under group subscriber contracts or plans covering vision careservices or procedures, for payment of necessary medical or surgical care and treatmentprovided by an optometrist licensed under chapter 154, if the care and treatment areprovided within the scope of the optometrist’s license and if the subscriber contract wouldpay for the care and treatment if it were provided by a person engaged in the practiceof medicine or surgery as licensed under chapter 148. The subscriber contract shall alsoprovide that the subscriber may reject the coverage or provision if the coverage or rson engaged in the practiceof medicine or surgery as licensed under chapter 148. The subscriber contract shall alsoprovide that the subscriber may reject the coverage or provision if the coverage or provisionfor services which may be provided by an optometrist is rejected for all providers of similarvision care services as licensed under chapter 148 or 154. This subsection applies to groupsubscriber contracts delivered after July 1, 1983, and to group subscriber contracts on theiranniversary or renewal date, or upon the expiration of the applicable collective bargainingcontract, if any, whichever is the later. This subsection does not apply to contracts designedonly for issuance to subscribers eligible for coverage under Tit. XVIII of the Social SecurityAct, or any other similar coverage under a state or federal government plan. 3. A provision shall be made available in approved contracts with hospital and medical subscribers under group subscriber contracts or plans covering diagnosis and treatmentof human ailments, for payment or reimbursement for necessary diagnosis or treatmentprovided by a chiropractor licensed under chapter 151 if the diagnosis or treatment isprovided agnosis and treatmentof human ailments, for payment or reimbursement for necessary diagnosis or treatmentprovided by a chiropractor licensed under chapter 151 if the diagnosis or treatment isprovided within the scope of the chiropractor’s license and if the subscriber contract wouldpay or reimburse for the diagnosis or treatment of the human ailments, irrespective ofand disregarding variances in terminology employed by the various licensed professionsin describing the human ailments or their diagnosis or treatment, if it were provided bya person licensed under chapter 148. The subscriber contract shall also provide that thesubscriber may reject the coverage or provision if the coverage or provision for diagnosis ortreatment of a human ailment by a chiropractor is rejected for all providers of diagnosis ortreatment for similar human ailments licensed under chapter 148 or 151. A group subscribercontract may limit or make optional the payment or reimbursement for lawful diagnostic ortreatment service by all licensees under chapters 148 and 151 on any rational basis whichis not solely related to the license under or the practices authorized by chapter 151 or isnot dependent upon a reatment service by all licensees under chapters 148 and 151 on any rational basis whichis not solely related to the license under or the practices authorized by chapter 151 or isnot dependent upon a method of classification, categorization, or description based upondifferences in terminology used by different licensees in describing human ailments or theirdiagnosis or treatment. This subsection applies to group subscriber contracts delivered afterJuly 1, 1986, and to group subscriber contracts on their anniversary or renewal date, or uponthe expiration of the applicable collective bargaining contract, if any, whichever is the later.This subsection does not apply to contracts designed only for issuance to subscribers eligiblefor coverage under Tit. XVIII of the Social Security Act, or any other similar coverage undera state or federal government plan. 4. A provision shall be available in approved contracts with hospital and medical service corporate subscribers under group subscriber contracts or plans covering medical andsurgical service, for payment of covered services determined to be medically necessaryprovided by certified registered nurses certified by a national certifying contracts or plans covering medical andsurgical service, for payment of covered services determined to be medically necessaryprovided by certified registered nurses certified by a national certifying organization, whichorganization shall be identified by the Iowa board of nursing pursuant to rules adopted bythe board, if the services are within the practice of the profession of a registered nurse asthat practice is defined in section 152.1, under terms and conditions agreed upon betweenthe corporation and subscriber group, subject to utilization controls. This subsection shall not require payment for nursing services provided by a certified registered nursepracticing in a hospital, nursing facility, health care institution, a physician’s office, orother noninstitutional setting if the certified registered nurse is an employee of the hospital, Sat Dec 23 00:44:15 2023 Iowa Code 2024, Section 514.7 (18, 0) §514.7, NONPROFIT HEALTH SERVICE CORPORATIONS 2 nursing facility, health care institution, physician, or other health care facility or health careprovider. This subsection applies to group subscriber contracts delivered in this state on orafter July 1, 1989, and to group care institution, physician, or other health care facility or health careprovider. This subsection applies to group subscriber contracts delivered in this state on orafter July 1, 1989, and to group subscriber contracts on their anniversary or renewal date, orupon the expiration of the applicable collective bargaining contract, if any, whichever is thelater. This subsection does not apply to limited or specified disease or individual contractsor contracts designed only for issuance to subscribers eligible for coverage under Tit. XVIIIof the federal Social Security Act, contracts which are rated on a community basis, or anyother similar coverage under a state or federal government plan. [C39, §8895.07; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §514.7]83 Acts, ch 166, §2; 84 Acts, ch 1122, §6; 84 Acts, ch 1290, §2; 86 Acts, ch 1180, §5; 89 Acts, ch 164, §3; 99 Acts, ch 75, §3; 2000 Acts, ch 1058, §46; 2008 Acts, ch 1088, §126; 2010 Acts,ch 1061, §180 Referred to in §514.21, 514.23 Sat Dec 23 00:44:15 2023 Iowa Code 2024, Section 514.7 (18, 0)
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