514C.3A Disclosures relating to dental coverage reimbursement rates. 1. An individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509, 514, or 514A, anddelivered, amended, or renewed on or after July 1, 1995, that provides dental care benefitswith a base payment for those benefits determined upon a usual and customary fee chargedby licensed dentists, shall disclose all of the following: a. The frequency of the determination of the usual and customary fee.b. A general description of the methodology used to determine usual and customary fees, including geographic considerations. c. The percentile that determines the maximum benefit that the insurer or nonprofit health service corporation will pay for any dental procedure, if the usual and customary feeis determined by taking a sample of fees submitted on actual claims from licensed dentistsand then determining the benefit by selecting a percentile of those fees. 2. The disclosure shall be provided upon request to all group and individual policyholders and subscribers. licensed dentistsand then determining the benefit by selecting a percentile of those fees. 2. The disclosure shall be provided upon request to all group and individual policyholders and subscribers. All proposals for dental care benefits shall inform the prospective policyholder or subscriber that information regarding usual and customary feedeterminations is available from the insurer or nonprofit health service corporation. Allemployee benefit descriptions or supplemental documents shall notify the employee thatinformation regarding reimbursement rates is available from the employer. 95 Acts, ch 78, §1; 95 Acts, ch 209, §26 Sat Dec 23 00:44:59 2023 Iowa Code 2024, Section 514C.3A (17, 0)
Iowa Legal Code