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Current as of January 01, 2024 | Updated by Findlaw Staff
Participating insurers shall meet the qualifying standards established by rule under this chapter and shall perform all of the following functions:
1. Provide plan cards and membership booklets to qualifying families.
2. Provide or reimburse accessible, quality medical or dental services.
3. Require that any plan provided by the participating insurer establishes and maintains a conflict management system that includes methods for both preventing and resolving disputes involving the health or dental care needs of eligible children, and a process for resolution of such disputes.
4. Provide the department with all of the following information pertaining to the participating insurer's plan:
a. A list of providers of medical or dental services under the plan.
b. Information regarding plan rules relating to referrals to specialists.
c. Information regarding the plan's conflict management system.
d. Other information as directed by the board.
5. Submit a plan for a health improvement program to the department, for approval by the board.
6. Develop a plan for provider network development including criteria for access to pediatric subspecialty services.
7. Permit any chiropractor licensed under chapter 151 who is located in the geographic coverage area served by the plan and who agrees to abide by the plan's terms, conditions, reimbursement rates, and quality standards to serve as a participating provider in any plan offered to eligible children under this chapter, including but not limited to a limited provider network plan as defined in section 514C.13.
Cite this article: FindLaw.com - Iowa Code Title XIII. Commerce [Chs. 505-554D] § 514I.6. Participating insurers - last updated January 01, 2024 | https://codes.findlaw.com/ia/title-xiii-commerce-chs-505-554d/ia-code-sect-514i-6/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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