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Current as of January 01, 2024 | Updated by Findlaw Staff
1. A health maintenance organization or an insurer using a preferred provider arrangement shall provide to each of its enrollees at the time of enrollment, and shall make available to each prospective enrollee upon request, written information as required by rules adopted by the commissioner. The information required by rule shall include but not be limited to all of the following:
a. A description of the plan's benefits and exclusions.
b. Enrollee cost-sharing requirements.
c. A list of participating providers.
d. Disclosure of the existence of any drug formularies used and, upon request, information about the specific drugs included in the formulary.
e. An explanation for accessing emergency care services.
f. Any policies addressing investigational or experimental treatments.
g. The methodologies used to compensate providers.
h. Performance measures as determined by the commissioner and the director.
i. Information on how to access internal and external grievance procedures.
2. The commissioner shall annually publish a consumer guide providing a comparison by plan on performance measures, network composition, and other key information to enable consumers to better understand plan differences.
Cite this article: FindLaw.com - Iowa Code Title XIII. Commerce [Chs. 505-554D] § 514K.1. Health care plan disclosures--information to enrollees - last updated January 01, 2024 | https://codes.findlaw.com/ia/title-xiii-commerce-chs-505-554d/ia-code-sect-514k-1/
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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