Iowa Code 252E.7 – Insurer authorization
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1. The entry of an order requiring a health benefit plan is authorization for enrollment of the dependent if the dependent is otherwise eligible to be enrolled. If the obligor fails to obtain coverage for a dependent, the insurer shall accept the signature of the obligee or other legal custodian of the child or of an employee of the department on the application for enrollment of the dependent under the health benefit plan. If the dependent is otherwise eligible to be enrolled in the plan pursuant to the applicable terms and conditions of the health benefit plan and the standard enrollment guidelines of the insurer, the insurer shall allow enrollment of the dependent at any time, notwithstanding any enrollment season restrictions.
Terms Used In Iowa Code 252E.7
- Child: includes but shall not be limited to a stepchild, foster child, or legally adopted child and means a child actually or apparently under eighteen years of age, and a dependent person eighteen years of age or over who is unable to maintain the person's self and is likely to become a public charge. See Iowa Code 252A.2
- Child: means a person for whom child or medical support may be ordered pursuant to chapter 234, 239B, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any other chapter of the Code or pursuant to a comparable statute of another state or foreign country. See Iowa Code 252E.1
- coverage: means providing and paying for the medical needs of a dependent through a health benefit plan. See Iowa Code 252E.1
- Department: means the department of health and human services. See Iowa Code 249L.2
- Department: means the department of health and human services, which includes but is not limited to child support services, or any comparable support enforcement agency of another state. See Iowa Code 252E.1
- Dependent: A person dependent for support upon another.
- Dependent: shall mean and include a spouse, child, mother, father, grandparent, or grandchild who is in need of and entitled to support from a person who is declared to be legally liable for such support. See Iowa Code 252A.2
- Dependent: means a child, or an obligee for whom a court may order health care coverage pursuant to section 252E. See Iowa Code 252E.1
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- Health benefit plan: means any policy or contract of insurance, indemnity, subscription, or membership issued by an insurer, health service corporation, health maintenance organization, or any similar corporation or organization, any public coverage, or any self-insured employee benefit plan, for the purpose of covering medical expenses. See Iowa Code 252E.1
- Insurer: means any entity, including a health service corporation, health maintenance organization, or any similar corporation or organization, or an employer offering self-insurance, that provides a health benefit plan, but does not include an entity that provides public coverage. See Iowa Code 252E.1
- Obligee: means a parent or another natural person legally entitled to receive a support payment on behalf of a child. See Iowa Code 252E.1
- Obligor: means a parent or another natural person legally responsible for the support of a dependent. See Iowa Code 252E.1
- Order: means a support order entered pursuant to chapter 234, 252A, 252C, 252F, 252H, 252K, 598, 600B, or any other support chapter, or pursuant to a comparable statute of another state or foreign country, or an ex parte order entered pursuant to section 252E. See Iowa Code 252E.1
- Signature: includes an electronic signature as defined in section 554D. See Iowa Code 4.1
2. An insurer shall not deny enrollment of a child under the health benefit plan of the obligor based on any of the following:
a. The child was born out of wedlock.
b. The child is not claimed as a dependent on the obligor’s federal income tax form.
c. The child does not reside with the obligor or in the insurer’s service area.
3. For purposes of processing claims for payment, the insurer shall accept the signature of the obligee or other legal custodian of the child or of an employee of the department as valid authorization for purposes of processing any medical expense claims on behalf of the dependent for payment or reimbursement of medical services rendered to the dependent.
4. The insurer shall have immunity from any liability, civil or criminal, which might otherwise be incurred or imposed for actions taken in implementing this section including, but not limited to, the insurer’s release of any information, or the payment of any claims for services by the insurer, or the insurer’s acceptance of applications for enrollment of the dependent and medical expense claims for the dependent which are signed by the obligee or an employee of the department pursuant to this section.
5. If a dependent has coverage under the health benefit plan of and through the insurer of the obligor, the insurer shall make payment directly to the obligee, the provider, or the department for claims submitted by the obligee, by the provider with the obligee’s approval, or by the department.
6. Payments remitted to the obligor by the insurer for services received by the dependent shall be recoverable by the obligee or the department from the obligor if not properly paid by the obligor to the provider or the obligee.