Iowa Code 514A.3B – Additional requirements
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Terms Used In Iowa Code 514A.3B
- Child: includes child by adoption. See Iowa Code 4.1
- Contract: A legal written agreement that becomes binding when signed.
- 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
- state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
514A.3B Additional requirements.
1. An insurer which accepts an individual for coverage under an individual policy or
contract of accident and health insurance shall waive any time period applicable to a preexisting condition exclusion or limitation period requirement of the policy or contract with respect to particular services in an individual health benefit plan for the period of time the individual was previously covered by qualifying previous coverage as defined in § 513C.3, by chapter 249A or 514I, or by Medicare coverage provided pursuant to Tit. XVIII of the federal Social Security Act that provided benefits with respect to such services, provided that the coverage was continuous to a date not more than sixty-three days prior to the effective date of the new policy or contract.
2. An insurer issuing an individual policy or contract of accident and health insurance which provides coverage for children of the insured shall permit continuation of existing coverage or reenrollment in previously existing coverage for an individual who meets the requirements of § 513B.2, subsection 14, paragraph “”a””, “”b””, “”c””, “”d””, or “”e””, and who is an unmarried child of an insured or enrollee who so elects, at least through the policy anniversary date on or after the date the child marries, ceases to be a resident of this state, or attains the age of twenty-five years old, whichever occurs first, or so long as the unmarried child maintains full-time status as a student in an accredited institution of postsecondary education.
3. For the purposes of any policies of accident and sickness insurance issued in this state, “”creditable coverage”” means health benefits or coverage provided to an individual under any of the following:
a. A group health plan.
b. Health insurance coverage.
c. Part A or Part B Medicare pursuant to Tit. XVIII of the federal Social Security Act.
d. Medicaid pursuant to Tit. XIX of the federal Social Security Act, other than coverage consisting solely of benefits under section 1928 of that Act.
e. 10 U.S.C. ch. 55.
f. A health or medical care program provided through the Indian health service or a tribal organization.
g. A state health benefits risk pool.
h. A health plan offered under 5 U.S.C. ch. 89.
i. A public health plan as defined under federal regulations.
j. A health benefit plan under section 5(e) of the federal Peace Corps Act, 22 U.S.C.
§2504(e).
k. A short-term limited duration policy.
l. The Hawki program authorized by chapter 514I.
2008 Acts, ch 1188, §42, 43; 2009 Acts, ch 118, §9, 11, 21, 22; 2017 Acts, ch 148, §60; 2023
Acts, ch 19, §1192
Referred to in §514D.3, 514D.7
Subsection 3, paragraph l amended
1. An insurer which accepts an individual for coverage under an individual policy or
contract of accident and health insurance shall waive any time period applicable to a preexisting condition exclusion or limitation period requirement of the policy or contract with respect to particular services in an individual health benefit plan for the period of time the individual was previously covered by qualifying previous coverage as defined in § 513C.3, by chapter 249A or 514I, or by Medicare coverage provided pursuant to Tit. XVIII of the federal Social Security Act that provided benefits with respect to such services, provided that the coverage was continuous to a date not more than sixty-three days prior to the effective date of the new policy or contract.
2. An insurer issuing an individual policy or contract of accident and health insurance which provides coverage for children of the insured shall permit continuation of existing coverage or reenrollment in previously existing coverage for an individual who meets the requirements of § 513B.2, subsection 14, paragraph “”a””, “”b””, “”c””, “”d””, or “”e””, and who is an unmarried child of an insured or enrollee who so elects, at least through the policy anniversary date on or after the date the child marries, ceases to be a resident of this state, or attains the age of twenty-five years old, whichever occurs first, or so long as the unmarried child maintains full-time status as a student in an accredited institution of postsecondary education.
3. For the purposes of any policies of accident and sickness insurance issued in this state, “”creditable coverage”” means health benefits or coverage provided to an individual under any of the following:
a. A group health plan.
b. Health insurance coverage.
c. Part A or Part B Medicare pursuant to Tit. XVIII of the federal Social Security Act.
d. Medicaid pursuant to Tit. XIX of the federal Social Security Act, other than coverage consisting solely of benefits under section 1928 of that Act.
e. 10 U.S.C. ch. 55.
f. A health or medical care program provided through the Indian health service or a tribal organization.
g. A state health benefits risk pool.
h. A health plan offered under 5 U.S.C. ch. 89.
i. A public health plan as defined under federal regulations.
j. A health benefit plan under section 5(e) of the federal Peace Corps Act, 22 U.S.C.
§2504(e).
k. A short-term limited duration policy.
l. The Hawki program authorized by chapter 514I.
2008 Acts, ch 1188, §42, 43; 2009 Acts, ch 118, §9, 11, 21, 22; 2017 Acts, ch 148, §60; 2023
Acts, ch 19, §1192
Referred to in §514D.3, 514D.7
Subsection 3, paragraph l amended