Iowa Code 514B.6 – Powers of health maintenance organizations
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Terms Used In Iowa Code 514B.6
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- 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
- Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
- person: means individual, corporation, limited liability company, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity. See Iowa Code 4.1
- property: includes personal and real property. 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
514B.6 Powers of health maintenance organizations.
1. The powers of a health maintenance organization include, but are not limited to, the following:
a. The purchase, lease, construction, renovation, operation or maintenance of hospitals,
medical facilities, or both, and their ancillary equipment, and such property as may reasonably be required for transacting the business of the organization.
b. The making of loans to a medical group under contract with it or to a corporation under
its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees.
c. The furnishing of health care services to the public through providers which are under
contract with or employed by the health maintenance organization.
d. The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration.
e. The contracting with an insurance company authorized to insure groups or individuals
in this state for the cost of health care or with a corporation authorized under chapter 514 for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization.
f. The offering, in addition to basic health care services, of health care services and
indemnity benefits to enrollees or groups of enrollees.
g. The acceptance from any person of payments covering all or part of the charges made to enrollees of the health maintenance organization.
2. A health maintenance organization shall file notice with the commissioner before the exercise of any power granted in subsection 1, paragraphs “”a”” and “”b””. The commissioner shall disapprove the exercise of power if in the commissioner’s opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. The commissioner may adopt rules exempting from the filing requirement of this section those activities having a minimum effect.
[C75, 77, 79, 81, §514B.6]
92 Acts, ch 1162, §24; 2012 Acts, ch 1023, §118
Referred to in §514B.15
1. The powers of a health maintenance organization include, but are not limited to, the following:
a. The purchase, lease, construction, renovation, operation or maintenance of hospitals,
medical facilities, or both, and their ancillary equipment, and such property as may reasonably be required for transacting the business of the organization.
b. The making of loans to a medical group under contract with it or to a corporation under
its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees.
c. The furnishing of health care services to the public through providers which are under
contract with or employed by the health maintenance organization.
d. The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration.
e. The contracting with an insurance company authorized to insure groups or individuals
in this state for the cost of health care or with a corporation authorized under chapter 514 for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization.
f. The offering, in addition to basic health care services, of health care services and
indemnity benefits to enrollees or groups of enrollees.
g. The acceptance from any person of payments covering all or part of the charges made to enrollees of the health maintenance organization.
2. A health maintenance organization shall file notice with the commissioner before the exercise of any power granted in subsection 1, paragraphs “”a”” and “”b””. The commissioner shall disapprove the exercise of power if in the commissioner’s opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. The commissioner may adopt rules exempting from the filing requirement of this section those activities having a minimum effect.
[C75, 77, 79, 81, §514B.6]
92 Acts, ch 1162, §24; 2012 Acts, ch 1023, §118
Referred to in §514B.15