514B.13 Open enrollment.
1. After a health maintenance organization has been in operation twenty-four months, it shall have an annual open enrollment period of at least one month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which the prospective enrollees apply for enrollment. A health maintenance organization may apply to the commissioner for authorization to impose such underwriting restrictions upon enrollment as are necessary to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees, or to avoid unreasonably high or unmarketable charges for enrollee coverage for health care services. The commissioner shall approve or deny the application made pursuant to this section within a reasonable period of time from the receipt of the application.
2. Health maintenance organizations providing services exclusively on a group contract basis may limit the open enrollment provided for in this section to all members of the group covered by the contract, including those members of the group who previously waived coverage.
[C75, 77, 79, 81, §514B.13]
2005 Acts, ch 70, §13; 2018 Acts, ch 1041, §127; 2019 Acts, ch 59, §186
Structure Iowa Code
Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS
Section 514B.1 - Definitions — services required or available.
Section 514B.2 - Establishment of health maintenance organizations.
Section 514B.3 - Application for a certificate of authority.
Section 514B.3A - Articles — approval — bylaws.
Section 514B.3B - Certificate of authority — renewal.
Section 514B.4 - Applicant for certificate of authority.
Section 514B.4A - Direct provision of health care services.
Section 514B.5 - Issuance and denial of a certificate of authority.
Section 514B.6 - Powers of health maintenance organizations.
Section 514B.7 - Governing body.
Section 514B.8 - Fiduciary responsibilities.
Section 514B.9 - Evidence of coverage.
Section 514B.9A - Coverage of children — continuation or reenrollment.
Section 514B.11 - Disapproval of filings.
Section 514B.12 - Annual report.
Section 514B.13 - Open enrollment.
Section 514B.14 - Complaint system.
Section 514B.15 - Investments.
Section 514B.16 - Protection against insolvency.
Section 514B.17 - Cancellation of enrollees.
Section 514B.17A - Rescission.
Section 514B.18 - False representation.
Section 514B.19 - Regulation of insurance producers.
Section 514B.20 - Powers of insurers and hospital and medical service corporations.
Section 514B.21 - Public employees included.
Section 514B.24 - Examinations permitted.
Section 514B.25 - Financially impaired or insolvent health maintenance organizations.
Section 514B.25A - Impairment and insolvency protection.
Section 514B.26 - Administrative procedures.
Section 514B.27 - Judicial review.
Section 514B.30 - Communications in professional confidence.
Section 514B.32 - Construction.
Section 514B.33 - Establishment of limited service organizations.