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
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.