514C.3A Disclosures relating to dental coverage reimbursement rates.
1. An individual or group policy of accident or health insurance or individual or group hospital or health care service contract issued pursuant to chapter 509, 514, or 514A, and delivered, amended, or renewed on or after July 1, 1995, that provides dental care benefits with a base payment for those benefits determined upon a usual and customary fee charged by licensed dentists, shall disclose all of the following:
a. The frequency of the determination of the usual and customary fee.
b. A general description of the methodology used to determine usual and customary fees, including geographic considerations.
c. The percentile that determines the maximum benefit that the insurer or nonprofit health service corporation will pay for any dental procedure, if the usual and customary fee is determined by taking a sample of fees submitted on actual claims from licensed dentists and then determining the benefit by selecting a percentile of those fees.
2. The disclosure shall be provided upon request to all group and individual policyholders and subscribers. All proposals for dental care benefits shall inform the prospective policyholder or subscriber that information regarding usual and customary fee determinations is available from the insurer or nonprofit health service corporation. All employee benefit descriptions or supplemental documents shall notify the employee that information regarding reimbursement rates is available from the employer.
95 Acts, ch 78, §1; 95 Acts, ch 209, §26
Structure Iowa Code
Chapter 514C - SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES
Section 514C.1 - Supplemental coverage for adopted or newly born children.
Section 514C.2 - Skilled nursing care covered in hospitals.
Section 514C.3 - Dentist’s services under accident and sickness insurance policies.
Section 514C.3A - Disclosures relating to dental coverage reimbursement rates.
Section 514C.3B - Dental coverage — fee schedules.
Section 514C.4 - Mandated coverage for mammography.
Section 514C.5 - Prescription drug benefit restrictions.
Section 514C.6 - Uniformity of treatment — employee welfare benefit plans.
Section 514C.8 - Coordination of health care benefits with state medical assistance.
Section 514C.9 - Medical support — insurance requirements.
Section 514C.10 - Coverage for adopted child.
Section 514C.12 - Postdelivery benefits and care.
Section 514C.14 - Continuity of care — pregnancy.
Section 514C.15 - Treatment options.
Section 514C.16 - Emergency room services.
Section 514C.17 - Continuity of care — terminal illness.
Section 514C.18 - Diabetes coverage.
Section 514C.19 - Prescription contraceptive coverage.
Section 514C.20 - Mandated coverage for dental care — anesthesia and certain hospital charges.
Section 514C.21 - Coverage for immunizations — mercury.
Section 514C.22 - Biologically based mental illness coverage.
Section 514C.23 - Human papilloma virus vaccinations — coverage.
Section 514C.24 - Cancer treatment — coverage.
Section 514C.25 - Coverage for prosthetic devices.
Section 514C.26 - Approved cancer clinical trials coverage.
Section 514C.27 - Mental illness and substance abuse treatment coverage for veterans.
Section 514C.28 - Autism spectrum disorders coverage.
Section 514C.29 - Services provided by a doctor of chiropractic.
Section 514C.31 - Applied behavior analysis for treatment of autism spectrum disorder — coverage.
Section 514C.33 - Services provided by provisionally licensed psychologists.
Section 514C.34 - Health care services delivered by telehealth — coverage.
Section 514C.35 - Behavioral health services provided in a school — coverage.