Iowa Code
Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS
Section 514J.103 - Applicability and scope.

514J.103 Applicability and scope.
1. Except as provided in subsection 2, this chapter shall apply to all health carriers.
2. This chapter shall not apply to any of the following:
a. A policy or certificate that provides coverage only for a specified disease, specified accident or accident-only, credit, disability income, hospital indemnity, long-term care, vision care, or any other limited supplemental benefit.
b. A Medicare supplement policy of insurance, as defined by the commissioner by rule.
c. Coverage under a plan through Medicare, Medicaid, or the federal employees health benefits program, any coverage issued under 10 U.S.C. ch. 55, and any coverage issued as supplemental to that coverage.
d. Any coverage issued as supplemental to liability insurance.
e. Workers’ compensation or similar insurance.
f. Automobile medical-payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis.
2011 Acts, ch 101, §3; 2014 Acts, ch 1140, §111

Structure Iowa Code

Iowa Code

Title XIII - COMMERCE

Chapter 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS

Section 514J.1 - Legislative intent.

Section 514J.2 - Definitions.

Section 514J.3 - Exclusions.

Section 514J.3A - Notice.

Section 514J.4 - External review request — fee.

Section 514J.5 - Certification of request — eligibility.

Section 514J.6 - Independent review entities.

Section 514J.7 - External review.

Section 514J.8 - Expedited review.

Section 514J.9 - Funding.

Section 514J.10 - Reporting.

Section 514J.11 - Immunity.

Section 514J.12 - Standard of review.

Section 514J.13 - Effect of external review decision.

Section 514J.14 - Rules.

Section 514J.15 - Penalties.

Section 514J.101 - Purpose — applicability.

Section 514J.102 - Definitions.

Section 514J.103 - Applicability and scope.

Section 514J.104 - Notice of right to external review.

Section 514J.105 - Request for external review.

Section 514J.106 - Exhaustion of internal grievance process — exceptions — expedited external review request.

Section 514J.107 - External review — standard.

Section 514J.108 - External review — expedited.

Section 514J.109 - External review of experimental or investigational treatment adverse determinations.

Section 514J.110 - Effect of external review decision.

Section 514J.111 - Approval of independent review organizations.

Section 514J.112 - Minimum qualifications for independent review organizations.

Section 514J.113 - Immunity for independent review organizations.

Section 514J.114 - External review reporting requirements.

Section 514J.115 - Expenses of external review.

Section 514J.116 - Disclosure requirements.

Section 514J.117 - Rulemaking authority.

Section 514J.118 - Severability.

Section 514J.119 - Penalties.

Section 514J.120 - Applicability.