reglab/statecodes huggingface dataset:
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.14 - Reinsurance.

512B.14 Reinsurance.
1. A domestic society may, by a reinsurance agreement, cede any individual risk or risks in whole or in part to an insurer, other than another fraternal benefit society, having the power to make such reinsurance agreements and authorized to do business in this state, or if not so authorized, one which is approved by the commissioner; but a society shall not reinsure substantially all of its insurance in force without the written permission of the commissioner. It may take credit for the reserves on ceded risks to the extent reinsured, but credit shall not be allowed as an admitted asset or as a deduction from liability, to a ceding society for reinsurance made, ceded, renewed, or otherwise becoming effective after January 1, 1991, unless the reinsurance is payable by the assuming insurer on the basis of the liability of the ceding society under the contract or contracts reinsured without diminution because of the insolvency of the ceding society.
2. Notwithstanding the limitation in subsection 1, a society may reinsure the risks of another society in a consolidation or merger approved by the commissioner under section 512B.15.
90 Acts, ch 1148, §14
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.15A - Conversion of fraternal benefit society into a mutual life insurance company.

512B.15A Conversion of fraternal benefit society into a mutual life insurance company.
A domestic fraternal benefit society may be converted and licensed as a mutual life insurance company by compliance with all the requirements of the general insurance laws for mutual life insurance companies. A plan of conversion shall be prepared in writing by the board of directors setting forth in full the terms and conditions of conversion. The affirmative vote of two-thirds of all members of the supreme governing body at a regular or special meeting is necessary for the approval of the plan of conversion. A conversion shall not take effect unless and until approved by the commissioner. The commissioner may give approval for the conversion if the commissioner finds that the proposed change is in conformity with the requirements of law and not prejudicial to the certificate holders of the society.
90 Acts, ch 1148, §16
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.16 - Benefits.

512B.16 Benefits.
1. A society may provide any or all of the following contractual benefits in any form:
a. Death benefits.
b. Endowment benefits.
c. Annuity benefits.
d. Temporary or permanent disability benefits.
e. Hospital, medical, or nursing benefits.
f. Monument or tombstone benefits to the memory of deceased members.
g. Other benefits authorized for life insurers and which are not inconsistent with this chapter.
2. A society shall specify in its regulations those persons who may be issued, or covered by, the contractual benefits in subsection 1, consistent with providing benefits to members and their dependents. A society may provide benefits on the lives of children under the minimum age for adult membership upon application of an adult person.
90 Acts, ch 1148, §17
Referred to in §512B.2, 512B.6
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.17 - Beneficiaries.

512B.17 Beneficiaries.
1. The owner of a benefit contract may change the beneficiary or beneficiaries in accordance with the laws or regulations of the society unless the owner waives this right by specifically requesting in writing that the beneficiary designation be irrevocable. A society may, through its laws or regulations, limit the scope of beneficiary designations and shall provide that a revocable beneficiary shall not have or obtain a vested interest in the proceeds of a certificate until the certificate has become due and payable in conformity with the benefit contract.
2. A society may make provision for the payment of funeral benefits to the extent of the portion of a payment under a certificate which reasonably appears to be due to a person equitably entitled to the benefit by reason of having incurred expense occasioned by the burial of the member. However, the portion so paid shall not exceed the sum of one thousand dollars.
3. If, at the death of a person insured under a benefit contract, there is no lawful beneficiary to whom the proceeds are payable, the amount of the benefit, except to the extent that funeral benefits may be paid pursuant to subsection 2, shall be payable to the estate of the deceased insured the same as other property not exempt. However, if the owner of the certificate is other than the insured, the proceeds are payable to the owner.
90 Acts, ch 1148, §18
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.18 - Benefits not attachable.

512B.18 Benefits not attachable.
Money or other benefit, charity, relief, or aid to be paid, provided, or rendered by a society, is not liable to attachment, garnishment, or other process, or to be seized, taken, appropriated, or applied by any legal or equitable process or operation of law to pay a debt or liability of a member or beneficiary, or any other person who may have a derivative right, either before or after payment by the society, except as provided in sections 627.11 and 627.12.
90 Acts, ch 1148, §19
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.20 - Nonforfeiture benefits, cash surrender values, certificate loans, and other options.

512B.20 Nonforfeiture benefits, cash surrender values, certificate loans, and other options.
1. For certificates issued before January 1, 1991, the value of every paid-up nonforfeiture benefit and the amount of any cash surrendered value, loan, or other option granted shall comply with chapter 512, Code 1989.
2. For certificates issued on or after January 1, 1991, for which reserves are computed on the commissioner’s 1980 standard mortality table, or any more recent table made applicable to life insurers, every paid-up nonforfeiture benefit and the amount of any cash surrender value, loan, or other option granted shall not be less than the corresponding amount ascertained in accordance with the laws of this state applicable to life insurers issuing policies containing like benefits based upon the same tables.
90 Acts, ch 1148, §21
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.21 - Investments.

512B.21 Investments.
A society shall invest its funds only as authorized by the laws of this state for the investment of assets of life insurers and subject to the same limitations. A foreign or alien society permitted or seeking to do business in this state which invests its funds in accordance with the laws of the state or nation in which it is incorporated, shall be held to meet the requirements of this section for the investment of funds. A society organized under the laws of this state shall deposit securities as required of life insurance companies pursuant to section 511.8, subsection 16.
90 Acts, ch 1148, §22
Referred to in §512B.21A
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.21A - Required reserves.

512B.21A Required reserves.
A society incorporated on or after July 1, 1993, shall have in cash, or in securities which are authorized for investment purposes for insurance companies pursuant to section 512B.21, surplus in an amount not less than five million dollars.
93 Acts, ch 88, §14
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.22 - Funds.

512B.22 Funds.
1. All assets shall be held, invested, and disbursed for the use and benefit of the society and a member or beneficiary shall not have or acquire individual rights in the society’s assets or become entitled to an apportionment on the surrender of any part of the society’s assets, except as provided in the benefit contract.
2. A society may create, maintain, invest, disburse, and apply any special fund or funds necessary to carry out any purpose permitted by the laws of the society.
3. A society may, pursuant to resolution of its supreme governing body, establish and operate one or more separate accounts and issue contracts on a variable basis, subject to the law regulating life insurers establishing equivalent accounts and issuing equivalent contracts. To the extent the society deems it necessary in order to comply with any applicable federal or state laws, regulations, or rules, the society may adopt special procedures for the conduct of the business and affairs of a separate account; may, for persons having beneficial interests in the account, provide special voting and other rights, including without limitation, special rights and procedures relating to investment policy, investment advisory services, selection of certified public accountants, and selection of a committee to manage the business and affairs of the account; and may issue contracts on a variable basis to which section 512B.19, subsections 2 and 4 shall not apply.
90 Acts, ch 1148, §23
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.23 - Valuation.

512B.23 Valuation.
1. Standards of valuation for certificates issued before January 1, 1991, are those provided by chapter 512, Code 1989.
2. a. The minimum standards of valuation for certificates issued on or after January 1, 1991, shall be based on the following tables:
(1) For certificates of life insurance, the commissioner’s 1980 standard ordinary mortality table or any more recent table made applicable to life insurers.
(2) For annuity and pure endowment certificates, for total and permanent disability benefits, for accidental death benefits and for noncancelable accident and health benefits, the tables authorized for use by life insurers in this state.
b. Paragraph “a”, subparagraphs (1) and (2) are under valuation methods and standards, including interest assumptions, in accordance with the laws of this state applicable to life insurers issuing policies containing like benefits.
3. The commissioner may, in the commissioner’s discretion, accept another standard for valuation if the commissioner finds that the reserves produced by the other standard will not be less in the aggregate than reserves computed in accordance with the minimum valuation standards prescribed by subsection 2. The commissioner may, in the commissioner’s discretion, vary the standards of mortality applicable to all benefit contracts on substandard lives or other extra hazardous lives by any society authorized to do business in this state.
4. A society, with the consent of the commissioner of insurance of the state of domicile of the society and under conditions which the commissioner may impose, may establish and maintain reserves on its certificates in excess of the reserves otherwise required, but the contractual rights of a benefit member shall not be affected by the excess reserves.
90 Acts, ch 1148, §24; 2012 Acts, ch 1023, §114
Referred to in §512B.24
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.24 - Reports.

512B.24 Reports.
Reports shall be filed in accordance with this section.
1. A society transacting business in this state, on or before March 1 annually, unless for cause shown the time has been extended by the commissioner, shall file with the commissioner a true statement of its financial condition, transactions, and affairs for the preceding calendar year and shall pay a fee of fifty dollars. The statement may be in general form and content as approved by the national association of insurance commissioners for fraternal benefit societies and shall be supplemented by additional information as adopted by rule of the commissioner.
2. As part of the annual statement, a society shall, on or before March 1, file with the commissioner of insurance a valuation of its certificates in force on the last preceding December 31. However, the commissioner may, for cause shown, extend the time for filing the valuation for not more than two calendar months. The valuation shall be done in accordance with the standards specified in section 512B.23. The valuation and underlying data shall be certified by a qualified actuary or, at the expense of the society, verified by the actuary of the department of insurance of the state of domicile of the society.
3. A society failing to file the annual statement in the form and within the time provided by this section shall forfeit one hundred dollars for each day during which the default continues, and, upon notice by the commissioner to that effect, the society’s authority to do business in this state shall cease while the default continues.
90 Acts, ch 1148, §25; 92 Acts, ch 1162, §17
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.25 - Annual license — renewal.

512B.25 Annual license — renewal.
The authority of a society to transact business in this state may be renewed annually. A license terminates on the first day of June following issuance or renewal. A society shall submit annually on or before March 1 a completed application for renewal of its license. For each license or renewal the society shall pay the commissioner a fee of fifty dollars. A society that fails to timely file an application for renewal shall pay an administrative penalty of five hundred dollars to the treasurer of state for deposit as provided in section 505.7. A duly certified copy or duplicate of the license is prima facie evidence that the licensee is a fraternal benefit society within the meaning of this chapter.
90 Acts, ch 1148, §26; 92 Acts, ch 1162, §18; 2006 Acts, ch 1117, §55; 2007 Acts, ch 126, §90; 2009 Acts, ch 181, §71
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.26 - Examination of societies — no adverse publications.

512B.26 Examination of societies — no adverse publications.
1. The commissioner, or the commissioner’s designee, may examine a domestic, foreign, or alien society transacting or applying for admission to transact business in this state in the same manner as authorized for examination of a domestic, foreign, or alien insurer. Requirements of notice and an opportunity to respond before findings are made public as provided in the laws regulating insurers are also applicable to the examination of a society.
2. The expense of each examination and of each valuation, including compensation and actual expense of examiners, shall be paid by the society examined or whose certificates are valued, upon statements furnished by the commissioner.
90 Acts, ch 1148, §27
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.27 - Foreign or alien society — admission.

512B.27 Foreign or alien society — admission.
A foreign or alien society shall not transact business in this state without a license issued by the commissioner. A society desiring admission to this state shall substantially comply with the requirements and limitations of this chapter applicable to domestic societies. A society may be licensed to transact business in this state upon filing with the commissioner all of the following:
1. A duly certified copy of its articles of incorporation.
2. A copy of its bylaws, certified by its secretary or a corresponding officer.
3. A power of attorney to the commissioner of insurance as prescribed in section 512B.33.
4. A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the commissioner, duly verified by an examination made by the supervising insurance official of its state of domicile, satisfactory to the commissioner.
5. Certification from the proper official of its state of domicile that the society is legally incorporated and licensed to transact business in that state.
6. Copies of its certificate forms.
7. Other information the commissioner requires.
8. A showing that its assets are invested in accordance with this chapter.
90 Acts, ch 1148, §28
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.29 - Suspension, revocation, or refusal of license of foreign or alien society.

512B.29 Suspension, revocation, or refusal of license of foreign or alien society.
1. When the commissioner upon investigation finds that a foreign or alien society transacting or applying to transact business in this state has exceeded its powers; failed to comply with a provision of this chapter; failed to fulfill a contract in good faith; or conducted its business fraudulently or in a manner hazardous to its members or creditors or the public, the commissioner shall notify the society of the deficiency or deficiencies and state in writing the alleged facts or circumstances constituting a deficiency. The commissioner shall at once issue a written notice to the society requiring that the deficiency or deficiencies which exist be corrected on or before thirty days from entry of the notice of deficiency. After notice the society has a thirty-day period in which to comply with the commissioner’s request for correction, and if the society fails to comply the commissioner shall notify the society of a finding of noncompliance and require the society to show cause on or before a date named why its license should not be suspended, revoked, or refused. If, on or before the date named, the society does not present good and sufficient reason why its license to do business in this state should not be suspended, revoked, or refused, the commissioner may suspend or refuse the license of the society to do business in this state until evidence satisfactory to the commissioner is furnished to the commissioner that the suspension or refusal should be withdrawn or the commissioner may revoke the license of the society to do business in this state.
2. A society whose license to do business in this state is suspended, revoked, or refused pursuant to subsection 1 shall continue in good faith all contracts made in this state during the time the society was legally authorized to transact business in this state. Lack of authority to transact business within the state is not a defense to an action by a person against the society to enforce a contract entered into by the society without compliance with this chapter, or prior applicable law.
90 Acts, ch 1148, §30
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.32 - Unfair methods of competition and unfair and deceptive acts and practices.

512B.32 Unfair methods of competition and unfair and deceptive acts and practices.
A society is subject to chapter 507B relating to unfair insurance trade practices. However, chapter 507B does not apply to or affect the right of a society to determine its eligibility requirements for membership, and does not apply to or affect the offering of benefits exclusively to members or persons eligible for membership in the society by a subsidiary corporation or affiliated organization of a society.
90 Acts, ch 1148, §33
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.33 - Service of process.

512B.33 Service of process.
1. A society authorized to do business in this state shall file in the office of the commissioner a power of attorney and an agreement in writing that service of process in any action or proceeding against the society may be served on the commissioner and shall be of the same legal force and validity as if served upon the society, and that the authority shall continue in force so long as any liability remains outstanding in this state. A copy of the power of attorney, certified by the commissioner, shall be deemed sufficient evidence of the appointment and shall be admitted in evidence with the same force and effect as the original.
2. Service of process made on the commissioner as the agent for service of process shall be made as provided in section 505.30. A society shall not be required to file its answer, pleading, or defense in less than thirty days from the date the commissioner sends a copy of the service of process to the society by certified mail as provided in section 505.30. Legal process shall not be made upon a society except in the manner provided in this section.
90 Acts, ch 1148, §34; 2003 Acts, ch 91, §23; 2018 Acts, ch 1018, §6
Referred to in §512B.27
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.35 - False or fraudulent statements.

512B.35 False or fraudulent statements.
1. It shall be unlawful for a person knowingly to make a false or fraudulent statement or representation in or relating to an application for membership or for the purpose of obtaining money from or a benefit in a society.
2. It shall be unlawful for a person to willfully make a false or fraudulent statement in a verified report or declaration under oath required or authorized by this chapter, or of a material fact or thing contained in a sworn statement concerning the death or disability of an insured for the purpose of procuring payment of a benefit named in the certificate.
3. It shall be unlawful for a person to solicit membership for, or in any manner to assist in procuring membership in, a society not licensed to do business in this state.
90 Acts, ch 1148, §36; 2004 Acts, ch 1110, §34
2023 Iowa Code › Title XIII - COMMERCE › Chapter 512B - FRATERNAL BENEFIT SOCIETIES › Section 512B.36 - Exemption of certain societies.

512B.36 Exemption of certain societies.
1. This chapter does not affect or apply to any of the following:
a. Grand or subordinate lodges of societies, orders, or associations now doing business in this state which provide benefits exclusively through local or subordinate lodges.
b. Orders, societies, or associations which admit to membership only persons engaged in one or more crafts or hazardous occupations, in the same or similar lines of business, insuring only their own members and their families, and the spouses’ societies or spouses’ auxiliaries to such orders, societies, or associations.
c. Domestic societies which limit their membership to employees of a particular city or town, designated firm, business house, or corporation which provide for a death benefit of not more than four hundred dollars or disability benefits of not more than three hundred fifty dollars to any person in any one year, or both.
d. Domestic societies or associations of a purely religious, charitable, or benevolent description, which provide for a death benefit of not more than four hundred dollars or for disability benefits of not more than three hundred fifty dollars to any one person in any one year, or both.
2. A society or association described in subsection 1, paragraph “a” or “d”, which provides for death or disability benefits for which benefit certificates are issued, and any such society or association included in paragraph “d” which has more than one thousand members, is not exempt from this chapter but shall comply with all requirements of this chapter.
3. A society which is exempt from the requirements of this chapter, except a society described in subsection 1, paragraph “b”, shall not give or allow, or promise to give or allow to any person any compensation for procuring new members.
4. A society which provides for benefits in case of death or disability resulting solely from accident, and which does not obligate itself to pay natural death or sick benefits, has all of the privileges and is subject to all the applicable provisions of this chapter and rules adopted by the commission pursuant to this chapter except that the provisions relating to medical examination, valuations of benefit certificates, and incontestability, do not apply to such a society.
5. The commissioner may require from a society, by examination or otherwise, information that will enable the commissioner to determine whether the society is exempt from this chapter.
6. A society exempt under this section, is also exempt from all other provisions of the general insurance laws of this state.
90 Acts, ch 1148, §37
Referred to in §512B.3
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513 - EMPLOYEES MUTUAL INSURANCE › Section 513.1 - Exemption.

513.1 Exemption.
Unless specific reference is made thereto, no provision of this subtitle shall include or apply to domestic societies which limit their membership to the employees of:
1. A particular city or
2. A designated firm, business house, or corporation.
[C24, 27, 31, 35, 39, §8894; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §513.1]
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513 - EMPLOYEES MUTUAL INSURANCE › Section 513.2 - Power of commissioner.

513.2 Power of commissioner.
The commissioner of insurance may require from any society such information as will enable the commissioner to determine whether such society is exempt from the provisions of the laws relating to insurance or to fraternal benefit societies.
[C24, 27, 31, 35, 39, §8895; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §513.2]
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513A - THIRD-PARTY PAYORS OF HEALTH CARE BENEFITS › Section 513A.1 - Purpose.

513A.1 Purpose.
The purpose of this chapter is to give the commissioner jurisdiction over third-party payors of health care benefits, to indicate how a third-party payor of health care benefits may show the jurisdiction to which the third-party payor is subject, to allow for examinations by the commissioner if the third-party payor of health care benefits is unable to establish that a third-party payor is subject to another jurisdiction, to make a third-party payor of health care benefits subject to the laws of this state if the third-party payor cannot show that it is subject to another jurisdiction, and to disclose to purchasers of such health care benefits whether or not the plans are fully insured.
91 Acts, ch 213, §11
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513A - THIRD-PARTY PAYORS OF HEALTH CARE BENEFITS › Section 513A.2 - Authority and jurisdiction of commissioner.

513A.2 Authority and jurisdiction of commissioner.
Except as provided in this chapter, a third-party payor providing coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether the coverage is by direct payment, reimbursement, or otherwise, is presumed to be subject to the jurisdiction of the commissioner of insurance, unless the person shows that while providing such services the person is subject to the jurisdiction of another agency of the state or the federal government.
91 Acts, ch 213, §12
Referred to in §513A.6
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513A - THIRD-PARTY PAYORS OF HEALTH CARE BENEFITS › Section 513A.3 - How to show jurisdiction.

513A.3 How to show jurisdiction.
A third-party payor may establish that the third-party payor is subject to the jurisdiction of another agency of the state, any subdivision of the state, or the federal government, by providing to the insurance commissioner the appropriate certificate, license, or other document issued by the agency which permits or qualifies the third-party payor to provide those services.
91 Acts, ch 213, §13
Referred to in §513A.4
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513A - THIRD-PARTY PAYORS OF HEALTH CARE BENEFITS › Section 513A.4 - Examination.

513A.4 Examination.
A third-party payor unable to establish under section 513A.3 that the third-party payor is subject to the jurisdiction of another agency of the state, any subdivision of the state, or the federal government, shall submit to an examination by the insurance commissioner to determine the organization and solvency of the third-party payor or the entity, and to determine whether or not the third-party payor complies with the applicable provisions of state law.
91 Acts, ch 213, §14
Referred to in §513A.6
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513A - THIRD-PARTY PAYORS OF HEALTH CARE BENEFITS › Section 513A.5 - Subject to state laws.

513A.5 Subject to state laws.
A third-party payor unable to establish that the third-party payor is subject to the jurisdiction of another agency of the state, any subdivision of the state, or the federal government, is subject to all appropriate provisions of Title XIII, subtitle 1, regarding the conduct of the business of the third-party payor including, but not limited to, filing with and approval by the commissioner of the form of the health benefit policy, contract, or certificate.
91 Acts, ch 213, §15; 92 Acts, ch 1162, §19
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513A - THIRD-PARTY PAYORS OF HEALTH CARE BENEFITS › Section 513A.6 - Production agency or administrator — disclosure.

513A.6 Production agency or administrator — disclosure.
1. A production agency or administrator which advertises, sells, transacts, or administers the coverage in this state as defined in section 513A.2 and which is required to submit to an examination by the insurance commissioner under section 513A.4, shall, if the coverage is not fully insured or otherwise fully covered by an admitted life or disability insurer, nonprofit hospital service plan, or nonprofit health care plan, advise every purchaser, prospective purchaser, and covered person of the lack of insurance or other coverage.
2. An administrator which advertises or administers the coverage in this state as defined in section 513A.2 and which is required to submit to an examination by the insurance commissioner under section 513A.4, shall advise any production agency of the elements of the coverage, including the amount of stop-loss insurance in effect.
91 Acts, ch 213, §16; 2021 Acts, ch 76, §150
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513A - THIRD-PARTY PAYORS OF HEALTH CARE BENEFITS › Section 513A.7 - Unfair competition or unfair and deceptive acts or practices prohibited.

513A.7 Unfair competition or unfair and deceptive acts or practices prohibited.
A third-party payor of health care benefits is subject to chapter 507B relating to unfair insurance trade practices.
93 Acts, ch 88, §15
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.1 - Title — purpose.

513B.1 Title — purpose.
1. This subchapter shall be known and may be cited as the “Model Small Group Rating Law”.
2. The intent of this subchapter is to promote the availability of health insurance coverage to small employers, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules for continuity of coverage for employers and covered individuals, and to improve the efficiency and fairness of the small group health insurance marketplace.
91 Acts, ch 244, §1; 93 Acts, ch 80, §1
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.3 - Applicability and scope.

513B.3 Applicability and scope.
This subchapter applies to a health benefit plan providing coverage to the employees of a small employer in this state if any of the following apply:
1. Any portion of the premium or benefits is paid by or on behalf of the small employer.
2. An eligible employee or dependent is reimbursed in any manner by or on behalf of the small employer for any portion of the premium or benefits.
3. The health insurance coverage is treated by the employer or any of the eligible employees or dependents as part of a coverage or program for the purposes of section 106, 125, or 162 of the Internal Revenue Code as defined in section 422.3.
4. a. Except as provided in paragraph “b”, for purposes of this subchapter, carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier and any restrictions or limitations imposed by this subchapter shall apply as if all health insurance coverages delivered or issued for delivery to small employers in this state by such carriers were issued by one carrier.
b. An affiliated carrier which is a health maintenance organization possessing a certificate of authority issued pursuant to chapter 514B shall be considered to be a separate carrier for the purposes of this subchapter.
c. Unless otherwise authorized by the commissioner, a small employer carrier shall not enter into one or more ceding arrangements with respect to health insurance coverages delivered or issued for delivery to small employers in this state if the arrangements would result in less than fifty percent of the insurance obligation or risk for such health insurance coverages being retained by the ceding carrier.
91 Acts, ch 244, §3; 92 Acts, ch 1167, §2; 97 Acts, ch 103, §12, 13
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.4A - Exemption from premium rate restrictions.

513B.4A Exemption from premium rate restrictions.
A Taft-Hartley trust or a carrier with the written authorization of such a trust may make a written request to the commissioner for an exemption from the application of any provisions of section 513B.4 with respect to health insurance coverage provided to such a trust. The commissioner may grant an exemption if the commissioner finds that application of section 513B.4 with respect to the trust would have a substantial adverse effect on the participants and beneficiaries of such trust, and would require significant modifications to one or more collective bargaining arrangements under which the trust is established or maintained. An exemption granted under this section shall not apply to an individual if the individual participates in a trust as an associate member of an employee organization.
93 Acts, ch 80, §5; 97 Acts, ch 103, §18
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.4B - Small employer incentives — suspension or modification of premium rate restrictions.

513B.4B Small employer incentives — suspension or modification of premium rate restrictions.
1. In order to encourage voluntary participation in wellness or disease management programs, a small employer carrier may offer premium credits or discounts to a small employer for the benefit of eligible employees of that small employer who participate in such a program. An employee shall not be penalized in any way for not participating in such a program.
2. The commissioner shall adopt, by rule or order, provisions allowing suspension or modification of premium rate restrictions to enable a small employer carrier to provide premium credits or discounts to a small employer based on measurable reductions in costs of that small employer, including but not limited to tobacco use cessation, participation in established wellness or disease management programs, and economies of acquisition or administration.
2007 Acts, ch 57, §7, 8
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.6 - Disclosure of rating practices and renewability provisions.

513B.6 Disclosure of rating practices and renewability provisions.
A small employer carrier shall make reasonable disclosure in solicitation and sales materials provided to small employers of all of the following:
1. The extent to which premium rates for a specific small employer are established or adjusted due to the claim experience, health status, or duration of coverage of the employees or dependents of the small employer.
2. The provisions concerning the small employer carrier’s right to change premium rates and factors, including case characteristics, which affect changes in premium rates.
3. The provisions relating to any preexisting condition provision.
4. The provisions relating to renewability of coverage.
91 Acts, ch 244, §6; 92 Acts, ch 1167, §10; 97 Acts, ch 103, §20, 21; 2017 Acts, ch 148, §39, 40
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.7 - Maintenance of records.

513B.7 Maintenance of records.
1. A small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation which demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
2. A small employer carrier shall file each March 1 with the commissioner an actuarial certification that the small employer carrier is in compliance with this section and that the rating methods of the small employer carrier are actuarially sound. A copy of the certification shall be retained by the small employer carrier at its principal place of business.
3. A small employer carrier shall make the information and documentation described in subsection 1 available to the commissioner upon request. The information is not a public record or otherwise subject to disclosure under chapter 22, and is considered proprietary and trade secret information and is not subject to disclosure by the commissioner to persons outside of the division except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.
91 Acts, ch 244, §7; 97 Acts, ch 103, §22; 98 Acts, ch 1100, §68; 2017 Acts, ch 148, §41
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.9A - Eligibility to enroll.

513B.9A Eligibility to enroll.
1. A carrier offering group health insurance coverage shall not establish rules for eligibility, including continued eligibility, of an individual to enroll under the terms of the coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
a. Health status.
b. Medical condition, including both physical and mental conditions.
c. Claims experience.
d. Receipt of health care.
e. Medical history.
f. Genetic information.
g. Evidence of insurability, including conditions arising out of acts of domestic violence.
h. Disability.
2. Subsection 1 does not require group health insurance coverage to provide particular benefits other than those provided under the terms of the coverage, and does not prevent a coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the coverage.
3. Rules for eligibility to enroll under group health insurance coverage include rules defining any applicable waiting periods for such enrollment.
4. a. A carrier offering health insurance coverage shall not require an individual, as a condition of enrollment or continued enrollment under the coverage, to pay a premium or contribution which is greater than a premium or contribution for a similarly situated individual enrolled in the coverage on the basis of a health status-related factor in relation to the individual or to a dependent of an individual enrolled under the coverage.
b. Paragraph “a” shall not be construed to do either of the following:
(1) Restrict the amount that an employer may be charged for health insurance coverage.
(2) Prevent a carrier offering group health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
97 Acts, ch 103, §23; 2017 Acts, ch 148, §42 - 44
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.11 - Notice of intent to operate as a risk-assuming carrier or reinsuring carrier.

513B.11 Notice of intent to operate as a risk-assuming carrier or reinsuring carrier.
1. a. Upon the approval of a plan of operation by the commissioner under section 513B.13, subsection 4, a small employer carrier authorized to transact the business of insurance in this state shall notify the commissioner of the carrier’s intention to operate as a risk-assuming carrier or a reinsuring carrier. The notification shall be made as deemed appropriate by the commissioner. A small employer carrier seeking to operate as a risk-assuming carrier shall make an application pursuant to section 513B.12.
b. The notification of the commissioner concerning the carrier’s intention pursuant to paragraph “a” is binding for a five-year period from the date notification is given, except that the initial notification given by carriers after July 1, 1992, is binding for a two-year period. The commissioner may permit a carrier to modify the carrier’s decision at any time for good cause.
c. The commissioner shall establish an application process for small employer carriers seeking to change their status pursuant to this subsection. If a small employer carrier has been acquired by another such carrier, the commissioner may waive or modify the time periods established in paragraph “b”.
2. A reinsuring carrier that applies and is approved to operate as a risk-assuming carrier shall not be permitted to continue to reinsure any health insurance coverage with the program. The carrier shall pay a prorated assessment based upon business issued as a reinsuring carrier for any portion of the year that the business was reinsured.
92 Acts, ch 1167, §12; 93 Acts, ch 80, §10; 97 Acts, ch 103, §25
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.12 - Application to become a risk-assuming carrier.

513B.12 Application to become a risk-assuming carrier.
1. A small employer carrier may apply to become a risk-assuming carrier by filing an application with the commissioner in a form and manner prescribed by the commissioner.
2. In evaluating an application made pursuant to this section, the commissioner shall consider the following factors:
a. The carrier’s financial condition.
b. The carrier’s history of rating and underwriting small employer groups.
c. The carrier’s commitment to market fairly to all small employers in the state or the carrier’s established geographic service area, as applicable.
d. The carrier’s experience with managing the risk of small employer groups.
3. The commissioner shall provide public notice of an application by a small employer carrier to be a risk-assuming carrier and shall provide at least a sixty-day period for public comment prior to making a decision on the application. If the application is not acted upon within ninety days of the receipt of the application by the commissioner, the carrier may request a hearing.
4. The commissioner may rescind the approval granted to a risk-assuming carrier under this section if the commissioner finds any of the following:
a. The carrier’s financial condition will no longer support the assumption of risk from issuing coverage to small employers in compliance with section 513B.10 without the protection provided by the program.
b. The carrier has failed to market fairly to all small employers in the state or the carrier’s established geographic service area, as applicable.
c. The carrier has failed to provide coverage to eligible small employers as required under section 513B.10.
5. A small employer carrier electing to be a risk-assuming carrier shall not be subject to the provisions of section 513B.13.
6. During the period of time that the operation of the small employer carrier reinsurance program is suspended pursuant to section 513B.13, subsection 14, a small employer carrier is not required to make an application to become a risk-assuming carrier pursuant to this section.
92 Acts, ch 1167, §13; 2005 Acts, ch 70, §8
Referred to in §513B.11
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.15 - Periodic market evaluation.

513B.15 Periodic market evaluation.
The board shall study and report at least every three years to the commissioner on the effectiveness of this subchapter. The report shall analyze the effectiveness of the subchapter in promoting rate stability, product availability, and coverage affordability. The report may contain recommendations for actions to improve the overall effectiveness, efficiency, and fairness of the small group health insurance marketplace. The report shall address whether carriers and producers are fairly and actively marketing or issuing health insurance coverages to small employers in fulfillment of the purposes of this subchapter. The report may contain recommendations for market conduct or other regulatory standards or action.
92 Acts, ch 1167, §16; 97 Acts, ch 103, §33
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.17 - Discretion of the commissioner.

513B.17 Discretion of the commissioner.
1. The commissioner may suspend all or any part of section 513B.4 as to the premium rates applicable to one or more small employers for one or more rating periods upon a filing by the small employer carrier and a finding by the commissioner that the suspension is reasonable in light of the financial condition of the carrier or that the suspension would enhance the efficiency and fairness of the marketplace for small employer health insurance.
2. The commissioner may suspend or modify the normal workweek requirement of thirty or more hours under the definition of eligible employee upon a finding by the commissioner that the suspension would enhance the availability of health insurance to employees of small employers.
3. The commissioner may adopt, by rule or order, transition provisions to facilitate the implementation and administration of this chapter.
91 Acts, ch 244, §8
CS91, §513B.8
92 Acts, ch 1167, §18
C93, §513B.17
93 Acts, ch 80, §14; 97 Acts, ch 103, §34; 2005 Acts, ch 70, §10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513B - SMALL GROUP HEALTH COVERAGE › Section 513B.18 - Uniform application form.

513B.18 Uniform application form.
The commissioner shall develop, by rule, a uniform application form for use by small employers applying for new health insurance coverage under group health plans offered by small employer carriers. Small employer carriers shall be required to use the uniform application form not less than six months after the rules developing the form become effective under chapter 17A.
2007 Acts, ch 169, §1
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM › Section 513C.2 - Purpose.

513C.2 Purpose.
The purpose and intent of this chapter is to promote the availability of health insurance coverage to individuals regardless of their health status or claims experience, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules regarding the renewal of coverage, to establish limitations on the use of preexisting condition exclusions, to assure fair access to health plans, and to improve the overall fairness and efficiency of the individual health insurance market.
95 Acts, ch 5, §4
2023 Iowa Code › Title XIII - COMMERCE › Chapter 513C - INDIVIDUAL HEALTH INSURANCE MARKET REFORM › Section 513C.4 - Applicability and scope.

513C.4 Applicability and scope.
1. Except as provided in subsection 2, for purposes of this chapter, carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier and any restrictions or limitations imposed by this chapter shall apply as if all individual health benefit plans delivered or issued for delivery to residents of this state by such affiliated carriers were issued by one carrier.
2. An affiliated carrier that is a health maintenance organization having a certificate of authority under section 514B.5 shall be considered to be a separate carrier for the purposes of this chapter.
95 Acts, ch 5, §6; 96 Acts, ch 1034, §48