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2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.1B - Definitions.

510.1B Definitions.
As used in this chapter, unless the context otherwise requires:
1. “Actuary” means a person who is a member in good standing of the American academy of actuaries.
2. “Commissioner” means the commissioner of insurance.
3. “Insurer” means a person duly licensed in this state as an insurance company pursuant to this subtitle.
4. a. “Managing general agent” means any person who engages in all of the following:
(1) Negotiates and binds ceding reinsurance contracts on behalf of an insurer or manages all or part of the insurance business of an insurer, including the management of a separate division, department, or underwriting office, and who acts as an agent for such insurer whether known as a managing general agent, manager, or other similar term or title.
(2) With or without authority and either separately or together with affiliates, directly or indirectly produces, and underwrites, an amount of gross direct written premium equal to or greater than five percent of the policyholder surplus in any one quarter or year as reported in the last annual statement of the insurer.
(3) Engages in either or both of the following:
(a) Adjusts or pays claims in excess of an amount determined by the commissioner.
(b) Negotiates reinsurance on behalf of the insurer.
b. Managing general agent does not include any of the following:
(1) An employee of the insurer.
(2) A manager of a United States branch of an alien insurer who resides in this country.
(3) An underwriting manager who, pursuant to contract, manages all insurance operations of the insurer, who is under common control with the insurer, subject to chapter 521A relating to the regulation of insurance holding company systems, and who is not compensated based upon the volume of premiums written.
(4) An insurance company, in connection with the acceptance or rejection of reinsurance on a block of business.
(5) The attorney-in-fact authorized by or acting for the subscribers of a reciprocal insurer or interinsurance exchange under power of attorney.
5. “Underwrite” means the authority to accept or reject risk on behalf of the insurer.
91 Acts, ch 26, §2
Referred to in §510.6, 510.10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.2 - Contracts with managing general agents.

510.2 Contracts with managing general agents.
1. A domestic insurer shall not enter into a contract with a managing general agent unless the domestic insurer notifies the commissioner in writing of its intention to enter into the contract at least thirty days prior to entering into the contract or within a shorter time permitted by the commissioner and the commissioner has not disapproved of the contracts within the time period. The commissioner shall not approve the contracts if the commissioner finds any of the following:
a. The service or management charges in the contract are based upon criteria unrelated either to the insurer’s profits or to the reasonable, customary, and usual charges for such services to the company.
b. Management personnel or other employees of the insurance company are to be performing management functions and receiving any remuneration for those management functions through the contract in addition to the compensation received directly from the insurance company for their services.
c. The contract would transfer substantial control of the insurer or any of the powers vested in the board of directors, by statute, articles of incorporation, or bylaws, or substantially all of the basic functions of the insurer’s management to the managing general agent.
d. The contract contains provisions which would be clearly detrimental to the best interest of policyholders, stockholders, or members of the company.
e. The officers and directors of the managing general agent firm are of known bad character or have been affiliated, directly or indirectly, through ownership, control, management, reinsurance transactions, or other insurance or business relations with any person known to have been involved in the improper manipulation of assets, accounts, or reinsurance.
2. If the commissioner disapproves of a contract, notice of the disapproval shall be given to the insurer, specifying the reasons in writing. The commissioner shall grant any party to the contract a hearing on the disapproval upon request pursuant to chapter 17A.
89 Acts, ch 227, §2; 2012 Acts, ch 1023, §157
Referred to in §510.10
Contracts; see also §510.5
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.3 - Liability of managing general agents.

510.3 Liability of managing general agents.
Notwithstanding any obligation of a director or officer of an insolvent insurer to the liquidator of the insolvent insurer, a managing general agent of a domestic insurer against whom an order of liquidation has been entered is liable for fees paid to the managing general agent prior to the entry of the order of liquidation upon a finding that the rendering of services, or failure to render services contracted for, substantially caused or contributed to the insolvency of the domestic insurer, and was pursuant to a contract which had not been submitted to the commissioner, or which had been submitted to the commissioner and disapproved, or the services did not meet accepted standards for such services.
89 Acts, ch 227, §3
Referred to in §510.10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.4 - Licensure required — bond.

510.4 Licensure required — bond.
1. A person shall not act in the capacity of a managing general agent with respect to risks located in this state for an insurer licensed in this state unless the person is a licensed producer in this state.
2. A person shall not act in the capacity of a managing general agent representing an insurer domiciled in this state with respect to risks located outside this state unless the person is licensed as a resident or nonresident producer in this state pursuant to the provisions of this chapter.
3. The commissioner may require a bond for each company represented by a managing general agent in an amount acceptable to the commissioner for the protection of the insurer.
4. The commissioner may require a managing general agent to maintain an errors and omissions policy.
91 Acts, ch 26, §3
Referred to in §510.10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.5A - Unfair competition or unfair and deceptive acts or practices prohibited.

510.5A Unfair competition or unfair and deceptive acts or practices prohibited.
A managing general agent is subject to chapter 507B relating to unfair insurance trade practices.
93 Acts, ch 88, §11
Referred to in §510.10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.6 - Duties of insurers.

510.6 Duties of insurers.
1. An insurer shall have on file an independent financial examination, in a form acceptable to the commissioner, of each managing general agent with which the insurer does or has done business.
2. If a managing general agent establishes loss reserves, the insurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by a managing general agent. This is in addition to any other required loss reserve certification.
3. An insurer shall periodically, but at least semiannually, conduct an on-site review of the underwriting and claims processing operations of each managing general agent with which the insurer is currently doing business.
4. Binding authority for all reinsurance contracts or participation in insurance or reinsurance syndicates shall rest with an officer of the insurer, who is not affiliated with the managing general agent.
5. Within thirty days of entering into or termination of a contract with a managing general agent, the insurer shall provide written notification of the appointment or termination to the commissioner. A notice of appointment of a managing general agent must include a statement of duties which the applicant is expected to perform on behalf of the insurer, the lines of insurance for which the applicant is to be authorized to act, and any other information the commissioner may request.
6. An insurer shall review its books and records each quarter and determine if any insurance producer, as defined by section 510A.2, has become, by operation of section 510.1B, subsection 4, a managing general agent as defined in that section. If the insurer determines that an insurance producer has become a managing general agent by operation of section 510.1B, subsection 4, the insurer shall promptly notify the insurance producer and the commissioner of such determination and the insurer and insurance producer shall fully comply with the provisions of this chapter within thirty days.
7. An insurer shall not appoint to its board of directors an officer, director, employee, insurance producer, or controlling shareholder of a managing general agent of the insurer. This subsection shall not apply to relationships governed by chapter 521A relating to the regulation of insurance company holding systems, or, if applicable, by chapter 510A relating to the regulation of insurance producer controlled property and casualty insurers.
91 Acts, ch 26, §5; 91 Acts, ch 258, §56; 2004 Acts, ch 1101, §71
Referred to in §510.5, 510.10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.7 - Examination authority.

510.7 Examination authority.
The acts of a managing general agent are considered to be the acts of the insurer on whose behalf a managing general agent is acting. A managing general agent may be examined as if it were the insurer.
91 Acts, ch 26, §6
Referred to in §510.10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.8 - Penalties and liabilities.

510.8 Penalties and liabilities.
1. If the commissioner finds, after a hearing conducted in accordance with chapter 17A, that any person has violated one or more provisions of this chapter, the commissioner may do one or more of the following:
a. For each separate violation, order the imposition of an administrative penalty of not more than ten thousand dollars.
b. Order the revocation or suspension of the producer’s license.
c. Bring a civil suit seeking reimbursement by the managing general agent of the insurer, the rehabilitator, or the liquidator of the insurer for any losses incurred by the insurer caused by a violation of this chapter committed by the managing general agent.
2. The decision, determination, or order of the commissioner pursuant to subsection 1 is subject to judicial review pursuant to chapter 17A.
3. This section does not affect the right of the commissioner to impose any other penalties provided for under this subtitle.
4. This chapter is not intended to and shall not in any manner limit or restrict the rights of policyholders, claimants, and auditors.
91 Acts, ch 26, §7; 91 Acts, ch 213, §8
Referred to in §510.10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.10 - Exemption.

510.10 Exemption.
A managing general agent who complies with sections 510.1A through 510.9 for a block of business, shall not also be required to comply with sections 510.20 and 510.21 with regard to the same block of business.
91 Acts, ch 26, §9; 91 Acts, ch 258, §57
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.11 - Definitions.

510.11 Definitions.
1. “Life or health insurance” includes but is not limited to the following:
a. Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. An individual or group Medicare supplemental policy.
e. A long-term care policy.
f. An individual or group life insurance policy or annuity issued pursuant to chapter 508, 508A, or 509A.
2. “Third-party administrator” means a person who collects charges or premiums from, or who adjusts or settles claims on, residents of this state in connection with life or health insurance coverage or annuities other than any of the following:
a. A union or association on behalf of its members.
b. An insurance company which is either licensed in this state or acting as an insurer with respect to a policy lawfully issued and delivered by it in and pursuant to the laws of a state in which the insurer was authorized to do insurance business.
c. An entity licensed under chapter 514, including its sales representatives licensed in this state when engaged in the performance of their duties as sales representatives.
d. A life or health agent or broker licensed in this state, whose activities are limited exclusively to the sale of insurance.
e. A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors.
f. A trust, its trustees, agents, and employees acting under the trust, established in conformity with 29 U.S.C. §186.
g. A trust exempt from taxation under section 501(a) of the Internal Revenue Code, its trustees, and employees acting under the trust.
h. A custodian, its agents, and employees acting pursuant to a custodial account which meets the requirements of section 401(f) of the Internal Revenue Code.
i. A bank, credit union, or other financial institution which is subject to supervision or examination by federal or state banking authorities.
j. A credit card-issuing company which advances for and collects premiums or charges from its credit card holders who have authorized it to do so, if the company does not adjust or settle claims.
k. A person who adjusts or settles claims in the normal course of the person’s practice or employment as an attorney, and who does not collect charges or premiums in connection with life or health insurance coverage or annuities.
89 Acts, ch 227, §4; 2006 Acts, ch 1117, §38
Referred to in §509A.15, 510.12, 729.6
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.12 - Written agreement necessary.

510.12 Written agreement necessary.
1. A person shall not act as a third-party administrator without a written agreement between the third-party administrator and the insurer, and the written agreement shall be retained as part of the official records of both the insurer and the third-party administrator for the duration of the agreement plus five years. The written agreement shall contain provisions which include the requirements of sections 510.11 through 510.16, except insofar as those requirements do not apply to the functions performed by the third-party administrator.
2. When a policy is issued to a trustee, a copy of the trust agreement and any amendments to the trust agreement shall be furnished to the insurer by the third-party administrator and shall be retained as part of the official records of both the insurer and the third-party administrator for the duration of the policy plus five years.
89 Acts, ch 227, §5; 2006 Acts, ch 1117, §39; 2021 Acts, ch 76, §150
Referred to in §510.13, 510.14
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.13 - Payment to third-party administrator.

510.13 Payment to third-party administrator.
If an insurer uses the services of a third-party administrator under the terms of a written contract as required in section 510.12, payment to the third-party administrator of any premiums or charges for insurance by or on behalf of the insured shall be deemed to have been received by the insurer, and the payment of return premiums or claims by the insurer to the third-party administrator shall not be deemed payment to the insured or claimant until the payments are received by the insured or claimant. This section does not limit any right of the insurer against the third-party administrator resulting from the third-party administrator’s failure to make payments to the insurer, insureds, or claimants.
89 Acts, ch 227, §6; 2006 Acts, ch 1117, §40
Referred to in §510.12
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.14 - Maintenance of information.

510.14 Maintenance of information.
A third-party administrator shall maintain at its principal administrative office for the duration of the written agreement referred to in section 510.12 plus five years, adequate books and records of all transactions between it, insurers, and insured persons. The third-party administrator’s books and records shall be maintained in accordance with prudent standards of insurance recordkeeping. The commissioner shall have access to such books and records for the purpose of examination, audit, and inspection. Trade secrets contained in a third-party administrator’s books and records, including but not limited to the identity and addresses of policyholders and certificate holders, shall be confidential, except the commissioner may use trade secret information in any proceeding instituted against the third-party administrator. The insurer retains the right to continuing access to the third-party administrator’s books and records sufficient to permit the insurer to fulfill all of its contractual obligations to insured persons, subject to any restrictions in the written agreement between the insurer and third-party administrator on the proprietary rights of the parties in the third-party administrator’s books and records.
89 Acts, ch 227, §7; 2006 Acts, ch 1117, §41
Referred to in §510.12
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.15 - Approval of advertising.

510.15 Approval of advertising.
A third-party administrator may use only such advertising pertaining to the business underwritten by an insurer as has been approved by the insurer in advance of its use.
89 Acts, ch 227, §8; 2006 Acts, ch 1117, §42
Referred to in §510.12
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.17 - Premium collection.

510.17 Premium collection.
1. All insurance charges or premiums collected by a third-party administrator on behalf of or for an insurer, and return premiums received from the insurer, shall be held by the third-party administrator in a fiduciary capacity. Such funds shall be immediately remitted to the person or persons entitled to them, or shall be deposited promptly in a fiduciary bank account established and maintained by the third-party administrator. If charges or premiums so deposited have been collected on behalf of or for more than one insurer, the third-party administrator shall cause the bank in which the fiduciary account is maintained to keep records clearly recording the deposits in and withdrawals from the account on behalf of or for each insurer. The third-party administrator shall promptly obtain and keep copies of all such records and, upon request of an insurer, shall furnish the insurer with copies of the records pertaining to deposits and withdrawals on behalf of or for that insurer.
2. The third-party administrator shall not pay a claim by withdrawal from the fiduciary account. Withdrawals from the fiduciary account shall be made, as provided in the written agreement between the third-party administrator and the insurer, for any of the following:
a. Remittance to an insurer entitled thereto.
b. Deposit in an account maintained in the name of the insurer.
c. Transfer to and deposit in a claims-paying account, with claims to be paid as provided in section 510.18.
d. Payment to a group policyholder for remittance to the insurer entitled thereto.
e. Payment to the third-party administrator of its commission, fees, or charges.
f. Remittance of return premiums to the persons entitled thereto.
89 Acts, ch 227, §10; 2006 Acts, ch 1117, §43
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.18 - Payment of claims.

510.18 Payment of claims.
A claim paid by the third-party administrator from funds collected on behalf of the insurer shall be paid only on a draft, check, or by electronic funds transfer as authorized by the insurer.
89 Acts, ch 227, §11; 96 Acts, ch 1122, §1; 2006 Acts, ch 1117, §44
Referred to in §510.17
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.19 - Claim adjustment and settlement.

510.19 Claim adjustment and settlement.
The compensation paid to a third-party administrator shall not be contingent on claim experience on policies for which the third-party administrator adjusts or settles claims. This section does not prevent the compensation of a third-party administrator from being based on premiums or charges collected or number of claims paid or processed.
89 Acts, ch 227, §12; 2006 Acts, ch 1117, §45
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.20 - Notification required.

510.20 Notification required.
When the services of a third-party administrator are used, the third-party administrator shall provide a written notice, approved by the insurer, to insured individuals, advising them of the identity of and relationship among the third-party administrator, the policyholder, and the insurer. When a third-party administrator collects funds, it shall identify and state separately in writing to the person paying to the third-party administrator any charge or premium for insurance coverage the amount of any such charge or premium specified by the insurer for such insurance coverage.
89 Acts, ch 227, §13; 2006 Acts, ch 1117, §46
Referred to in §510.10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.21 - Certificates — registration and renewal.

510.21 Certificates — registration and renewal.
1. A person shall not act as or represent oneself to be a third-party administrator in this state, other than an adjuster licensed in this state for the kinds of business for which the person is acting as a third-party administrator, unless the person holds a current certificate of registration as a third-party administrator issued by the commissioner of insurance. A certificate of registration as a third-party administrator shall be renewed every three years. Failure to hold a current certificate of registration shall subject a third-party administrator to the sanctions set out in section 507B.7. An application for a certificate of registration shall be accompanied by a filing fee of one hundred dollars. A certificate of registration shall be issued by the commissioner to a third-party administrator unless the commissioner determines that the third-party administrator is not competent, trustworthy, financially responsible, of good personal and business reputation, or has had an application for an insurance license denied for cause within the preceding five years.
2. If the commissioner denies an application for registration or renewal, a written notice that specifies the reasons for the denial or nonrenewal shall be provided to the applicant. Pursuant to chapter 17A, upon the applicant’s request, the commissioner shall grant the applicant a hearing on the denial or nonrenewal.
89 Acts, ch 227, §14; 2006 Acts, ch 1117, §47; 2007 Acts, ch 152, §56; 2008 Acts, ch 1074, §2; 2021 Acts, ch 76, §150; 2021 Acts, ch 181, §9
Referred to in §509A.15, 510.10, 510.22, 513D.1
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.22 - Waiving of requirements.

510.22 Waiving of requirements.
The commissioner may waive the requirements of section 510.21 for any person or class of persons. The factors taken into account in granting a waiver shall include, but are not limited to whether:
1. The person acting as a third-party administrator is primarily in a business other than that of a third-party administrator.
2. The financial strength and history of the organization indicates stability in its continuity of doing business.
3. The regular duties being performed as a third-party administrator are such that the covered persons are not likely to be injured by a waiver of such requirements.
89 Acts, ch 227, §15; 2006 Acts, ch 1117, §48
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510 - MANAGING GENERAL AGENTS AND THIRD-PARTY ADMINISTRATORS › Section 510.23 - Violations and penalties.

510.23 Violations and penalties.
1. If, after hearing, the commissioner determines that a third-party administrator has violated this chapter, or chapter 507B, the commissioner may order any one or more of the sanctions or penalties set out in section 507B.7.
2. If, after hearing, the commissioner determines that a person has aided and abetted a third-party administrator in commission of a violation of this chapter, or chapter 507B, the commissioner may order any one or more of the sanctions or penalties set out in section 507B.7.
3. If, after hearing, the commissioner determines that a third-party administrator is not competent, trustworthy, financially responsible, or of good personal and business reputation, the commissioner may order any one or more of the sanctions and penalties set out in section 507B.7.
93 Acts, ch 88, §12; 2006 Acts, ch 1117, §49; 2021 Acts, ch 181, §10
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510A - BUSINESS PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURERS › Section 510A.1 - Short title.

510A.1 Short title.
This chapter shall be known and may be cited as the “Business Producer Controlled Property and Casualty Insurer Act.”
91 Acts, ch 26, §10; 92 Acts, ch 1117, §35
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510A - BUSINESS PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURERS › Section 510A.2 - Definitions.

510A.2 Definitions.
As used in this chapter unless the context otherwise requires:
1. “Accredited state” means a state in which the insurance department or regulatory agency has qualified as meeting the minimum financial regulatory standards promulgated and established by the national association of insurance commissioners.
2. “Control” or “controlled” has the meaning ascribed in section 521A.1, subsection 3.
3. “Controlled insurer” means a licensed insurer that is controlled, directly or indirectly, by an insurance producer.
4. “Controlling producer” means an insurance producer who, directly or indirectly, controls an insurer.
5. “Independent casualty actuary” means a casualty actuary who is a member of the American academy of actuaries and who is not an employee, principal, the direct or indirect owner of, affiliated with, or in any way controlled by the insurer or insurance producer.
6. “Insurance producer” means a person required to be licensed under the laws of this state to sell, solicit, or negotiate insurance.
7. “Licensed insurer” or “insurer” means any person duly licensed to transact a property and casualty insurance business in this state. The following are not licensed property and casualty insurers for the purposes of this chapter:
a. All risk retention groups as defined in the Superfund Amendments Reauthorization Act of 1986, Pub. L. No. 99-499, 100 Stat. 1613 (1986) and the Risk Retention Act, 15 U.S.C. §3901 et seq. (1982 & Supp. 1986), or chapter 515E.
b. All residual market pools and joint underwriting authorities or associations.
c. All captive insurers. For the purposes of this chapter, captive insurers are insurance companies owned by another organization whose exclusive purpose is to insure risks of the parent organization and affiliated companies or, in the case of groups and associations, insurance organizations owned by the insureds whose exclusive purpose is to insure risks of any group and association members and any affiliates.
91 Acts, ch 26, §11; 92 Acts, ch 1117, §36; 2003 Acts, ch 91, §13 – 15
Referred to in §510.6, 510A.3
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510A - BUSINESS PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURERS › Section 510A.3 - Applicability.

510A.3 Applicability.
This chapter applies to licensed insurers as defined in section 510A.2, either domiciled in this state or domiciled in a state that is not an accredited state and having a substantially similar law. All provisions of the insurance holding company Act, to the extent those provisions are not superseded by this chapter, continue to apply to all persons associated with holding companies subject to this chapter.
91 Acts, ch 26, §12; 92 Acts, ch 1117, §37
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510A - BUSINESS PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURERS › Section 510A.5 - Disclosure.

510A.5 Disclosure.
The insurance producer, prior to the effective date of the policy, shall deliver written notice to the prospective insured disclosing the relationship between the insurance producer and the controlled insurer; except that, if the business is placed through a subproducer who is not a controlling producer, the controlling producer shall retain in the producer’s records a signed commitment from the subproducer that the subproducer is aware of the relationship between the insurer and the insurance producer and that the subproducer has notified or will notify the insured.
92 Acts, ch 1117, §39; 2003 Acts, ch 91, §19
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510A - BUSINESS PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURERS › Section 510A.6 - Penalties.

510A.6 Penalties.
1. If the commissioner believes that a controlling producer or any other person subject to this chapter has not materially complied with this chapter, or any rule adopted or order issued pursuant to this chapter, after notice and opportunity to be heard, the commissioner may order the controlling producer to cease placing business with the controlled insurer. Additionally, if the commissioner finds that because of such noncompliance the controlled insurer or any policyholder of the controlled insurer has suffered any loss or damage, the commissioner may maintain a civil action or intervene in an action brought by or on behalf of the insurer or policyholder for recovery of compensatory damages for the benefit of the insurer or policyholder, or for other appropriate relief.
2. If an order for liquidation or rehabilitation of the controlled insurer has been entered pursuant to chapter 507C, and the receiver appointed under that order believes that the controlling producer or any other person has not materially complied with this chapter, or any rule adopted or order issued pursuant to this chapter, and that the insurer suffered any loss or damage as a result of the noncompliance, the receiver may maintain a civil action for recovery of damages or other appropriate sanctions for the benefit of the insurer.
3. This section shall not be construed to affect or limit the right of the commissioner to impose any other penalties, as appropriate, which the commissioner is authorized to impose.
4. This section shall not be construed to affect or limit the rights of policyholders, claimants, creditors, or other third parties.
93 Acts, ch 88, §13
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.2 - Certification as a third-party administrator required.

510B.2 Certification as a third-party administrator required.
A pharmacy benefits manager doing business in this state shall obtain a certificate as a third-party administrator under chapter 510, and the provisions relating to a third-party administrator pursuant to chapter 510 shall apply to a pharmacy benefits manager.
2007 Acts, ch 193, §2, 9
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.3 - Enforcement — rules.

510B.3 Enforcement — rules. Repealed by 2022 Acts, ch 1113, §15, 16, 23. See §510B.10 and 510B.11.
2022 repeal applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.4 - Standards of conduct — good faith — conflict of interest.

510B.4 Standards of conduct — good faith — conflict of interest.
1. A pharmacy benefits manager shall exercise good faith and fair dealing in the performance of the pharmacy benefits manager’s contractual obligations toward a third-party payor.
2. A pharmacy benefits manager shall notify a health carrier in writing of any activity, policy, practice ownership interest, or affiliation of the pharmacy benefits manager that presents any conflict of interest.
3. A pharmacy benefits manager shall act in the best interest of each third-party payor for whom the pharmacy benefits manager manages a prescription drug benefit provided by the third-party payor, and shall discharge its duties in accordance with applicable state and federal law.
2007 Acts, ch 193, §4, 9; 2022 Acts, ch 1113, §3, 16, 23
2022 amendment applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
Section amended
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.5 - Contacting covered persons — requirements.

510B.5 Contacting covered persons — requirements.
A pharmacy benefits manager, unless authorized pursuant to the terms of its contract with a health carrier, shall not contact any covered person without the express written permission of the health carrier.
2007 Acts, ch 193, §5, 9; 2022 Acts, ch 1113, §4, 16, 23
2022 amendment applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
Section amended
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.6 - Substitute prescription drugs.

510B.6 Substitute prescription drugs.
1. The following provisions shall apply if a pharmacy benefits manager requests the dispensing of a substitute prescription drug for a drug prescribed for a covered person:
a. The pharmacy benefits manager may request the substitution of a lower priced generic and therapeutically equivalent prescription drug for a higher priced prescription drug.
b. If the substitute prescription drug’s net cost to the covered person or to the health carrier exceeds the cost of the prescription drug originally prescribed for the covered person, the substitution shall be made only for medical reasons that benefit the covered person.
2. A pharmacy benefits manager shall obtain the approval of the prescribing health care professional prior to requesting any substitution under this section.
3. A pharmacy benefits manager shall not substitute an equivalent prescription drug contrary to a prescription drug order that prohibits a substitution.
2007 Acts, ch 193, §6, 9; 2022 Acts, ch 1113, §5, 16, 23
2022 amendment applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
Section amended
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.7 - Pharmacy networks.

510B.7 Pharmacy networks.
A pharmacy benefits manager shall not assess, charge, or collect any form of remuneration that passes from a pharmacy or a pharmacist in a pharmacy network to the pharmacy benefits manager including but not limited to claim processing fees, performance-based fees, network participation fees, or accreditation fees.
2007 Acts, ch 193, §7, 9; 2022 Acts, ch 1113, §6, 16, 23
2022 amendment applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
Section stricken and rewritten
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.8 - Prescription drugs — point of sale.

510B.8 Prescription drugs — point of sale.
1. A covered person shall not be required to make a cost-sharing payment at the point of sale for a prescription drug in an amount that exceeds the total amount that the pharmacy at which the covered person fills the covered person’s prescription drug order is reimbursed.
2. A pharmacy benefits manager shall not prohibit a pharmacy from disclosing the availability of a lower-cost prescription drug option to a covered person, or from selling a lower-cost prescription drug option to a covered person.
2014 Acts, ch 1016, §2; 2022 Acts, ch 1113, §7, 16, 23
2022 amendment applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
Section stricken and rewritten
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.8A - Maximum allowable cost lists.

510B.8A Maximum allowable cost lists.
1. Prior to placement of a particular prescription drug on a maximum allowable cost list, a pharmacy benefits manager shall ensure that all of the following requirements are met:
a. The particular prescription drug must be listed as therapeutically and pharmaceutically equivalent in the most recent edition of the publication entitled “Approved Drug Products with Therapeutic Equivalence Evaluations”, published by the United States food and drug administration, otherwise known as the orange book.
b. The particular prescription drug must not be obsolete or temporarily unavailable.
c. The particular prescription drug must be available for purchase, without limitations, by all pharmacies in the state from a national or regional wholesale distributor that is licensed in the state.
2. For each maximum allowable cost list that a pharmacy benefits manager uses in the state, the pharmacy benefits manager shall do all of the following:
a. Provide each pharmacy in a pharmacy network reasonable access to the maximum allowable cost list to which the pharmacy is subject.
b. Update the maximum allowable cost list within seven calendar days from the date of an increase of ten percent or more in the pharmacy acquisition cost of a prescription drug on the list by one or more wholesale distributors doing business in the state.
c. Update the maximum allowable cost list within seven calendar days from the date of a change in the methodology, or a change in the value of a variable applied in the methodology, on which the maximum allowable cost list is based.
d. Provide a reasonable process for each pharmacy in a pharmacy network to receive prompt notice of all changes to the maximum allowable cost list to which the pharmacy is subject.
2022 Acts, ch 1113, §8, 16, 23
Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
NEW section
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.8B - Pharmacy benefits manager affiliates — reimbursement.

510B.8B Pharmacy benefits manager affiliates — reimbursement.
A pharmacy benefits manager shall not reimburse any pharmacy located in the state in an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for dispensing the same prescription drug as dispensed by the pharmacy. The reimbursement amount shall be calculated on a per unit basis based on the same generic product identifier or generic code number.
2022 Acts, ch 1113, §9, 16, 23
Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
NEW section
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.8C - Clean claims.

510B.8C Clean claims.
After the date of receipt of a clean claim submitted by a pharmacy in a pharmacy network, a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly except in the following circumstances:
1. The claim is found not to be a clean claim during the course of a routine audit.
2. The claim submission was fraudulent.
3. The claim submission was a duplicate submission of a claim for which the pharmacy had already received payment.
2022 Acts, ch 1113, §10, 16, 23
Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
NEW section
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.9 - Prior authorization.

510B.9 Prior authorization.
A pharmacy benefits manager shall comply with all applicable prior authorization requirements pursuant to section 505.26.
2014 Acts, ch 1140, §100, 101; 2022 Acts, ch 1113, §11, 16, 23
2022 amendment applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
Section amended
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.10 - Enforcement.

510B.10 Enforcement.
1. The commissioner may take any enforcement action under the commissioner’s authority to enforce compliance with this chapter.
2. After notice and hearing, the commissioner may issue any order or impose any penalty pursuant to section 507B.7, and may suspend or revoke a pharmacy benefits manager’s certificate of registration as a third-party administrator upon a finding that the pharmacy benefits manager violated this chapter, or any applicable requirements pertaining to third-party administrators under chapter 510.
3. A pharmacy benefits manager shall be subject to the commissioner’s authority to conduct an examination pursuant to chapter 507.
4. A pharmacy benefits manager is subject to the commissioner’s authority to conduct a proceeding pursuant to chapter 507B. The procedures set forth in chapter 507B regarding proceedings shall apply to a proceeding related to a pharmacy benefits manager under this chapter.
5. A pharmacy benefits manager is subject to the commissioner’s authority to conduct an examination, audit, or inspection pursuant to chapter 510 for third-party administrators. The procedures set forth in chapter 510 for third-party administrators shall apply to an examination, audit, or inspection of a pharmacy benefits manager under this chapter.
6. If the commissioner conducts an examination of a pharmacy benefits manager under chapter 507; a proceeding under chapter 507B; or an examination, audit, or inspection under chapter 510, all information received from the pharmacy benefits manager, and all notes, work papers, or other documents related to the examination, proceeding, audit, or inspection shall be confidential records pursuant to chapter 22 and shall be accorded the same confidentiality as notes, work papers, investigatory materials, or other documents related to the examination of an insurer as provided in section 507.14.
7. A violation of this chapter shall be an unfair or deceptive act or practice in the business of insurance pursuant to section 507B.4, subsection 3.
2022 Acts, ch 1113, §12, 16, 23
Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
Former section 510B.10 stricken by
2022 Acts, ch 1113, §12
; see §510B.8(2)
NEW section
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.11 - Rules.

510B.11 Rules.
The commissioner may adopt rules pursuant to chapter 17A to administer this chapter.
2022 Acts, ch 1113, §13, 16, 23
Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
NEW section
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS › Section 510B.12 - Severability.

510B.12 Severability.
If a provision of this chapter or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are severable.
2022 Acts, ch 1113, §14, 16, 23
Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
NEW section
2023 Iowa Code › Title XIII - COMMERCE › Chapter 510C - PHARMACY BENEFITS MANAGER REPORTING › Section 510C.1 - Definitions.

510C.1 Definitions.
As used in this chapter unless the context otherwise requires:
1. “Administrative fees” means a fee or payment, other than a rebate, under a contract between a pharmacy benefits manager and a pharmaceutical drug manufacturer in connection with the pharmacy benefits manager’s management of a third-party payor’s prescription drug benefit, that is paid by a pharmaceutical drug manufacturer to a pharmacy benefits manager or is retained by the pharmacy benefits manager.
2. “Aggregate retained rebate percentage” means the percentage of all rebates received by a pharmacy benefits manager that is not passed on to the pharmacy benefits manager’s third-party payor clients.
3. “Commissioner” means the commissioner of insurance.
4. “Covered person” means the same as defined in section 510B.1.
5. “Formulary” means a complete list of prescription drugs eligible for coverage under a health benefit plan.
6. “Health benefit plan” means the same as defined in section 510B.1.
7. “Health carrier” means the same as defined in section 510B.1.
8. “Pharmacy benefits manager” means the same as defined in section 510B.1.
9. “Prescription drug benefit” means the same as defined in section 510B.1.
10. “Rebate” means the same as defined in section 510B.1.
11. “Third-party payor” means the same as defined in section 510B.1.
12. “Third-party payor administrative service fee” means a fee or payment under a contract between a pharmacy benefits manager and a third-party payor in connection with the pharmacy benefits manager’s administration of the third-party payor’s prescription drug benefit that is paid by a third-party payor to a pharmacy benefits manager or is otherwise retained by a pharmacy benefits manager.
2019 Acts, ch 88, §1; 2020 Acts, ch 1063, §279 – 281; 2022 Acts, ch 1113, §17, 23
Section amended