Iowa Administrative Code › Agency 191 - Insurance Division › Securities › Chapter 58 - Third-party Administrators › Rule 191-58.2 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
The terms defined in Iowa Code section
				  510.11 and rule
				  191-1.1 (502,505) shall have the
				  same meaning for the purposes of this chapter In addition, for purposes of this
				  chapter:
"Affiliate"
or
"affiliates"
means an entity or person who directly or indirectly through one or more
				  intermediaries, controls or is controlled by, or is under common control with,
				  a specified entity or person. For purposes of this definition, "control"
				  (including the terms "controls" or "controlled by") means the possession,
				  direct or indirect, of the power to direct or cause the direction of the
				  management and policies of a person, whether through the ownership of voting
				  securities, by contract other than a commercial contract for goods or
				  nonmanagement services, or otherwise, unless the power is the result of an
				  official position with or corporate office held by the person. Control shall be
				  presumed to exist if any person, directly or indirectly, owns, controls, holds
				  with the power to vote, or holds proxies representing, 10 percent or more of
				  the voting securities of any other person. This presumption may be rebutted by
				  a showing made in the manner provided by Iowa Code section
				  505.23 and Iowa Code
				  chapter 521A that control does not exist in fact. The commissioner may
				  determine, after furnishing notice and opportunity to be heard to all persons
				  in interest and after making specific findings of fact to support the
				  determination, that control exists in fact notwithstanding the absence of a
				  presumption to that effect.
"Home state"
means the United States state
				  or territory or the District of Columbia designated by a third-party
				  administrator as its principal regulator, which shall be either its place of
				  incorporation or its principal place of business within the United States. A
				  third-party administrator may designate as its home state any United States
				  jurisdiction in which it does business and which has adopted a law governing
				  third-party administrators substantially similar to Iowa Code chapter 510 and
				  this chapter
"Insurance producer"
means the same as
				  defined in Iowa Code section
				  522B.1.
"Insurer"
means a person engaged in the
				  business of insurance who is regulated under Iowa Code chapter 508, 512B, 514,
				  514B, 515, or 520.
"Nonresident third-party administrator"
means a person whose home state is not Iowa.
"Person"
means any individual, aggregation
				  of individuals, trust, association, partnership, or corporation or an affiliate
				  of any of these.
"Stop-loss"
or
"stop-loss
				  insurance"
means insurance protecting an employer or other person
				  responsible for an otherwise self-insured health or life benefit plan against
				  higher than expected obligations under the plan.
"Underwrites"
or
"underwriting"
or
"underwritten"
means, but
				  is not limited to, the acceptance of employer or individual applications for
				  coverage of individuals in accordance with the written rules of the insurer or
				  self-funded plan, or the overall planning and coordinating of a benefits
				  program.