Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 75 - Iowa Individual Health Benefit Plans › Rule 191-75.5 - Transition for Assumptions of Business From Another Carrier

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Transfer or assumption of insurance
				obligation.
a. A carrier shall not transfer or
				assume the entire insurance obligation or risk of a health benefit plan
				covering a block of business in this state unless the transaction has been
				approved by the commissioner of the state of domicile of the ceding
				carrier.
b. A carrier domiciled in
				this state that proposes to assume or cede the entire insurance obligation or
				risk or one or more blocks of business from another carrier shall make a filing
				for approval with the commissioner at least 60 days prior to the date of the
				proposed assumption. The commissioner may approve the transaction upon a
				finding that the transaction is in the best interests of the individuals
				insured under the health benefit plans to be transferred and is consistent with
				the purposes of Iowa Code chapter 513C and this chapter.
c. The filing required under paragraph
				75.5(1)
"b"
shall:
(1)
				Describe the block of business, including any eligibility requirements, of the
				ceding carrier from which the health benefit plans will be ceded;
(2) Describe whether the assuming carrier
				will maintain the assumed health benefit plans as a separate block of business,
				pursuant to subrule 75.5(3), or will incorporate them into an existing block of
				business, pursuant to subrule 75.5(4). If the assumed health benefit plans will
				be incorporated into an existing block of business, the filing shall describe
				the block of business of the assuming carrier into which the health benefit
				plans will be incorporated;
(3)
				Describe whether the health benefit plans being assumed are currently available
				for purchase by individuals;
(4)
				Describe the potential effect of the assumption on the benefits provided by the
				health benefit plans to be assumed;
(5) Describe the potential effect of the
				assumption on the premiums for the health benefit plans to be
				assumed;
(6) Describe any other
				potential material effects of the assumption on the coverage provided to the
				individuals covered by the health benefit plans to be assumed; and
(7) Include any other information required by
				the commissioner.
d. A
				carrier required to make a filing under paragraph 75.5(1)
"b"
shall also make an informational filing with the commissioner of each state in
				which there are individual health benefit plans that would be included in the
				transaction. The informational filing to each state shall be made concurrently
				with the filing made under paragraph 75.5(1)
"b"
and shall
				include at least the information specified in subparagraph
				75.5(1)
"c"
(1) for the individual health benefit plans in that
				state.
e. A carrier shall not
				transfer or assume the entire insurance obligation or risk of a health benefit
				plan covering an individual in this state unless it complies with the following
				provisions:
(1) The carrier has provided
				notice to the commissioner at least 60 days prior to the date of the proposed
				assumption. The notice shall contain the information specified in paragraph
				75.5(1)
"c"
for the health benefit plans covering individuals
				in this state.
(2) If the
				assumption of a block of business would result in the assuming carrier's being
				out of compliance with the limitations related to premium rates contained in
				Iowa Code section
				513C5.,
				the assuming carrier shall make a filing with the commissioner pursuant to Iowa
				Code section 513 C. 5 seeking suspension of the application of Iowa Code
				section
				513C5..
(3) An assuming carrier seeking suspension of
				the application of Iowa Code section
				513C5.
				shall not complete the assumption of health benefit plans covering individuals
				unless the commissioner grants the suspension requested pursuant to
				subparagraph 75.5(1)
"e"
(2).
(4) Unless a different period is approved by
				the commissioner, a suspension of the application of Iowa Code section
				513C5.
				shall, with respect to an assumed block of business, be for no more than 15
				months and, with respect to each individual, last only until the anniversary
				date of such individual's coverage. With respect to an individual this period
				may be extended beyond its first anniversary date for a period of up to 12
				months if the anniversary date occurs within 3 months of the date of assumption
				of the block of business.