Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 73 - Health Insurance Purchasing Cooperatives › Rule 191-73.4 - Division Duties-application-filing Requirements-license-audits and Examinations

Current through Register Vol. 47, No. 3, July 24, 2024
(1) The
				division shall have the authority to regulate the establishment and conduct of
				a HIPC as set forth in this chapter
(2) A HIPC shall not operate in Iowa without
				an approved license from the division. An application form shall be completed
				and signed by an authorized representative of the HIPC sponsor and proposed
				HIPC administrator (if applicable). The completed application form shall be
				verified and filed at the division. An application will not be deemed to be
				filed until all information necessary to properly process the application has
				been received by the commissioner Upon filing, the division will make its
				determination concerning the application and will provide notice of the
				determination to the HIPC. If approved, a copy of the approved license shall be
				provided to the HIPC sponsor The license shall serve as the HIPC's
				authorization until the yearly renewal date. Any amendment to the license shall
				be filed in the same manner as the application and approved by the commissioner
				before the change proposed by the amendment is effective.
(3) Each HIPC doing business in the state
				shall file with the division the following information or documents:
a. A business plan for approval by the
				commissioner as provided in rule 73.7(75GA,chI58). The business plan is a
				detailed, written plan of operations explaining how the proposed HIPC intends
				to meet the public policy objectives of reduced cost, increased access and
				improved quality. The business plan is a written commitment by the HIPC if
				approved. Failure to comply with the business plan is a basis for license
				suspension or revocation. Material changes in policy or operations are subject
				to the prior approval of the commissioner on the same basis as the original
				business plan.
b. Quarterly
				financial statements and annual reports on forms approved by the commissioner
				Financial statements and annual reports are to ensure the operation of the HIPC
				in a fiscally sound fashion; to ensure the HIPC is not a risk-bearing entity;
				to ensure sound financial controls and money management; and to prevent
				mismanagement or misappropriation of funds either through neglect or
				malfeasance.
c. Reports of any
				material changes in the business plan or operation. The changes are subject to
				approval by the commissioner prior to implementation. The original business
				plan is the basis of licensure. Material changes in the business plan therefore
				require similar prior approval by the commissioner
d. Any other information required by the
				commissioner deemed pertinent to the operation of a HIPC in the state. The
				specifics of a business plan, market conditions, enforcement cases, or other
				issues may make it necessary for the commissioner to gather additional
				information to make an informed decision in the public interest. Failure to
				provide requested information is a basis for denial, suspension or revocation
				of a license.
e. A HIPC shall not
				enter the market place until the commissioner has approved the business
				plan.