Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 77 - Multiple Employer Welfare Arrangements › Rule 191-77.6 - Fully Insured Association Health Plans

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Certificate of
				registration.
A person shall not establish or maintain a fully insured
				association health plan in this state unless the group or association of
				employers obtains and maintains a certificate of registration pursuant to this
				rule. Such certificate of registration is required for all fully insured
				association health plans that elect to offer fully insured association health
				plans to residents of this state whether or not the AHP is domiciled in the
				state.
(2)
Application for
				certificate of registration.
a. A
				person wishing to obtain a certificate of registration as a fully insured AHP
				pursuant to this chapter shall submit an application to the commissioner. This
				application shall include the following:
(1)
				A business plan, including a copy of all health coverage contracts or other
				instruments which the fully insured AHP applicant proposes to make with or sell
				to its employer members or its association's or group's members, a copy of its
				health coverage description, and the printed matter to be used in the
				solicitation of employer members or its association's or group's members to
				purchase the health coverage.
(2)
				Copies of all articles, bylaws, agreements, or other documents or instruments
				describing the rights and obligations of employers, employees, and
				beneficiaries with respect to the fully insured AHP applicant.
(3) A current list of all members of the
				employer group or association sponsoring the fully insured AHP applicant, a
				description of the relationship among the employers, a description of how the
				relationship serves as the basis for the formation of the association or
				employer group, and a description of how the employer group or association
				complies with paragraphs 77.6(4)
"a"
and
				77.6(4)
"b,"
if applicable.
(4) A description of the activities of the
				association or group of employers on behalf of its employer members or its
				association's or group's members other than the sponsorship of the fully
				insured AHP applicant, to further demonstrate compliance with paragraph
				77.6(4)
"a,"
if applicable.
(5) A statement from an authorized
				representative of the fully insured AHP applicant that certifies all of the
				following:
1. The fully insured AHP applicant
				shall be administered by an insurer authorized to do the business of insurance
				in this state or by an authorized third-party administrator that holds a
				current certificate of registration issued by the commissioner pursuant to Iowa
				Code section
				51021..
2. The fully insured AHP applicant is
				established by a trade, industry, or professional association of employers that
				has a constitution or bylaws, is organized and maintained in good faith, and
				meets all membership requirements set forth in subrule 77.6(4).
3. The association or group of employers
				sponsoring the fully insured AHP applicant is engaged in at least one
				substantial business purpose for its members other than sponsorship of an
				employee welfare benefit plan.
4.
				The association is a nonprofit entity organized or authorized to do business
				under applicable Iowa law.
5. No
				insurance producers or benefits consultants established, sponsored, administer,
				or serve as a trustee or on the governing body of the fully insured AHP
				applicant.
(6) A
				certificate from an authorized representative of the fully insured AHP
				applicant that, to the best of the authorized representative's knowledge and
				belief, the fully insured AHP applicant is in compliance with all applicable
				provisions of the Employee Retirement Income Security Act of 1974 (
				29 U.S.C. Section
				1001 et seq.).
(7) A description of and evidence of a
				mechanism, approved by the commissioner, to ensure that claims shall be paid in
				the event a member of the fully insured AHP applicant is unable to comply with
				the fully insured AHP applicant's contribution requirements.
(8) A copy of the most recent Form M-l filed
				by the fully insured AHP applicant with the U.S. Department of Labor, Pension
				and Welfare Benefits Administration.
(9) Biographical affidavits from all members
				of the board of directors of the fully insured AHP applicant. The affidavits
				shall be prepared using the current template for biographical affidavits
				prescribed by the National Association of Insurance Commissioners.
(10) Any additional information requested by
				the commissioner.