Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 77 - Multiple Employer Welfare Arrangements › Rule 191-77.5 - Self-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 self-insured
				association health plan in this state unless the self-insured AHP obtains and
				maintains a certificate of registration pursuant to this rule. Such certificate
				of registration is required for all AHPs that elect to offer self-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 self-insured AHP pursuant to this chapter shall submit an
				application and a plan of operation to the commissioner. This application and
				plan of operation shall include the following:
(1) A business plan, including a copy of all
				health coverage contracts or other instruments which the self-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
				self-insured AHP applicant.
(3) A
				current list of all members of the employer group or association sponsoring the
				self-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 77.5(5)
"a"
and 77.5(5)
"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 self-insured
				AHP applicant, to further demonstrate compliance with paragraph
				77.5(5)
"a,"
if applicable.
(5) Current financial statements of the
				self-insured AHP applicant that shall include, at a minimum, balance sheets, an
				income statement, a cash flow statement and a detailed listing of
				assets.
(6) An actuarial opinion
				which is prepared, signed, and dated by a person who is a member of the
				American Academy of Actuaries and which states that appropriate loss and loss
				adjustment reserves have been established, that adequate premiums are being
				charged, and that the association is operating in accordance with sound
				actuarial principles and in conformance with this rule.
(7) A statement from an authorized
				representative of the self-insured AHP applicant that certifies all of the
				following:
1. The self-insured AHP applicant
				shall be administered by an insurer authorized to do business 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
				510.21.
2. The self-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
				77.5(5).
3. The association or
				group of employers sponsoring the self-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 self-insured AHP applicant.
(8) A certificate from an authorized
				representative of the self-insured AHP applicant that, to the best of the
				authorized representative's knowledge and belief, the self-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.).
(9) 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 self-insured AHP applicant is unable to comply with
				the self-insured AHP applicant's contribution requirements.
(10) A copy of the most recent Form M-l filed
				by the self-insured AHP applicant with the U.S. Department of Labor, Pension
				and Welfare Benefits Administration.
(11) Biographical affidavits from all members
				of the board of directors of the self-insured AHP applicant. The affidavits
				shall be prepared using the current template for biographical affidavits
				prescribed by the National Association of Insurance Commissioners.
(12) Any additional information requested by
				the commissioner.