reglab/statecodes huggingface dataset:
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 40 - Health Maintenance Organizations › Rule 191-40.21 - Reimbursement

Current through Register Vol. 47, No. 3, July 24, 2024
Reimbursement to a provider of "emergency services," as
				  defined in
				  191-401. (514B),
				  shall not be denied by any health maintenance organization without that
				  organization's review of the patient's medical history, presenting symptoms,
				  and admitting or initial as well as final diagnosis, submitted by the provider,
				  in determining whether, by definition, emergency services could reasonably have
				  been expected to be provided. Reimbursement for emergency services shall not be
				  denied solely on the groimds that services were performed by a noncontracted
				  provider If reimbursement for emergency services is denied, the enrollee may
				  file a complaint with the HMO as outlined in rule 40.9(514B). Upon denial of
				  reimbursement for emergency services, the HMO shall notify the enrollee and the
				  provider that they may register a complaint with the commissioner of
				  insurance.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 40 - Health Maintenance Organizations › Rule 191-40.22 - Health Maintenance Organization Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
(1) A health maintenance organization shall
				not prohibit a participating provider from or penalize a participating provider
				for discussing treatment options with covered persons, irrespective of the
				health maintenance organization's position on the treatment options, or from
				advocating on behalf of covered persons within the utilization review or
				grievance processes established by the health maintenance organization or a
				person contracting with the health maintenance organization.
(2) A health maintenance organization shall
				not penalize a provider because the provider, in good faith, reports to state
				or federal authorities any act or practice by the health maintenance
				organization that, in the opinion of the provider, jeopardizes patient health
				or welfare.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 40 - Health Maintenance Organizations › Rule 191-40.23 - Disclosure Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
All HMOs shall include in contracts and evidence of coverage
				  forms a statement disclosing the existence of any prescription drug
				  formularies. Upon request, an HMO offering a plan that includes a prescription
				  drug formulary shall inform enrollees of the plan, and prospective enrollees of
				  the plan during any open enrollment period, whether a prescription drug
				  specified in the request is included in such formulary.
All HMOs shall also disclose the existence of any contractual
				  arrangements providing rebates received by them for prescription drugs or
				  durable medical equipment. Durable medical equipment means equipment that can
				  stand repeated use and is primarily and customarily used to serve a medical
				  purpose and is generally not useful to a person who is not sick or injured or
				  used by other family members and is appropriate for home use for the purpose of
				  improving bodily functions or preventing further deterioration of the medical
				  condition caused by sickness or injury.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 40 - Health Maintenance Organizations › Rule 191-40.24 - Provider Access

Current through Register Vol. 47, No. 3, July 24, 2024
A health maintenance organization shall allow a female
				  enrollee direct access to obstetrical and gynecological services from network
				  or participating providers. The plan shall also allow a pediatrician to be the
				  primary care provider for a child through the age of 18.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 40 - Health Maintenance Organizations › Rule 191-40.25 - Electronic Delivery of Accident and Health Group Insurance Certificates

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Purpose.
The purpose of this rule is to authorize the
				electronic delivery of accident and health group insurance certificates in an
				efficient manner by health maintenance organizations and group policyholders,
				while guaranteeing that individual plan members still receive the important
				information contained in such group insurance certificates, as required by Iowa
				Code section
				514B9. and
				as allowed by the imiform electronic transactions Act, Iowa Code chapter
				554D.
(2)
Scope.
This rule shall apply to all health maintenance organizations holding a
				certificate of authority to transact the business of insurance under the
				provisions of Iowa Code chapter 514B.
(3)
Electronic delivery-health
				maintenance organizations.
The health maintenance organization will be
				deemed to comply with the requirements of Iowa Code section
				514B9. if
				the group insurance certificate is delivered to the group policyholder
				electronically and if:
a. The health
				maintenance organization takes appropriate and necessary measures to ensure
				that the system for furnishing group insurance certificates results in actual
				receipt of transmitted information by group policyholders, which may be done
				by:
(1) Using return-receipt electronic mail
				features;
(2) Periodic reviews or
				surveys to confirm receipt of the transmitted information; or
(3) Any other method approved by the
				insurance commissioner
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 40 - Health Maintenance Organizations › Rule 191-40.26 - Notice of Cancellation, Nonrenewal or Termination of Enrollment

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Purpose
				and definitions.
a.
Purpose.
The purpose of this rule is to clarify the authorized
				methods of delivery for notices of cancellation, nonrenewal or termination by a
				health maintenance organization, so as to implement the various consumer
				protections intended by Iowa Code sections
				514B17.
				and
				514B17A. and rule
				191-4010.
				(514B).
b.
Definitions.
As used in Iowa Code section
				505B1.
				and this rule:
"Commissioner "
means the Iowa insurance
				  commissioner or insurance division.
"Notice of cancellation, nonrenewal or
				  termination"
means:
1. Notice
				of an insurance company's termination of an insurance policy at the end of a
				term or before the termination date;
2. Notice of an insurance company's decision
				or intention not to renew a policy; and
3. For purposes of notices required by Iowa
				Code sections
				514B17.
				and
				514B17A. and rule
				191-4010.
				(514B), "notice of cancellation, nonrenewal or termination" includes but is not
				limited to a health maintenance organization's notice to an enrollee of
				cancellation or rescission of membership.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.1 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Act"
when used in these rules shall mean
				  Iowa Code chapter 514B.
"Complaint"
means a written communication
				  expressing a grievance concerning a limited service organization.
"Governing body"
means the persons in which
				  the ultimate responsibility and authority for the conduct of the LSO is
				  vested.
"Limitedhealth services"
include dental care
				  services, vision care services, mental health services, behavioral health care
				  services, substance abuse services, pharmaceutical services, podiatric care
				  services, chiropractic services, nursing services, services of a licensed
				  dietitian, physical therapy services, or any other category of services
				  approved by the commissioner. "Limited health services" do not include employee
				  assistance programs which provide only assessment and referral services or
				  intermediate or long-term care facilities.
"Limited service organization"
or
"LSO"
means any corporation or limited liability company or
				  other entity which, in return for prepayment, undertakes to provide or arrange
				  for the provision of one or more limited health services to enrollees. Entities
				  authorized to do business pursuant to Iowa Code chapters 508, 512B, 514, 514B
				  (health maintenance organizations), 515, and 520 shall not be required to
				  obtain separate licensure as an LSO.
"Outpatient provider services"
means
				  outpatient provider services provided within or outside of a hospital. These
				  services shall include, but not be limited to, laboratory and diagnostic X-ray
				  with emphasis directed toward primary care.
"Producer"
means a person engaged in
				  solicitation or enrollment for an LSO and who ultimately delivers the
				  certificate of membership or policy to a member.
"Provider"
means any person or institution
				  duly licensed or otherwise authorized to deliver or furnish limited health
				  services.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.2 - Application

Current through Register Vol. 47, No. 3, July 24, 2024
An application on forms provided by the insurance division
				  accompanied by a filing fee of $100 payable to State Treasurer, State of Iowa,
				  shall be completed by an officer or authorized representative of the LSO. The
				  application with copies in duplicate shall be executed in conformance with rule
				  191-41.10 (514B) and shall be
				  accompanied by the information found in Iowa Code section
				  514B.3(1).
				  An application shall not be deemed to be filed until all information necessary
				  to properly process said application has been received by the commissioner, as
				  indicated in rule 191-41.10 (514B). Amendments to
				  the application form shall be filed in the same manner as the application and
				  approved by the commissioner before the change proposed by the amendment is
				  effective.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.3 - Inspection of Evidence of Coverage

Current through Register Vol. 47, No. 3, July 24, 2024
Except for groups which maintain a cafeteria plan pursuant to
				  Section 125 of the Internal Revenue Code ( 28 U.S.C.A. § 125), an
				  enrollee may, if evidence of coverage is not satisfactory for any reason,
				  return evidence of coverage within ten days of receipt of same and receive full
				  refund of the deposit paid, if any. This right shall not act as a cure for
				  misleading or deceptive advertising or marketing methods, nor may it be
				  exercised if the enrollee utilizes the services of the LSO within the ten-day
				  period. Enrollees in cafeteria plans must adhere to the plan provisions
				  concerning termination or changes in coverage.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.4 - Governing Body and Enrollee Representation

Current through Register Vol. 47, No. 3, July 24, 2024
An LSO shall have a basic written organizational document
				  setting forth its scheme of organization and establishing a governing body
				  appropriate to its form of organization. The governing body shall be
				  responsible for matters of policy and operation.
The LSO shall develop bylaws or guidelines which describe the
				  scope of the health care services the LSO renders to enrollees directly by a
				  provider Initial articles of incorporation, bylaws, guidelines of the LSO and
				  revisions thereto shall be submitted to the commissioner of insurance for
				  review and approval.
The articles of incorporation, bylaws, guidelines, or similar
				  document shall provide for "reasonable representation" on the governing body by
				  enrollees. "Reasonable representation" as used in Iowa Code section
				  514B7. shall
				  require that not less than 30 percent of the governing board members be
				  enrollees who are not providers or are not associated with a provider.
				  Enrollees shall have the opportunity to nominate said enrollee
				  representatives.
The LSO may provide upon its initial formation that all
				  representatives on the governing board shall be selected by the organizers of
				  the LSO. Such members shall serve until the first annual meeting or election.
				  If there are no enrollee representatives on the initial governing board, they
				  shall be elected at the first annual meeting or election. The nomination
				  procedures for enrollee representatives should provide for the following to
				  ensure an adequate opportunity for participation by enrollees:
(1) An opportunity for adult enrollees to
				nominate candidates for the governing body.
(2) Notice to all adult enrollees of the
				nomination and elective procedures. The LSO shall be deemed to have complied
				with these requirements if it provides notice in its regular newsletter to
				enrollees of the opportunity to and the procedures for nomination of enrollee
				representatives. Nomination procedures may be waived by the commissioner for a
				period of up to three years from the LSO's commencement of delivery of services
				to enrollees.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.5 - Quality of Care

Current through Register Vol. 47, No. 3, July 24, 2024
Each LSO shall:
(1)
				Advise the insurance division annually of the ratio of full-time providers and
				ancillary health personnel to enrollees to ensure an adequate network. Changes
				in the provider ratios shall be immediately reported together with action taken
				to correct any deficiencies in the ratios.
(2) Provide assurance that all personnel
				engaged in the provision of health services to enrollees are currently licensed
				or certified by the appropriate state agency where the providers are located to
				practice their respective professions. These personnel shall be no less
				qualified in their respective professions than the current level of
				qualification, which is maintained in the providers' communities.
(3) Provide assurance that any health care
				facilities utilized by the LSO are licensed by the appropriate state agency
				where the facilities are located. These facilities shall be accredited by the
				Joint Commission on Accreditation of Hospitals or the American Osteopathic
				Association; or they shall be certified as a provider for Medicare or Medicaid;
				or as otherwise accredited or licensed in accordance with state or federal
				law.
(4) Have a qualified
				administrator designated by the governing body who shall be responsible for the
				management of the LSO.
(5) Provide
				for an ongoing internal peer review program.
(6) Maintain a provider records system which
				includes at a minimum the following information:
a. Documentation of utilization rates for
				every enrollee.
b. Patient's name,
				identification number, age, sex, and place of residence, and place of
				employment, if applicable.
c.
				Services provided, when provided, where provided, and by whom.
d. Provider diagnosis, treatment prescribed,
				therapy prescribed and drugs administered.
e. Statement in regard to the status of the
				patient's health, as appropriate.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.7 - Change of Ownership

Current through Register Vol. 47, No. 3, July 24, 2024
Each LSO which desires to transfer ownership of more than 10
				  percent of the stock or ownership interest in the LSO shall not do so without
				  first submitting a proposed plan to the division for review and approval or
				  disapproval.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.8 - Complaints

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Each LSO shall
				provide in its bylaws for a system to resolve and record complaints.
(2) The complaint system shall provide for
				the resolution of the following kinds of complaints and the recording of the
				information required to be reported to the commissioner.
a. Complaints about the quality of health
				care services provided by the LSO.
b. Complaints about the availability of such
				services.
c. Complaints relating to
				enrollee participation in the operation of the LSO.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.9 - Cancellation of Enrollees

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Membership of an enrollee in an LSO may be terminated by the LSO for the
				following reasons and no other:
a. Nonpayment
				of charges when due.
b. Termination
				of the conditions, other than a change in the health of the enrollee, under
				which the enrollee became eligible to be enrolled under a group
				contract.
c. Termination of the
				group contract under which the enrollee was enrolled.
d. Change of place of residence of the
				enrollee from the geographic area served by the LSO.
e. Failure of the enrollee to pay deductible
				or coinsurance charges permitted under Iowa Code section
				514B.5(l)"c."
f. Unreasonable
				refusal of the enrollee to follow a prescribed course of treatment.
g. A materially false statement or
				misrepresentation by the enrollee in an application for membership or
				benefits.
h. Withdrawal of
				licensure by the LSO from the state. Upon withdrawal, an LSO has no obligation
				to secure replacement coverage for enrollees.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.11 - Net Equity and Deposit Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Net equity requirements.
a. Each LSO shall,
				at all times, have and maintain a tangible net equity at least equal to the
				greater of:
(1) $100,000 at the inception of
				the first year of operation, $200,000 at the inception of the second year of
				operation and thereafter; or
(2)
				Two percent of the organization's annual gross premium income, up to a maximum
				of the required capital and surplus of an accident and health insurer
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.12 - Fidelity Bond

Current through Register Vol. 47, No. 3, July 24, 2024
An LSO shall maintain in force a fidelity bond on employees
				  and officers in an amount not less than $ 100,000 or such other sum as may be
				  prescribed by the commissioner All such bonds shall be written with at least a
				  one-year discovery period and if written with less than a three-year discovery
				  period shall contain a provision that no cancellation or termination of the
				  bond, whether by or at the request of the insured or by the underwriter, shall
				  take effect prior to the expiration of 90 days after written notice of
				  cancellation or termination has been filed with the commissioner unless an
				  earlier date of cancellation or termination is approved by the
				  commissioner.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.13 - Annual Report

Current through Register Vol. 47, No. 3, July 24, 2024
An LSO shall annually, on or before the first day of March,
				  file with the commissioner of insurance a report verified by at least two of
				  its principal officers and covering the preceding calendar year The report
				  shall be on the form designated by the National Association of Insurance
				  Commissioners (NAIC) as the report form for LSOs. The report shall be completed
				  using statutory accounting practices (SAP), and shall include any other
				  information required under law or rule.
The commissioner of insurance may request additional reports
				  and information from an LSO as often as is deemed necessary to enable the
				  commissioner to carry out the duties of Iowa Code chapter
				  514B.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.14 - Cash or Asset Management Agreements

Current through Register Vol. 47, No. 3, July 24, 2024
If an LSO utilizes a cash or asset management arrangement
				  with its parent, affiliate, or any other person, the arrangement shall be
				  written and subject to prior approval by the commissioner Cash or asset
				  management agreements shall meet the following minimum requirements:
1. Cash receipts shall be under the direct
				control of the LSO that generated the receipts. If the system is under the
				control of the LSO's parent or affiliate, then receipts shall be transferred to
				the LSO within five working days.
2. Securities purchased shall be in the name
				of the LSO generating the funds for the security purchase.
3. An LSO's investments shall not be pooled
				with other entities' investments imless there is an agreement which vests an
				undivided interest in the pooled arrangement to the LSO. Such an agreement
				shall be subject to prior approval by the commissioner.
4. An LSO's cash or investments shall not be
				commingled with the cash or investments of any other person.
5. Investments made on behalf of an LSO shall
				be subject to the limitations imposed by Iowa Code sections
				5118.
				and
				514B15..
6. The agreement shall provide for prompt
				notice and verification of investments, establish responsibility for brokerage
				and other fees and provide for periodic reports on earnings and
				expenses.
7. A parent, affiliate,
				person, and employees thereof providing cash or asset management services shall
				be bonded and responsible for any physical loss of investments.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.15 - Reinsurance

Current through Register Vol. 47, No. 3, July 24, 2024
Reinsurance contracts and stop-loss agreements entered into
				  by an LSO shall be subject to prior approval and shall meet the following
				  minimum requirements:
1. Reinsurance
				contracts and stop-loss agreements shall provide that the commissioner of
				insurance be given notice of termination by certified mail at least 30 days
				prior to the effective date of termination of the reinsurance contract or
				stop-loss agreement.
2. Retention
				levels shall be reasonable in light of the LSO's financial condition and
				potential liabilities.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.16 - Provider Contracts

Current through Register Vol. 47, No. 3, July 24, 2024
An LSO's arrangements for health care services shall be by
				  written contract. Initial provider contracts shall be subject to prior
				  approval. Thereafter, any provider contract deviating from previously submitted
				  or approved contracts shall be submitted to the division for approval. In all
				  instances, all provider contracts shall include the following provision:
(Provider), or its assignee or subcontractor, hereby agrees
				  that in no event, including, but not limited to, nonpayment by the LSO, LSO
				  insolvency or breach of this agreement, shall (Provider), or its assignee or
				  subcontractor, bill, charge, collect a deposit from, seek compensation,
				  remuneration or reimbursement from, or have any recourse against
				  subscriber/enrollee or persons other than the LSO acting on the providers'
				  behalf for services provided pursuant to this agreement. This provision shall
				  not prohibit collection of supplemental charges or copayments on LSO's behalf
				  made in accordance with terms of (applicable agreement) between LSO and
				  subscriber/enrollee.
(Provider), or its assignee or subcontractor, further agrees
				  that (1) this provision shall survive the termination of this agreement
				  regardless of the cause giving rise to termination and shall be construed to be
				  for the benefit of the LSO subscriber/enrollee and that (2) this provision
				  supersedes any oral or written contrary agreement now existing or hereafter
				  entered into between (Provider) and subscriber/enrollee or persons acting on
				  their behalf
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.17 - Producers' Duties

Current through Register Vol. 47, No. 3, July 24, 2024
In order to qualify for solicitation, enrollment, or delivery
				  of a certificate of membership or policy in an LSO, a producer must comply with
				  the licensing rules set forth in 191-Chapter 10 and in particular pass the
				  accident and health or sickness insurance line of authority
				  examination.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.18 - Emergency Services

Current through Register Vol. 47, No. 3, July 24, 2024
"Emergency services" (inpatient and outpatient), as defined
				  in rule
				  191-4020.
				  (514B), shall be provided by the LSO, either through its own facilities or
				  through guaranteed arrangements with other providers, on a 24-hour basis unless
				  a waiver fi-om such services is approved by the commissioner A provider and
				  sufficient other licensed and ancillary personnel shall be readily available at
				  all times to render such services. Since LSOs may not contract with every
				  emergency care provider in an area, LSOs shall make every effort to inform
				  members of participating providers.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.19 - Reimbursement

Current through Register Vol. 47, No. 3, July 24, 2024
Reimbursement to a provider of "emergency services," as
				  defined in rule 191- 40.20(514B), shall not be denied by any LSO without that
				  organization's review of the patient's provider history, presenting symptoms,
				  and admitting or initial as well as final diagnosis, submitted by the provider,
				  in determining whether, by definition, emergency services could reasonably have
				  been expected to be provided. Reimbursement for emergency services shall not be
				  denied solely on the grounds that services were performed by a noncontracted
				  provider If reimbursement for emergency services is denied, the enrollee may
				  file a complaint with the LSO as outlined in rule
				  191-409. (514B). Upon
				  denial of reimbursement for emergency services, the LSO shall notify the
				  enrollee and the provider that they may register a complaint with the
				  commissioner of insurance.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.20 - Limited Service Organization Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
An LSO shall not prohibit or otherwise restrict a
				  participating provider from advising a covered person about the health status
				  of the covered person or medical care or treatment of the covered person's
				  condition or disease, regardless of whether benefits for such care or treatment
				  are provided under the plan, if the provider is acting within the lawful scope
				  of practice.
An LSO shall not penalize a provider because the provider, in
				  good faith, reports to state or federal authorities any act or practice by the
				  LSO that, in the opinion of the provider, jeopardizes patient health or
				  welfare.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 41 - Limited Service Organizations › Rule 191-41.21 - Disclosure Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
All LSOs shall include in contracts and evidence of coverage
				  forms a statement disclosing the existence of any prescription drug
				  formularies. Upon request, all LSOs offering policies under this chapter that
				  include a prescription drug formulary shall inform policyholders, and
				  prospective policyholders at time of issuance, whether a prescription drug
				  specified in the request is included in such formulary.
All LSOs shall also disclose the existence of any contractual
				  arrangements providing rebates received by them for drugs or durable medical
				  equipment. Durable medical equipment means equipment that can stand repeated
				  uses and is primarily and customarily used to serve a medical purpose and is
				  generally not useful to a person who is not sick or injured or used by other
				  family members and is appropriate for home use for the purpose of improving
				  bodily function or preventing further deterioration of the medical condition
				  caused by sickness or injury.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 42 - Gender-blended Minimum Nonforfeiture Standards for Life Insurance › Rule 191-42.1 - Purpose

Current through Register Vol. 47, No. 3, July 24, 2024
The purpose of this rule is to permit life insurance policies
				  to provide the same cash surrender values and paid-up nonforfeiture benefits to
				  both men and women. No change in minimum valuation standards is implied by this
				  rule.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 42 - Gender-blended Minimum Nonforfeiture Standards for Life Insurance › Rule 191-42.2 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
For purposes of this chapter, the following definitions shall
				  apply:
"1980 CSO Table, with or without Ten-Year Select
				  Mortality Factors"
means that mortality table, consisting of separate
				  rates of mortality for male and female lives, developed by the Society of
				  Actuaries Committee to Recommend New Mortality Tables for Valuation of Standard
				  Individual Ordinary Life Insurance, incorporated in the 1980 NAIC Amendments to
				  the Model Standard Valuation Law and Standard Nonforfeiture Law for Life
				  Insurance, and referred to in those models as the Commissioners 1980 Standard
				  Ordinary Mortality Table, with or without Ten-Year Select Mortality
				  Factors.
"1980 CSO Table (M), with or without Ten-Year Select
				  Mortality Factors"
means that mortality table consisting of the rates
				  of mortality for male lives from the 1980 CSO Table with or without Ten-Year
				  Select Mortality Factors.
"1980 CSO Table (F), with or without Ten-Year Select
				  Mortality Factors"
means that mortality table consisting of the rates
				  of mortality for female lives from the 1980 CSO Table, with or without Ten-Year
				  Select Mortality Factors.
"1980 CET Table"
means that mortality table
				  consisting of separate rates of mortality for male and female lives, developed
				  by the Society of Actuaries Committee to Recommend New Mortality Tables for
				  Valuation of Standard Individual Ordinary Life Insurance, incorporated in the
				  1980 NAIC Amendments to the Model Standard Valuation Law and Standard
				  Nonforfeiture Law for Life Insurance, and referred to in those models as the
				  Commissioners 1980 Extended Term Insurance Table.
"1980 CET Table (M)"
means that mortality
				  table consisting of the rates of mortality for male lives from the 1980 CET
				  Table.
"1980 CET Table (F)"
means that mortality
				  table consisting of the rates of mortality for female lives from the 1980 CET
				  Table.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 42 - Gender-blended Minimum Nonforfeiture Standards for Life Insurance › Rule 191-42.3 - Use of Gender-blended Mortality Tables

Current through Register Vol. 47, No. 3, July 24, 2024
For any policy of insurance on the life of either a male or
				  female insured delivered or issued for delivery in this state after the
				  operative date of Iowa Code section
				  50837.,
				  an insurer may:
(1) Substitute a
				mortality table which is a blend of the 1980 CSO Table (M) and the 1980 CSO
				Table (F) with or without Ten-Year Select Mortality Factors for the 1980 CSO
				Table, with or without Ten-Year Select Mortality Factors for use in determining
				minimum cash surrender values and amounts of paid-up nonforfeiture values,
				and
(2) Substitute a mortality
				table which is of the same blend as used in subrule 42.3(1) above but applied
				to form a blend of the 1980 CET Table (M) and the 1980 CET Table (F) for the
				1980 CET Table for use in determining minimum cash surrender values and amounts
				of paid-up nonforfeiture benefits.
(3) The following tables, as developed and
				revised by the Society of Actuaries and adopted by the National Association of
				Insurance Commissioners shall be considered as the basis for acceptable
				gender-blended mortality tables:
a. 100
				percent male 0 percent female, for tables to be designated as the "1980 CSO-A"
				and "1980 CET-A" tables.
b. 80
				percent male 20 percent female, for tables to be designated as the "1980 CSO-B"
				and "1980 CET-B" tables.
c. 60
				percent male 40 percent female, for tables to be designated as the "1980 CSO-C"
				and "1980 CET-C" tables.
d. 50
				percent male 50 percent female, for tables to be designated as the "1980 CSO-D"
				and "1980 CET-D" tables.
e. 40
				percent male 60 percent female, for tables to be designated as the "1980 CSO-E"
				and "1980 CET-E" tables.
f. 20
				percent male 80 percent female, for tables to be designated as the "1980 CSO-F"
				and "1980 CET-F" tables.
g. 0
				percent male 100 percent female, for tables to be designated as the "1980
				CSO-G" and "1980 CET-G" tables.
Tables 1980 CSO-A, 1980 CET-A, 1980 CSO-G, and 1980 CET-G
				  shall not be used with respect to policies issued on or after January 1,1985,
				  except where 90 percent or more of persons insured thereunder are anticipated
				  to be of one gender or except for certain policies converted from group
				  insurance. Such group conversions issued on or after January I, 1986, shall use
				  mortality tables based on the blend of lives by gender expected for such
				  policies if the group conversion policy is considered to be controlled by the
				  decision in
Arizona Governing Committee v.
				  Norris.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 42 - Gender-blended Minimum Nonforfeiture Standards for Life Insurance › Rule 191-42.4 - Unfair Discrimination

Current through Register Vol. 47, No. 3, July 24, 2024
It shall not be a violation of Iowa Code section
				  507B4(7).
				  for an insurer to issue the same kind of policy of life insurance on both a
				  sex-distinct and sex-neutral basis.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 42 - Gender-blended Minimum Nonforfeiture Standards for Life Insurance › Rule 191-42.5 - Separability

Current through Register Vol. 47, No. 3, July 24, 2024
If any provision of this rule or its application to any
				  person or circumstance is for any reason held to be invalid, the remainder of
				  the rule and the application of such provision to other persons or
				  circumstances shall not be affected.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 42 - Gender-blended Minimum Nonforfeiture Standards for Life Insurance › Rule 191-42.6 - 2001 Cso Mortality Table

Current through Register Vol. 47, No. 3, July 24, 2024
The 2001 CSO Mortality Table shall be used for purposes of
				  this chapter pursuant to the requirements of 191-Chapter 91.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 43 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Rule 191-43.1 - Purpose

Current through Register Vol. 47, No. 3, July 24, 2024
The purpose of this chapter is to recognize the following
				  mortality tables for use in determining the minimum standard of valuation for
				  annuity and pure endowment contracts: the 1983 Table "a" and 1983 Group Annuity
				  Mortality (1983 GAM) Table, the Annuity 2000 Mortality Table, the 2012
				  Individual Annuity Reserving (2012IAR) Table, and the 1994 Group Annuity
				  Reserving (1994 GAR) Table.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 43 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Rule 191-43.2 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
For purposes of this chapter, the following definitions
				  shall apply:
"1983 GAM Table "
means that mortality table
				  developed by the Society of Actuaries Committee on Annuities and adopted as a
				  recognized mortality table for annuities in December 1983 by the National
				  Association of Insurance Commissioners.
"1983 Table 'a'"
means that mortality table
				  developed by the Society of Actuaries Committee to Recommend a New Mortality
				  Basis for Individual Annuity Valuation and adopted as a recognized mortality
				  table for annuities in June 1982 by the National Association of Insurance
				  Commissioners.
"1994 GAR Table "
means that mortality table
				  developed by the Society of Actuaries Group Annuity Valuation Table Task Force
				  and shown on pages 866 and 867 of Volume XLVII of the Transactions of the
				  Society of Actuaries (1995). The 1994 GAR Table was adopted as a recognized
				  mortality table for annuities in December 1996 by the National Association of
				  Insurance Commissioners.
"2012 IAR Table "
means the generational
				  mortality table developed by the Society of Actuaries Committee on Life
				  Insurance Research and containing rates,
				  qx2012+n derived from a
				  combination of the 2012 IAM Period Table and Projection Scale G2, using the
				  methodology stated in subrule 43.3(6).
"2012 Individual Annuity Mortality Period Life
				  Table"
or
"2012 IAM Period"
means the period table
				  containing loaded mortality rates for calendar year 2012. This table contains
				  rates, qx2012+n, developed by
				  the Society of Actuaries Committee on Life Insurance Research and is shown in
				  Appendices I and II.
"Annuity 2000 Mortality Table "
means that
				  mortality table developed by the Society of Actuaries Committee on Life
				  Insurance Research and shown on page 240 of Volume XLVII of the Transactions of
				  the Society of Actuaries (1995). The Annuity 2000 Mortality Table was adopted
				  as a recognized mortality table for annuities in December 1996 by the National
				  Association of Insurance Commissioners.
"Generational mortality table"
means a
				  mortality table containing a set of mortality rates that decrease for a given
				  age from one year to the next based on a combination of a period table and a
				  projection scale containing rates of mortality improvement.
"Period table "
means a table of mortality
				  rates applicable to a given calendar year (the period).
"Projection Scale G2"
or
"Scale
				  G2"
means a table of annual rates, G2X, of
				  mortality improvement by age for projecting future mortality rates beyond
				  calendar year 2012. This table was developed by the Society of Actuaries
				  Committee on Life Insurance Research and is shown in Appendices III and
				  IV
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 43 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Rule 191-43.3 - Individual Annuity or Pure Endowment Contracts

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Except as provided in subrules 43.3(2)
				and 43.3(3), the 1983 Table "a" is recognized and approved as an individual
				annuity mortality table for valuation and, at the option of the company, may be
				used for purposes of determining the minimum standard of valuation for any
				individual annuity or pure endowment contract issued on or after January 1,
				1980.
(2) Except as provided in
				subrule 43.3(3), either the 1983 Table "a" or the Annuity 2000 Mortality Table
				shall be used for determining the minimum standard of valuation for any
				individual annuity or pure endowment contract issued on or after December 30,
				1985.
(3) Except as provided in
				subrule 43.3(4), the Annuity 2000 Mortality Table shall be used for determining
				the minimum standard of valuation for any individual annuity or pure endowment
				contract issued on or after January 1, 2000.
(4) The 1983 Table "a" without projection is
				to be used for determining the minimum standard of valuation for an individual
				annuity or pure endowment contract issued on or after January 1, 2000, solely
				when the contract is based on life contingencies and is issued to fund periodic
				benefits arising from:
1. Settlements of
				various forms of claims pertaining to court settlements or out-of-court
				settlements from tort actions;
2.
				Settlements involving similar actions such as workers' compensation claims;
				or
3. Settlements of long-term
				disability claims where a temporary or life annuity has been used in lieu of
				continuing disability payments.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 43 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Rule 191-43.4 - Group Annuity or Pure Endowment Contracts

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Except as provided in subrules 43.4(2)
				and 43.4(3), the 1983 GAM Table, the 1983 Table "a" and the 1994 GAR Table are
				recognized and approved as group annuity mortality tables for valuation and, at
				the option of the company, any one table may be used for purposes of valuation
				for any annuity or pure endowment purchased on or after January 1, 1980, under
				a group annuity or pure endowment contract.
(2) Except as provided in subrule 43.4(3),
				either the 1983 GAM Table or the 1994 GAR Table shall be used for determining
				the minimum standard of valuation for any annuity or pure endowment purchased
				on or after December 30, 1985, under a group annuity or pure endowment
				contract.
(3) The 1994 GAR Table
				shall be used for determining the minimum standard of valuation for any annuity
				or pure endowment purchased on or after January 1, 2000, under a group annuity
				or pure endowment contract.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 43 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Rule 191-43.5 - Application of the 1994 Gar Table

Current through Register Vol. 47, No. 3, July 24, 2024
In using the 1994 GAR Table, the mortality rate for a person
				  aged x in year (1994 + n) is calculated as follows:
qx 1994+n =
				  qx1994 (1 - AAx) 
				  n
where the qx1994 and
				  AAxS are as specified in the 1994 GAR
				  Table.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 43 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Rule 191-43.6 - Application of the 2012iar Mortality Table

Current through Register Vol. 47, No. 3, July 24, 2024
In using the 2012 IAR Mortality Table, the mortality rate for
				  a person age x in year (2012 + n) is calculated as follows:
qx2012+n
				  =qx2012 (1 .
				  G2X)n
The resulting
				  qx2012+n shall be rounded to
				  three decimal places per 1,000, e.g., 0.741 deaths per 1,000. Also, the
				  rounding shall occur according to the formula above, starting at the 2012
				  period table rate.
For example, for a male age 30,
				  qx2012= 0.741.
qx2013 =
				  0.741 * (1 - 0.010)^1 = 0.73359, which is rounded to
				  0.734.
qx2014 =
				  0.741 * (1 - 0.010)^2 = 0.7262541, which is rounded
				  to 0.726.
A method leading to incorrect rounding would be to calculate
				  qx2014
				  as qx2013 * (1 -
				  0.010), or 0.734 * 0.99 = 0.727.
It is incorrect to use the already rounded
				  qx2013 to calculate
				  qx2014.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 43 - Annuity Mortality Tables for Use in Determining Reserve Liabilities for Annuities › Rule 191-43.7 - Separability

Current through Register Vol. 47, No. 3, July 24, 2024
If any provision of this rule or the application thereof to
				  any person or circumstances is for any reason held to be invalid, the remainder
				  of the rule and the application of such provision to other persons or
				  circumstances shall not be affected thereby.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 44 - Smoker/nonsmoker Mortality Tables for Use in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits › Rule 191-44.1 - Purpose

Current through Register Vol. 47, No. 3, July 24, 2024
The purpose of the rule is to permit the use of mortality
				  tables that reflect differences in mortality between smokers and nonsmokers in
				  determining minimum reserve liabilities and minimum cash surrender values and
				  amounts of paid-up nonforfeiture benefits for plans of insurance with separate
				  risk classifications for smokers and nonsmokers.