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Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 32 - Deposits by a Domestic Life Company in a Custodian Bank or Clearing Corporation › Rule 191-32.2 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
As used in this chapter:
(1)
"Commissioner"
means the
				commissioner of insurance of the state of Iowa.
(2)
"Company"
means a
				company organized under Iowa Code chapter 508.
(3)
"Custodial account"
means an account established by agreement between a company and a custodian
				pursuant to Iowa Code section
				5118.,
				subsection 21, and these rules.
(4)
"Custodial agreement"
means an agreement entered into between
				a company and a custodian pursuant to these rules.
(5)
"Custodian"
means an
				institution meeting the requirements of rule 32.4(508) which has entered into a
				custodial agreement with a company.
(6)
"Custodied securities"
means securities held by or through a custodian when held directly by the
				custodian or held for the account of the custodian in an authorized clearing
				corporation or in the federal reserve book entry system.
(7)
"Authorized clearing corporations
				"
means the following organizations, which are hereby recognized by
				the commissioner as authorized clearing corporations for purposes of Iowa Code
				section
				5118.,
				subsection 21, paragraph
"b,"
subparagraph (2), and such other
				corporations as the commissioner may from time to time designate:
a. Depository Trust Company.
b. Midwest Securities Trust
				Company.
c. Pacific Securities
				Depository Trust Company.
d.
				Philadelphia Depository Trust Company.
e. Euroclear Clearance Ltd.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 32 - Deposits by a Domestic Life Company in a Custodian Bank or Clearing Corporation › Rule 191-32.4 - Requirements Upon Custodians

Current through Register Vol. 47, No. 3, July 24, 2024
The custodian shall be a bank or trust company having its
				  principal place of business in the United States, selected by the company to
				  act as the custodian under an agreement authorized by Iowa Code section
				  5118.,
				  subsection 21, and shall possess the following qualifications:
(1) The custodian shall be audited annually
				by independent public accountants whose audit report, together with the related
				financial statements, and opinion on internal controls shall be made available
				to the company and the commissioner
(2) The laws governing the custodian shall
				recognize that the custodied securities remain the specific property of the
				company, and are not subject to the claim of any third parties arising out of
				the third party's claim against the custodian.
(3) The custodian shall maintain blanket bond
				coverage relating to its custodial functions with limits satisfactory to the
				commissioner
(4) The custodian's
				capital and surplus funds shall at all times equal or exceed $25 million and
				the custodian shall at all times have assets in excess of $500 million, unless
				the commissioner finds that a particular custodian with less than that amount
				of funds or assets would possess the requisite stability and soundness to
				perform the custodial functions without detriment to a company's policyholders.
This rule is intended to implement Iowa Code section 511.8,
				  subsection 21, paragraph
"b."
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 32 - Deposits by a Domestic Life Company in a Custodian Bank or Clearing Corporation › Rule 191-32.5 - Deposit of Securities

Current through Register Vol. 47, No. 3, July 24, 2024
Banks or trust companies meeting the requirements of rule
				  32.4(508) are hereby designated by the commissioner as places for the deposits
				  under Iowa Code sections
				  5086.
				  and
				  5118(16)..
				  Securities required to be deposited under these Iowa Code sections shall no
				  longer be deposited with the commissioner
This rule is intended to implement Iowa Code sections
				  5086.
				  and
				  5118.,
				  subsection 16.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 33 - Variable Life Insurance Model Regulation › Rule 191-33.1 - Authority

Current through Register Vol. 47, No. 3, July 24, 2024
(1) This chapter,
				applicable to variable life insurance policies, is promulgated under the
				authority of Iowa Code sections
				5058.
				and
				508A4..
(2) This chapter is supplementary to
				191-Chapter 31, which remains in effect except that, with respect to any
				variable life insurance policy issued on or after the effective date of this
				chapter, this chapter shall control to the extent there is any
				conflict.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 33 - Variable Life Insurance Model Regulation › Rule 191-33.3 - Qualification of Insurer to Issue Variable Life Insurance

Current through Register Vol. 47, No. 3, July 24, 2024
The following requirements are applicable to all insurers
				  either seeking authority to issue variable life insurance in this state or
				  having authority to issue variable life insurance in this state.
(1)
Licensing and approval to do
				business in this state.
An insurer shall not deliver or issue for
				delivery in this state any variable life insurance policy unless the insurer is
				licensed or organized to do a life insurance business in this state, and the
				insurer has obtained the written approval of the commissioner for the issuance
				of variable life insurance policies in this state. The commissioner shall grant
				such written approval only after the commissioner has found that:
a. The plan of operation for the issuance of
				variable life insurance policies is not unsound;
b. The general character, reputation, and
				experience of the management and those persons or firms proposed to supply
				consulting, investment, administrative, or custodial services to the insurer
				are such as to reasonably ensure competent operation of the variable life
				insurance business of the insurer in this state; and
c. The present and foreseeable future
				financial condition of the insurer and its method of operation in connection
				with the issuance of such policies is not likely to render its operation
				hazardous to the public or its policyholders in this state. The commissioner
				shall consider, among other things:
(1) The
				history of operation and financial condition of the insurer;
(2) The qualifications, fitness, character,
				responsibility, reputation, and experience of the officers and directors and
				other management of the insurer and those persons or firms proposed to supply
				consulting, investment, administrative, or custodial services to the
				insurer;
(3) The applicable law and
				regulations under which the insurer is authorized in its state of domicile to
				issue variable life insurance policies. The state of entry of an alien insurer
				shall be deemed its state of domicile for this purpose; and
(4) If the insurer is a subsidiary of, or is
				affiliated by common management or ownership with another company, its
				relationship to such other company and the degree to which the requesting
				insurer, as well as the other company, meet these standards.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 33 - Variable Life Insurance Model Regulation › Rule 191-33.4 - Insurance Policy Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
The commissioner shall not approve any variable life
				  insurance form filed pursuant to this chapter unless it conforms to the
				  requirements of this rule.
(1)
Filing of variable life insurance policies.
Prior to delivery
				or issuance for delivery in this state, all variable life insurance policies,
				and all riders, endorsements, applications and other documents which are to be
				attached or made a part of the policy and which relate to the variable nature
				of the policy, shall be filed with the commissioner using the National
				Association of Insurance Commissioners' System for Electronic Rate and Form
				Filing (SERFF) and shall be approved by the commissioner prior to delivery or
				issuance for delivery in this state. Insurance companies must comply with the
				commissioner's requirements regarding filing, including SERFF general
				instructions, Iowa general instructions and the specific submission
				requirements for the type of insurance for which the companies are submitting
				documents, as set out on the SERFF website at
www.serff.or g
.
a.
				The procedures and requirements for such filing and approval shall be, to the
				extent appropriate and not inconsistent with this chapter, the same as those
				otherwise applicable to other life insurance policies.
b. The commissioner may approve variable life
				insurance policies and related forms with provisions the commissioner deems to
				be not less favorable to the policyholder and the beneficiary than those
				required by this chapter.
c. A
				filing which has not been previously approved, disapproved or questioned shall
				be deemed approved on or after 30 days from its receipt by the
				commissioner.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 33 - Variable Life Insurance Model Regulation › Rule 191-33.6 - Separate Accounts

Current through Register Vol. 47, No. 3, July 24, 2024
The following requirements apply to the establishment and
				  administration of variable life insurance separate accounts by any domestic
				  insurer:
(1)
Establishment and
				administration of separate accounts.
Any domestic insurer issuing
				variable life insurance shall establish one or more separate accounts pursuant
				to Iowa Code section
				508A.1.
a. If no law or other regulation provides for
				the custody of separate account assets and if such insurer is not the custodian
				of such separate account assets, all contracts for custody of such assets shall
				be in writing and the commissioner shall have authority to review and approve
				of both the terms of any such contract and the proposed custodian prior to the
				transfer of custody.
b. Such
				insurer shall not without prior written approval of the commissioner employ in
				any material connection with the handling of separate account assets any person
				who:
(1) Within the last ten years has been
				convicted of any felony or a misdemeanor arising out of such person's conduct
				involving embezzlement, fraudulent conversion, or misappropriation of funds or
				securities or involving violation of Section 1341, 1342, or 1343 of Title 18,
				United States Code; or
(2) Within
				the last ten years has been found by any state regulatory authority to have
				violated or has acknowledged violation of any provision of any state insurance
				law involving fraud, deceit, or knowing misrepresentation; or
(3) Within the last ten years has been found
				by federal or state regulatory authorities to have violated or has acknowledged
				violation of any provision of federal or state securities laws involving fraud,
				deceit, or knowing misrepresentation.
c. All persons with access to the cash,
				securities, or other assets of the separate account shall be under bond in the
				amount of not less than the greater of the amount required pursuant to Section
				17(g) of the Investment Company Act of 1940 or such other amount as the
				commissioner may deem appropriate.
d. The assets of such separate accounts shall
				be valued at least as often as variable benefits are determined but in any
				event at least monthly.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 33 - Variable Life Insurance Model Regulation › Rule 191-33.7 - Information Furnished to Applicants

Current through Register Vol. 47, No. 3, July 24, 2024
An insurer delivering or issuing for delivery in this state
				  any variable life insurance policies shall deliver to the applicant for the
				  policy, and obtain a written acknowledgment of receipt from such applicant
				  coincident with or prior to the execution of the application, the following
				  information. The requirements of this rule shall be deemed to have been
				  satisfied to the extent that a disclosure containing information required by
				  this rule is delivered, either in the form of (1) a prospectus included in the
				  requirements of the Securities Act of 1933 and which was declared effective by
				  the Securities and Exchange Commission; or (2) all information and reports
				  required by the Employee Retirement Income Security Act of 1974 if the policies
				  are exempted from the registration requirements of the Securities Act of 1933
				  pursuant to Section 3(a)(2) thereof
(1) A summary explanation, in nontechnical
				terms, of the principal features of the policy, including a description of the
				manner in which the variable benefits will reflect the investment experience of
				the separate account and the factors which affect such variation. Such
				explanation must include notices of the provision required by subrule 33.4(3),
				paragraph
"a,"
subparagraph (5), and 33.4(3),
				paragraph
"f."
(2)
				A statement of the investment policy of the separate account, including:
a. A description of the investment objectives
				intended for the separate account and the principal types of investments
				intended to be made; and
b. Any
				restrictions or limitations on the manner in which the operations of the
				separate account are intended to be conducted.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 33 - Variable Life Insurance Model Regulation › Rule 191-33.8 - Applications

Current through Register Vol. 47, No. 3, July 24, 2024
The application for a variable life insurance policy shall
				  contain:
(1) A prominent statement
				that the death benefit may be variable or fixed under specified
				conditions.
(2) A prominent
				statement that cash values may increase or decrease in accordance with the
				experience of the separate account (subject to any specified minimum
				guarantees).
(3) Questions designed
				to elicit information which enable the insurer to determine the suitability of
				variable life insurance for the applicant.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 33 - Variable Life Insurance Model Regulation › Rule 191-33.10 - Foreign Companies

Current through Register Vol. 47, No. 3, July 24, 2024
If the law or regulation in the place of domicile of a
				  foreign company provides a degree of protection to the policyholders and the
				  public which is substantially similar to that provided by this chapter, the
				  commissioner to the extent deemed appropriate in the commissioner's discretion,
				  may consider compliance with such law or regulation as compliance with this
				  chapter
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 33 - Variable Life Insurance Model Regulation › Rule 191-33.12 - Separability Article

Current through Register Vol. 47, No. 3, July 24, 2024
If any provision of this chapter or the application thereof
				  to any person or circumstance is for any reason held to be invalid, the
				  remainder of the regulation 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 34 - Nonprofit Health Service Corporations › Rule 191-34.1 - Purpose

Current through Register Vol. 47, No. 3, July 24, 2024
The purpose of this chapter is to specify those requirements
				  imposed upon heahh service corporations under Iowa Code chapter 514 and
				  delineate standards for the commissioner's implementation of these
				  requirements.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 34 - Nonprofit Health Service Corporations › Rule 191-34.3 - Annual Report Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
Each corporation subject to Iowa Code chapter 514 shall file
				  an annual statement on the National Association of Insurance Commissioner's
				  annual statement blank.
This rule is intended to implement Iowa Code section
				  5149..
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 34 - Nonprofit Health Service Corporations › Rule 191-34.4 - Arbitration

Current through Register Vol. 47, No. 3, July 24, 2024
Parties defined in Iowa Code section
				  51413.
				  may submit covered disputes to the commissioner The following procedures shall
				  be followed when covered disputes are submitted to the commissioner
(1) The party seeking arbitration shall file
				a petition for arbitration requesting arbitration by the commissioner and
				setting forth the facts which are the basis for the dispute, together with a
				statement of the factual or legal issue(s), and the party's position on the
				issue(s), and serve a copy of the petition by certified mail upon the other
				party(ies) to the dispute. Proof of service shall be promptly filed with the
				commissioner
(2) The other
				party(ies) shall file within 20 days an answer to the petition for arbitration,
				admitting or denying the facts alleged in the petition and indicating whether
				there is agreement with the statement of the issue(s) in the petition and
				setting forth the other party's position on the issue(s). All papers other than
				the petition shall be served in accordance with Iowa Rule of Civil Procedure
				1.415 with proof of service to be made in conformance therewith.
(3) The commissioner shall conduct a
				prehearing conference in accordance with rule
				191-35.
				(17A,502,505) at which the commissioner may set a schedule for the submission
				of briefs by the parties, and, if necessary, shall provide for the holding of
				an evidentiary hearing. The parties are encouraged to stipulate to the facts
				and agree as to the legal issue(s).
(4) The commissioner may submit the dispute
				to a person selected by the commissioner, who may or may not be employed by the
				division, who shall make proposed findings and recommendations to the
				commissioner for a decision by the commissioner
[Editorial change: lAC Supplement 11/17/10]
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 34 - Nonprofit Health Service Corporations › Rule 191-34.5 - Filing Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
All matters subject to the division's approval under Iowa
				  Code chapter 514 shall be submitted pursuant to rule
				  191-201.
				  (505,509,514A,515,515A,515F) prior to the intended effective
				  date.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 34 - Nonprofit Health Service Corporations › Rule 191-34.6 - Participating Hospital Contracts

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				The following standards shall be applied to all participating hospital
				contracts subject to approval under Iowa Code section
				5148.
				and shall be relied upon by the commissioner in deciding whether approval is
				granted:
a. Contracts shall be fair to the
				subscribers of the hospital service corporation.
b. Contracts shall be fair to the hospital
				service corporation.
c. Contracts
				shall be fair, reasonable, and in the public interest.
d. The subscribers' rights to service under
				participating hospital contracts shall be adequately specified and
				protected.
e. The contract shall
				not be unfairly discriminatory with respect to the provision of services to
				subscribers.
f. Contracts shall not
				be detrimental to the financial condition of the hospital service
				corporation.
g. The payment of
				consideration required of the hospital service corporation by the provisions of
				the contract shall not be excessive, inadequate or unfair
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 34 - Nonprofit Health Service Corporations › Rule 191-34.7 - Composition, Nomination, and Election of Board of Directors

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Composition of hoard of
				directors.
The composition of the board of directors of each
				corporation subject to Iowa Code chapter 514 shall be as follows:
a. On and after August 1, 1984, a majority of
				the members of the board of directors of each corporation subject to Iowa Code
				chapter 514 shall be subscriber directors.
b. On and after August 1, 1985, at least
				two-thirds of the members of the board of directors of each corporation subject
				to Iowa Code chapter 514 shall be subscriber directors.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.1 - Purpose

Current through Register Vol. 47, No. 3, July 24, 2024
The purpose of this regulation is to establish guidelines for
				  insurers to make special risk coverage available to particular groups that will
				  be exposed to specific hazards for a certain period of time.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.2 - Scope

Current through Register Vol. 47, No. 3, July 24, 2024
These rules shall apply to all insurance companies holding a
				  certificate of authority to transact the business of insurance under the
				  provisions of Iowa Code chapters 508 and 515.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.3 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Blanket
				accident and sickness insurance is hereby declared to be that form of accident,
				sickness or accident and sickness insurance designed to insure against
				specified hazards incident to or defined by reference to a particular activity
				or activities and covering groups of persons as enumerated in the following
				subparagraphs:
a. Under a policy issued to an
				employer, who shall be deemed the policyholder covering any group of employees
				defined by reference to specific hazards incident to an activity or activities
				of the policyholder.
b. Under a
				policy issued to a college, high school, junior high school, grade school,
				school district, school jurisdictional unit or other institution of learning;
				or to the head, principal, governing board of any such educational unit who or
				which shall be deemed the policyholder covering students, teachers or
				employees.
c. Under a policy issued
				to any religious, charitable or educational organization, or branch thereof,
				which shall be deemed the policyholder covering any group of members or
				participants defined by reference to specified hazards incident to an activity
				or activities sponsored or supervised by such policyholder.
d. Under a policy issued to a sports team,
				youth camp, recreational organization or sponsor thereof, which shall be deemed
				the policyholder, covering members, campers, participants, employees, officials
				or supervisors.
e. Under a policy
				issued to any volunteer fire department, first aid, civil defense or other such
				volunteer organizations, which shall be deemed the policyholder, covering any
				group of members or participants defined by reference to specified hazards
				incident to an activity or activities or operations sponsored or supervised by
				such policyholder.
f. Under a
				policy issued to a newspaper or other publisher, which shall be deemed the
				policyholder, covering its carriers.
g. Under a policy issued to an association,
				other than a labor union, trade association or industrial association, which
				shall have a constitution and bylaws and which has been organized and is
				maintained in good faith for purposes other than that of obtaining insurance,
				which shall be deemed the policyholder, covering any group of members or
				participants defined by reference to specified hazards incident to an activity
				or activities or operations sponsored or supervised by such
				policyholder.
h. Under a policy
				issued to cover any other risk or class of risks which, in the discretion of
				the commissioner, may be properly eligible for blanket accident and sickness
				insurance. The discretion of the commissioner may be exercised on an individual
				risk basis or class of risks, or both.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.5 - Application and Certificates Not Required

Current through Register Vol. 47, No. 3, July 24, 2024
An individual application need not be required from a person
				  covered under a blanket accident and sickness policy, nor shall it be necessary
				  for the insurer to furnish each person a certificate; however, a brochure as
				  herein defined shall be issued to the policyholder for delivery to each person
				  insured as defined in 35.3(1)
"b."
and
"g."
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.6 - Facility of Payment

Current through Register Vol. 47, No. 3, July 24, 2024
All benefits under any blanket accident and sickness policy
				  shall be payable to the person insured, to a designated beneficiary or
				  beneficiaries, or to their estate, except that if the person insured be a minor
				  or otherwise not competent to give a valid release, such benefits may be made
				  payable to their parent, guardian or other person actually supporting the
				  insured, designated beneficiary, or beneficiaries. The policy may also provide
				  that all or a portion of any indemnities provided by any such policy on account
				  of hospital, nursing, medical or surgical services may with the consent of the
				  insured be paid directly to the hospital or person rendering such services, but
				  the policy may not require that the services be rendered by a particular
				  hospital or person. Payment so made shall discharge the obligation of the
				  insurer with respect to the amount of insurance so paid.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.7 - General Filing Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Insurance companies required to file rates or forms with the division shall
				submit required rate and form filings pursuant to rule
				191-201.
				(505,509,514A,515,515A,515F).
(2)
				Each filing must be submitted to the division of insurance not less than 60
				days prior to the effective date of the filing. Any deficiencies or
				discrepancies in the filing will delay final approval. In case of disapproval,
				the company will be notified by the division.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.8 - 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 insurers 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
				509.3(1)
"b,"
and as allowed by the uniform electronic transactions
				Act, Iowa Code chapter 554D.
(2)
Scope.
This rule shall apply to all insurance companies
				holding a certificate of authority to transact the business of insurance under
				the provisions of Iowa Code chapters 508 and 515.
(3)
Electronic delivery-insurance
				companies.
The insurer will be deemed to comply with the requirements
				of Iowa Code section
				509.3(1)
"b"
if the group insurance certificate is delivered to the
				group policyholder electronically and if:
a.
				The insurer 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 35 - Accident and Health Insurance › Rule 191-35.9 - Notice of Cancellation, Nonrenewal or Termination of Accident and Health Insurance

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
				an insurer, issuer, employer, group policyholder, or carrier, so as to
				implement the various policyholder protections intended by Iowa Code sections
				509B.5,
				513B.5,
				514D.3,
				515.125
				and 515.129A and chapter 505B.
b.
Definitions.
As used in Iowa Code section
				505B.1
				and this rule:
"Commissioner"
means the Iowa insurance
				  commissioner or insurance division.
"Notice of cancellation, nonrenewal or
				  termination"
means:
1. Notice
				of termination of an insurance policy at the end of a term or before the
				termination date;
2. Notice of a
				decision or intention not to renew a policy; and
3. For purposes of notices required by Iowa
				Code sections
				509B.5,
				513B.5,
				514D.3,
				515.125
				and
				515.129A
				and chapter 505B, "notice of cancellation, nonrenewal or termination" includes
				but is not limited to the following:
* An employer's or group policyholder's notification to
				  employees or members of the termination or substantial modification of the
				  continuation of an employer group accident or health policy pursuant to Iowa
				  Code section
				  509B.5;
* A carrier's advance notice to all affected small employers,
				  participants, and beneficiaries of its decision to discontinue offering a
				  particular type of small group health insurance plan pursuant to Iowa Code
				  section
				  513B.5(1)
"e"
(2);
* An insurance company's notice of termination of an
				  individual accident and sickness policy, pursuant to rules promulgated pursuant
				  to Iowa Code section
				  514D.3;
* An insurance company's notice of forfeiture, suspension,
				  cancellation, or intention not to renew, pursuant to Iowa Code section
				  515.125;
				  or
* An insurance company's notice of cancellation of personal
				  lines policies or contracts pursuant to Iowa Code section
				  515.129A.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.20 - Life and Health Self-funded Plans

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Scope. This rule shall apply to life and
				health self-funded plans for political subdivisions of the state, school
				corporations, and all other public bodies of the state. This rule shall not
				apply to life and health self-funded plans for the state of Iowa.
(2) Iowa Code chapter 28E
				agreements-certificate of registration. Public entities seeking to pool risk
				through a joint exercise of power under Iowa Code chapter 28E shall apply for
				and obtain a certificate of registration from the commissioner. This subrule
				shall not apply to single-employer public entities with self-insured plans.
a. An application for a certificate of
				registration shall contain the following:
(1)
				A copy of the proposed agreement entered into pursuant to Iowa Code chapter
				28E, to be executed by all plan participants;
(2) A copy of the articles of incorporation,
				bylaws, agreements, or other documents or instruments describing the rights and
				obligations of employers, employees and beneficiaries;
(3) A copy of all contracts with insurance
				companies, consultants and third-party administrators;
(4) A business plan, including a copy of all
				contracts or other instruments which the 28E agreement proposes to make with or
				sell to its members, a copy of its plan description and the printed matter to
				be used in the solicitation of members; and
(5) A current list of all participating
				public entities.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.21 - Review of Certificates Issued Under Group Policies

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Nondiscretionary groups.
A certificate of coverage delivered
				in this state under a group life or accident and health insurance policy issued
				to a group substantially as described in Iowa Code sections
				509.1(1)
				 to
				509.1(7)
				 may not be reviewed by the commissioner if
				the policy is issued outside of this state.
(2)
Discretionary groups.
A
				certificate of coverage delivered in this state under a group life or accident
				and health insurance policy issued to a group not substantially as described in
				Iowa Code sections
				509.1(1)
				 to
				509.1(7)
				 may not be reviewed by the commissioner if
				the policy is issued outside of this state and if the policy is issued or
				offered in a state which has reviewed and approved the policy under a statute
				substantially similar to Iowa Code section
				509.1(8).
This rule is intended to implement Iowa Code sections
				  509.1,
				  509.6,
				  and
				  509A.14.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.22 - Purpose

Current through Register Vol. 47, No. 3, July 24, 2024
This division of Chapter 35 implements the requirements of
				  Pub.L. 104-191, the Health Insurance Portability and Accountability Act of 1996
				  and Iowa Code section
				  5093.
				  for large group health insurance coverage.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.24 - Eligibility to Enroll

Current through Register Vol. 47, No. 3, July 24, 2024
(1) A carrier
				offering group health insurance coverage shall not establish rules for
				eligibility, including continued eligibility, of an individual to enroll under
				the terms of the coverage based on any of the following health status-related
				factors in relation to the individual or a dependent of the individual:
a. Health status.
b. Medical condition, including both physical
				and mental conditions.
c. Claims
				experience.
d. Receipt of health
				care.
e. Medical history.
f. Genetic information.
g. Evidence of insurability, including
				conditions arising out of acts of domestic violence.
h. Disability.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.27 - Methods of Counting Creditable Coverage

Current through Register Vol. 47, No. 3, July 24, 2024
For purposes of reducing any preexisting condition exclusion
				  period, a group health plan or carrier offering group health insurance coverage
				  shall determine the amount of an individual's creditable coverage by using the
				  standard method described in subrule 35.27(1) except that the plan or carrier
				  may use the alternative method under subrule 35.27(2) with respect to any or
				  all of the categories of benefits described under subrule 35.27(4).
(1) Under the standard method, a group health
				plan or health insurance carrier offering group health insurance coverage shall
				determine the amount of creditable coverage without regard to the specific
				benefits included in the coverage.
a. For
				purposes of reducing the preexisting condition exclusion period, a group health
				plan or health insurance carrier offering group health insurance coverage shall
				determine the amount of creditable coverage by counting all the days that the
				individual has under one or more types of creditable coverage. If on a
				particular day, an individual has creditable coverage from more than one
				source, all the creditable coverage on that day is counted as one day. Further,
				any days in a waiting period for a plan or policy are not creditable coverage
				under the plan or policy.
b. Days
				of creditable coverage that occur before a significant break in coverage are
				not required to be counted.
c.
				Notwithstanding any other provisions of subrule 35.27(2) for purposes of
				reducing a preexisting condition exclusion period, a group health plan or a
				health insurance carrier offering group health insurance coverage may determine
				the amount of creditable coverage in any other manner that is at least as
				favorable to the individual as the method set forth in subrule
				35.27(2).
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.28 - Certificates of Creditable Coverage

Current through Register Vol. 47, No. 3, July 24, 2024
(1) Group health plans or carriers shall
				issue certificates of creditable coverage to persons losing coverage. A group
				health plan or carrier required to provide a certificate under this rule for an
				individual is deemed to have satisfied the certification requirements for that
				individual if another party provides the certificate, but only to the extent
				that information relating to the individual's creditable coverage and waiting
				or affiliation period is provided by the other party. Certificates shall be
				issued within a reasonable amount of time following termination to employees
				and dependents:
a. Automatically upon the
				termination of an individual's group coverage;
b. Automatically upon the termination of
				COBRA coverage;
c. Upon request
				within 24 months after coverage ends.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.29 - Notification Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
(1) A
				group health plan or carrier shall provide written notice to the employee and
				dependents that includes the following:
a. The
				existence of any preexisting condition exclusions.
b. A determination that the group health plan
				or carrier intends to impose a preexisting condition exclusion and:
(1) The basis for the decision to do
				so;
(2) The length of time to which
				the exclusion will apply;
(3) The
				right of the employee or dependent to appeal a decision to impose a preexisting
				condition exclusion;
(4) The right
				of the person to demonstrate creditable coverage including the right of the
				person to request a certificate from a prior group health plan or carrier and a
				statement that the current group health plan or carrier will assist in
				obtaining the certificate.
c. That the group health plan, carrier, or
				ODS will use the alternative method of counting creditable coverage.
d. Special enrollment rights when an employee
				declines coverage for the employee or dependents.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.31 - Disclosure Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
All carriers shall include in contracts and evidence of
				  coverage forms a statement disclosing the existence of any prescription drug
				  formularies. Upon request, all carriers offering health insurance coverage that
				  includes a prescription drug formulary shall inform enrollees of the coverage,
				  and prospective enrollees of the coverage during any open enrollment period,
				  whether a prescription drug specified in the request is included in such
				  formulary.
All carriers 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 35 - Accident and Health Insurance › Rule 191-35.32 - Treatment Options

Current through Register Vol. 47, No. 3, July 24, 2024
(1) A carrier
				shall not prohibit a participating provider from or penalize a participating
				provider for discussing treatment options with covered persons, irrespective of
				the carrier's position on the treatment options, or from advocating on behalf
				of covered persons within the utilization review or grievance processes
				established by the carrier or a person contracting with the carrier
(2) A carrier shall not penalize a provider
				because the provider, in good faith, reports to state or federal authorities
				any act or practice by the carrier that, in the opinion of the provider,
				jeopardizes patient health or welfare.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.33 - Emergency Services

Current through Register Vol. 47, No. 3, July 24, 2024
Benefits shall be available by the carrier for inpatient and
				  outpatient emergency services. Since carriers may not contract with every
				  emergency care provider in an area, carriers shall make every effort to inform
				  members of participating providers.
(1) The term "emergency services" means, with
				respect to an individual enrolled with an organization, covered inpatient and
				outpatient services that are furnished by a provider who is qualified to
				furnish the services that are needed to evaluate or stabilize an emergency
				medical condition.
(2) The term
				"emergency medical condition" means a medical condition manifesting itself by
				symptoms of sufficient severity, including but not limited to severe pain, that
				an ordinarily prudent layperson, who possesses an average knowledge of health
				and medicine, could reasonably expect the absence of immediate medical
				attention to result in one of the following:
a. Placing the health of the individual or,
				with respect to a pregnant woman, the health of the woman and her unborn child
				in serious jeopardy;
b. Serious
				impairment to bodily function; or
c. Serious dysfunction of any bodily organ or
				part.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.34 - Provider Access

Current through Register Vol. 47, No. 3, July 24, 2024
A carrier subject to this chapter shall allow a female
				  enrollee direct access to obstetrical and gynecological services from network
				  or participating providers. The carrier 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 35 - Accident and Health Insurance › Rule 191-35.35 - Reconstructive Surgery

Current through Register Vol. 47, No. 3, July 24, 2024
(1) A carrier
				that provides medical and surgical benefits with respect to a mastectomy shall
				provide the following coverage in the event an enrollee receives benefits in
				connection with a mastectomy and elects breast reconstruction:
a. Reconstruction of the breast on which the
				mastectomy has been performed;
b.
				Surgery and reconstruction of the other breast to produce a symmetrical
				appearance; and
c. Prostheses and
				coverage of physical complications at all stages of a mastectomy including
				lymphedemas.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.36 - Purpose

Current through Register Vol. 47, No. 3, July 24, 2024
These rules implement Iowa Code section
				  514K.1(2)
				   which requires the commissioner and the
				  director of public health to annually publish a consumer guide. These rules
				  apply to all carriers providing health insurance coverage in the individual,
				  small employer group and large group markets that utilize a preferred provider
				  arrangement and to all health maintenance organizations.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.37 - Information Filing Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
				Each health maintenance organization shall annually file with the division no
				later than July 1 the following information by plan as requested by the
				division:
a. Health plan employer data
				information set (HEDIS).
b. Network
				composition.
c. Other information
				determined to be beneficial to consumers including but not limited to consumer
				survey information.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.38 - Limitation of Information Published

Current through Register Vol. 47, No. 3, July 24, 2024
The division may establish limits on the data to be collected
				  and published in the event the division believes the information is not
				  statistically relevant and would not be beneficial to
				  consumers.
Iowa Administrative Code › Agency 191 - Insurance Division › Life and Health Insurance › Chapter 35 - Accident and Health Insurance › Rule 191-35.39 - Contraceptive Coverage

Current through Register Vol. 47, No. 3, July 24, 2024
(1) A
				carrier that provides benefits for outpatient prescription drugs or devices
				shall provide benefits for prescription contraceptive drugs or prescription
				contraceptive devices which prevent conception and are approved by the United
				States Food and Drug Administration or generic equivalents approved as
				substitutable by the United States Food and Drug Administration.
(2) A carrier is not required to provide
				benefits for over-the-counter contraceptive drugs or contraceptive devices that
				do not require a prescription for purchase.
(3) A contraceptive drug or contraceptive
				device does not include surgical services intended for sterilization,
				including, but not limited to, tubal ligation or vasectomy.
(4) A carrier shall be required to provide
				benefits for services related to outpatient contraceptive services for the
				purpose of preventing conception if the policy or contract provides benefits
				for other outpatient services provided by a health care professional.
(5) If a carrier does not provide benefits
				for a routine physical examination, the carrier is not required to provide
				benefits for a routine physical examination provided in the course of
				prescribing a contraceptive drug or contraceptive device.
This rule is intended to implement Iowa Code chapter
				  514C.