Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 73 - Health Insurance Purchasing Cooperatives › Rule 191-73.7 - Business Plan

Current through Register Vol. 47, No. 3, July 24, 2024
A HIPC shall submit its business plan for the prior review
				  and approval by the commissioner The business plan shall include but shall not
				  be limited to the following information:
(1) The specific steps by the HIPC sponsor to
				advance cost control, quality improvement, and improve access to health
				insurance or health care services. The business plan should affirmatively
				demonstrate that the HIPC has the technical expertise and physical capacity to
				serve as a significant group of buyers not currently being served by a HIPC.
				Significant means at least 10 percent of the population within the proposed
				service territory. The business plan should affirmatively demonstrate that the
				HIPC will reduce cost, improve quality and improve access to health insurance
				or health care services.
(2) The
				scope of HIPC services to be offered in the service territory and the resources
				and expertise to be used to implement and administer the plan. The HIPC as a
				condition of licensure must demonstrate the technical and physical capacity to
				serve a significant group of buyers over a wide territory, encompassing at
				minimum a regional health care center and its associated rural market. The HIPC
				as a condition of licensure must demonstrate the technical and physical
				capacity to provide equal service quality throughout the entire HIPC service
				territory.
(3) The corporate
				charter, bylaws and other business operation documents of the HIPC. As a
				condition of licensure the HIPC must demonstrate to the satisfaction of the
				commissioner that its corporate governance makes it an appropriate and
				effective representative of buyers' interests within the service territory. A
				HIPC must be more than a marketing or distribution channel for a single product
				or the products of a single carrier A HIPC as a condition of licensure must
				organize and facilitate competition between multiple insurers or health care
				providers.
(4) A list of officers
				and directors of the HIPC and the contract administrator if one is employed and
				personal biographical information or firm descriptions for each. The officers,
				directors, or contract administrator shall not have a prior record of
				administrative, civil or criminal violations within any financial service
				industry. The personal biographical information and firm descriptions shall
				demonstrate by clear and convincing evidence that those involved in the HIPC
				have the expertise, experience and character to effectively and professionally
				represent buyers in a fiduciary capacity.
(5) Evidence of adequate security and
				prudence in the accounting, deposit, collection, handling and transfer of
				moneys. Because the HIPC may handle payments or accounting, the HIPC must
				affirmatively demonstrate adequate financial controls to the satisfaction of
				the division as a condition of licensure. Failure to have adequate controls or
				failure to follow approved procedures shall be a basis to deny, suspend, or
				revoke licensure.
(6) The market
				segments and participants to which the HIPC will be marketing. The HIPC must
				demonstrate to the satisfaction of the commissioner that it will extend HIPC
				services to a significant group of buyers not currently served by a HIPC.
				Failure to achieve this result can be the basis of later denial to renew a
				license.
(7) Disclosure of any
				preexisting oral or written agreements. Preexisting agreements may raise
				questions of conflict or demonstrate the intention to create a marketing
				channel for a single product or single carrier Conversely, preexisting
				agreements may assist in affirmatively demonstrating technical or physical
				capacity to serve a service territory or to extend HIPC services to a
				significant group of buyers not currently served by a HIPC. Regardless, any
				preexisting oral or written agreements must be disclosed. Failure to disclose
				an agreement is the basis for license denial or revocation.
(8) Any other information required by the
				commissioner to verify the HIPC is qualified.