Iowa Administrative Code

A third-party administrator shall not operate as a third-party administrator in Iowa without an approved certificate of registration from the division. A third-party administrator that has a home state other than Iowa must apply for and obtain a nonresident third-party administra…

58.4(1) A third-party administrator registered or applying for a certificate of registration or renewal under Iowa Code section 510.21 and this chapter shall: a. Make available for inspection on request by the commissioner copies of all contracts with insurers or other persons ut…

A third-party administrator that wants to maintain its certificate of registration in Iowa shall file a completed request for renewal within 60 days prior to the expiration date on the certificate of registration. 58.5(1) The division shall provide notice to the third-party admin…

58.6(1) If an insurer utilizes the services of a third-party administrator, the insurer shall be responsible for determining the benefits, premium rates, underwriting criteria, and claims payment procedures applicable to the coverage. 58.6(2) An insurer must supervise its contrac…

58.7(1) The written agreement required by Iowa Code section 510.12 shall include a statement of duties that the third-party administrator is expected to perform on behalf of the insurer and the lines, classes or types of insurance for which the third-party administrator is to be …

A third-party administrator and an insurer shall not enter into an agreement or understanding that makes the amount of the third-party administrator’s commissions, fees, or charges contingent upon savings effected in the adjustment, settlement and payment of losses covered by the…

The third-party administrator shall disclose to the insurer all charges, fees and commissions received from all services in connection with the provision of administrative services for the insurer, including any fees or commissions paid by insurers providing reinsurance. Addition…

The purpose of this chapter is to administer the provisions of Iowa Code chapters 510, 510B and 510C relating to the regulation of pharmacy benefits managers. [ARC 1466C, IAB 5/28/14, effective 7/2/14; ARC 4578C, IAB 7/31/19, effective 9/4/19; ARC 6739C, IAB 12/14/22, effective 1…

59.10(1) Cooperation of pharmacy benefits managers with the commissioner. A pharmacy benefits manager shall cooperate with the commissioner and comply with the commissioner’s requests to aid with the commissioner’s administration of Iowa Code chapters 507, 507B, 510, and 510B and…

59.11(1) Filing of annual report. In addition to submitting the third-party administrator annual report required under rule 191—58.11(510), each pharmacy benefits manager shall submit to the commissioner on or before February 15 of each year the annual report required by Iowa Cod…

Failure to comply with the provisions of this chapter or with Iowa Code chapters 510, 510B and 510C or failure to comply with 191—Chapters 58 and 78 or Iowa Code chapters 507 and 514L as they are relevant to the administration of this chapter shall subject the pharmacy benefits m…

The terms defined in Iowa Code sections 510.11, 510B.1, and 510C.1 shall have the same meaning for the purposes of this chapter. The definitions contained in 191—Chapter 58, “Third-Party Administrators,” and 191—Chapter 78, “Uniform Prescription Drug Information Card,” are incorp…

59.3(1) All benefits payable under a pharmacy benefits management plan shall be paid as soon as feasible but within 20 days after receipt of a clean claim when the claim is submitted electronically and shall be paid within 30 days after receipt of a clean claim when the claim is …

59.4(1) An audit of pharmacy records by a pharmacy benefits manager shall be conducted in accordance with the following: a. The pharmacy benefits manager conducting the initial on-site audit must provide the pharmacy written notice at least ten business days prior to conducting a…

59.6(1) A contract between a pharmacy benefits manager and a pharmacy shall include a provision describing notification procedures for contract termination. The contract shall require no less than 60 days’ prior written notice by either party that wishes to terminate the contract…

59.8(1) System to record complaints. Each pharmacy benefits manager shall develop an internal system to record and report complaints. This system shall include but not be limited to the following information regarding each complaint: a. The reason for the complaint and any factua…

A third-party payor that contracts with a pharmacy benefits manager to perform the third-party payor’s services shall require the pharmacy benefits manager to follow Iowa Code section 507E.6 in notifying the commissioner of any detection of fraud, including but not limited to pre…

6.1(1) “Promoters” shall mean any incorporator, organizer, founder or other person or corporation who, acting alone or in concert with other persons, is initiating or directing, or has within one year initiated or directed, the organization of a new insurance company. 6.1(2) “Pub…

Promoters shall invest of their own funds at least 20 percent of the proposed issue in cash. If something other than cash is contemplated to meet the requirements of this rule, it shall be valued by the commissioner of insurance in accordance with the provisions of Iowa Code sect…

All public moneys shall be escrowed 100 percent until the issue is sold unless sooner released by written order of the commissioner of insurance; in the event the issue is not completely sold, all expenses incurred in corporate organization, sale of securities and cost of liquida…

In the event of a public offering, no securities held by the promoters shall, for a three-year period from the date of acquisition, be alienated or hypothecated (except by operation of the law) unless the operation of the insurance company produces earned surplus for two consecut…

In the event of a public offering, no securities shall be acquired by promoters at less than the public offering price.

In the event of public offering, stock options or warrants acquired by promoters shall not exceed 10 percent of the issue.

The general plan of organization as contemplated in Iowa Code section 506.3 shall include proposed management personnel with biographical sketches, including state of residence and complete insurance experience of each.

The chief executive officer of a newly organized insurance company shall be a bona fide resident of Iowa and unless removed for cause and while acting in this capacity shall devote the entire time to such duties unless this requirement is specifically waived by written order of t…

The majority of the directors shall be bona fide residents of the state of Iowa unless specifically waived by written permission of the commissioner of insurance. These rules are intended to implement Iowa Code section 506.1. [Filed 11/21/63] [Editorially transferred from [510] t…

60.1(1) The purpose of this chapter is to set forth filing procedures and parameters for rates as required by Iowa Code chapter 515A. 60.1(2) Nothing herein shall be construed to create or imply a private cause of action for a violation of this chapter. [ARC 7740C, IAB 3/20/24, e…

60.2(1) The definitions in Iowa Code section 515A.2 are incorporated into this chapter by this reference. In addition, the following definitions shall apply: “Division” means the Iowa insurance division. “SERFF” means the National Association of Insurance Commissioners’ System fo…

60.3(1) Insurers required to file rates with the division shall submit required rate filings and any fees required for the filings electronically using SERFF. Insurers must comply with the division’s requirements, including both the Iowa general instructions and the specific subm…

60.4(1) Every insurer, either on its own or via a licensed rating organization, shall file with the division, pursuant to provisions of Iowa Code chapter 515A, every manual, minimum, class rate, rating schedule or rating plan and every other rating rule, and every modification of…

Any insurer found after hearing to have violated a provision of this chapter shall be deemed to have committed an unfair trade practice under Iowa Code chapter 507B and shall be subject to the penalties set forth in Iowa Code chapter 507B. [ARC 7740C, IAB 3/20/24, effective 4/24/…

If any provision of this chapter or the application thereof to any person or circumstance is held invalid for any reason, the invalidity shall not affect the other provisions or any other application of these rules that can be given effect without the invalid provisions or applic…

These rules are effective as of April 24, 2024, and apply to acts or practices committed on or after January 1, 2009. [ARC 7740C, IAB 3/20/24, effective 4/24/24] These rules are intended to implement Iowa Code section 515A.7. [Filed 8/20/08, Notice 7/2/08—published 9/10/08, effec…

This regulation is applicable to all domestic stock insurers having 100 or more stockholders; provided, however, that this regulation shall not apply to any insurer if 95 percent or more of its stock is owned or controlled by a parent or an affiliated insurer and the remaining sh…

7.10(1) Applicability. This rule shall apply to any solicitation subject to this regulation by any person or group for the purpose of opposing a solicitation subject to this regulation by any other person or group with respect to the election or removal of directors at any annual…

These rules are applicable to all domestic mutual insurance companies.

No proxy shall be valid unless signed and executed within two months prior to such meeting or election for which said proxy was given, and such proxy shall be limited to 30 days subsequent to the date of such meeting or election, and may be revoked at any time by the policyholder…

All proxies shall be filed with the company at least one day prior to any meeting or election at which they are to be used.

Soliciting of proxies by an agent of a company either for personal use, or for the use of officers of the company or for any other person or persons, is forbidden. Company funds shall not be expended in procuring proxies. 191—7.15 to 7.19 Reserved. STOCK TRANSACTION REPORTING…

No domestic stock insurer, or any director, officer or employee of such insurer subject to 7.1(523) hereof, or any other person, shall solicit, or permit the use of the person’s name to solicit, by mail or otherwise, any proxy, consent or authorization in respect of any stock of …

7.20(1) Directors, executive officers, and principal stockholders of domestic insurers required to file. Every person who is directly or indirectly the beneficial owner of more than 10 percent of any class of any equity security of an insurer exempt from the filing requirements o…

Unless proxies, consents or authorizations in respect of a stock of a domestic insurer subject to 7.1(523) hereof are solicited by or on behalf of the management of such insurer from the holders of record of stock of such insurer in accordance with this regulation and the schedul…

7.4(1) The definitions and instructions set out in Schedule SIS, as promulgated by the National Association of Insurance Commissioners, shall be applicable for purposes of this regulation. 7.4(2) The terms “solicit” and “solicitation” for purposes of this regulation shall include…

7.5(1) No solicitation subject to this regulation shall be made unless each person solicited is concurrently furnished or has previously been furnished with a written proxy statement containing the information specified in Schedule A. 7.5(2) If the solicitation is made on behalf …

7.6(1) The form of proxy (a) shall indicate in bold-face type whether or not the proxy is solicited on behalf of the management, (b) shall provide a specifically designated blank space for dating the proxy, and (c) shall identify clearly and impartially each matter or group of re…

7.7(1) Two preliminary copies of the proxy statement and form of proxy and any other soliciting material to be furnished to stockholders concurrently therewith shall be filed with the commissioner at least ten days prior to the date definitive copies of such material are first se…

No solicitation subject to this regulation shall be made by means of any proxy statement, form of proxy, notice of meeting, or other communication, written or oral, containing any statement which at the time and in the light of the circumstances under which it is made, is false o…