Iowa Administrative Code

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 prescri…

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 sh…

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 s…

41.5(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…

name of the LSO may not be changed without prior approval of the division.

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.

41.8(1) Each LSO shall provide in its bylaws for a system to resolve and record complaints. 41.8(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. Comp…

41.9(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 …

cash surrender values and paid-up nonforfeiture benefits to both men and women. No change in minimum valuation standards is implied by this rule.

“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 Individ…

a male or female insured delivered or issued for delivery in this state after the operative date of Iowa Code section 508.37, an insurer may: 42.3(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…

insurer to issue the same kind of policy of life insurance on both a sex-distinct and sex-neutral basis.

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. 191—42.6(508) 2001 CSO Mortality Table. The 2001 CSO Mortality Table shall be used for purposes of this chapter pursuant …

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 (2012 IAR) Table, and the 1994 Group Annuity Re…

“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 …

43.3(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 in…

43.4(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 valua…

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.

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, …

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. [ARC 1110C, IAB 10/16/13, effective 1/1/15] These rules are intended to implement Iowa Code section…

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.

“1980 CSO Table, with or without Ten-Year Select Mortality Factor” 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 Individu…

44.3(1) In determining minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits for any policy of insurance delivered or issued for delivery in this state after the operative date of Iowa Code section 508.37(7)“k” for that policy…

insurer may: 1. Use composite mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits, 2. Use smoker and nonsmoker mortality tables to determine the valuation net premiums and additional minimum res…

person or circumstance is for any reason held to be invalid, the remainder of this chapter and the application of the remaining provisions to other persons or circumstances shall not be affected. 191—44.6(508) 2001 CSO Mortality Table. The 2001 CSO Mortality Table shall be used f…

which the commissioner deems necessary to carry out the provisions of Iowa Code chapter 521A. The information called for by these rules is hereby declared to be necessary and appropriate in the public interest and for the protection of policyholders in this state. This rule is in…

45.10(1) Requests for approval of extraordinary dividends or any other extraordinary distribution to shareholders shall include the following: a. The date established for payment of the dividend; b. The amount of the proposed dividend; c. A statement as to whether the dividend is…

enterprise risk report pursuant to Iowa Code section 521A.4(12) shall furnish the required information on Form F, hereby made a part of these rules. [ARC 1844C, IAB 2/4/15, effective 1/14/15]

expressly required to be included in Form A, Form B, Form C, Form D, and Form F, the commissioner may request such further material information, if any, as may be necessary to make the information contained therein not misleading. The person filing may also file such exhibits as …

191—1.1(502,505), the following rules apply to this chapter, unless otherwise required by the context: “Executive officer” means any individual charged with active management and control in an executive capacity (including a president, vice-president, treasurer, secretary, contro…

Code section 521A.2(3) is in addition to any authority to invest in subsidiaries which may be contained in any other provision of the insurance code. An investment by a subsidiary under Iowa Code section 521A.2(3)“c” may cause the total investment of the insurer to exceed any of …

pursuant to Iowa Code section 521A.3 entitled “Acquisition of control of or merger with domestic insurer,” shall furnish all the information requested on Form A hereto annexed and hereby made a part of these rules. 45.4(1) If the person being acquired is a “domestic insurer” sole…

45.5(1) Annual registration. Any insured required to file an annual registration statement pursuant to Iowa Code section 521A.4 shall furnish all the information required on Form B hereto annexed and hereby made a part of these rules. 45.5(2) Amendment to Form B. An amendment to …

registration statement on behalf of any affiliated insurer or insurers which are required to register under section 521A.4. A registration statement may include information regarding any insurer in the insurance holding company system even if such insurer is not authorized to do …

shall not be required to register pursuant to that section if it is admitted in the domiciliary state of the principal insurer (as that term is defined in 45.6(1)) and in said state if subject to disclosure requirements and standards adopted by the statute or rules which are subs…

termination of registration claiming that a person does not, or will not upon the taking of some proposed action, control another person (hereinafter referred to as the “subject”) shall contain the following information: 45.8(1) The number of authorized, issued and outstanding vo…

45.9(1) An insurer required to give notice of a proposed transaction pursuant to Iowa Code section 521A.5 shall furnish the required information on Form D, hereby made a part of these rules. 45.9(2) Agreements for cost-sharing services and management services shall, at a minimum …

521A.14 to provide for: 46.1(1) The formation of a mutual insurance holding company through an application process subject to regulation by the division. A domestic mutual insurance company may reorganize by forming a mutual insurance holding company based upon a mutual plan. The…

j. Describing other relevant matters the applicant deems appropriate. 46.4(3) With regard to either a limited or standard application, the plan of reorganization submitted to the commissioner shall demonstrate: a. Policyholder interests are properly preserved and protected. b. Th…

46.11(1) A mutual insurance holding company, and its subsidiaries and affiliates, shall be subject to all provisions of Iowa Code chapter 521A, “Insurance Holding Company Systems.” In addition to the provisions of that chapter, all material transactions, as that term is defined i…

46.12(1) Any director or officer of a mutual insurance holding company, its subsidiary or affiliate, who acquires directly or indirectly the beneficial ownership of any security issued by any member of the mutual insurance holding company system shall, within 15 days following th…

definitions apply to this chapter: “Affiliated person” of another person means: 1. Any person directly or indirectly owning, controlling, or holding with power to vote, 5 percent or more of the outstanding voting securities of such other person, 2. Any person 5 percent or more of…

46.3(1) An application shall be designated as either: a. A limited application, or b. A standard application. The filing of a limited application shall not preclude the subsequent filing of an application for approval of an initial sale of stock as provided in rule 46.9(521A). 46…

46.4(1) A limited application plan of reorganization shall include provisions: a. Establishing a mutual insurance holding company with at least one stock insurance company subsidiary or one intermediary stock holding company with a stock insurance company subsidiary, the shares o…

46.5(1) The commissioner shall at all times retain jurisdiction over the mutual insurance holding company and its intermediate holding company subsidiaries with stock insurance company subsidiaries. 46.5(2) Following the hearing provided in 46.3(3) the commissioner shall, by orde…

46.6(1) Mutual insurance holding companies shall comply with the provisions of Iowa Code chapter 521A except as expressly provided herein. 46.6(2) No regulatory standards are waived during the pendency of an application for a plan of reorganization. 46.6(3) Mergers and acquisitio…

company. A domestic mutual insurance company may apply to reorganize by merging its policyholders’ membership interests into a mutual insurance holding company by filing with the commissioner a joint application with the mutual insurance holding company complying with the provisi…

A foreign mutual insurance company, or a foreign health service corporation, which if a domestic corporation would be organized under Iowa Code chapter 514, may apply to reorganize by merging its policyholders’ membership interests into a mutual insurance holding company by filin…

company may apply to merge with another mutual insurance holding company by filing with the commissioner a plan of merger and complying with the provisions of Iowa Code chapters 521 and 521A. 191—46.10(521A) Stock offerings. 46.10(1) No stock offering by a mutual insurance holdin…

rules for their use, rules concerning a minimum standard for the valuation of plans with nonlevel premiums or benefits, and rules concerning a minimum standard for the valuation of plans with secondary guarantees. The method for calculating basic reserves defined in this chapter …