Iowa Administrative Code

shall be in the following form: LIMITED SERVICE ORGANIZATION APPLICATION FOR CERTIFICATE OF AUTHORITY (Name of Limited Service Organization) Organized as ___________________________________ under the laws of the state of ________________________, makes application to the commissi…

41.11(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 …

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 cancell…

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 sha…

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 direc…

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 o…

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 followi…

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. [ARC 5515C, IAB 3/10/21, effective 4/14/21]

rule 191—40.20(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 from such services is approved by the commissioner. A provider and sufficient other licensed and ancil…

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 servic…

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 informa…

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 …

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…