Iowa Administrative Code

56.6(1) Every workers’ compensation self-insurance association shall adhere to the uniform classification system, uniform experience rating plan, and manual rules filed with the commissioner by an advisory organization designated by the commissioner. 56.6(2) Premium contributions…

56.7(1) If the association fails to pay workers’ compensation benefits when due, the commissioner may appoint a party to receive funds from excess insurance or the surety bond, or both, to be disbursed to individual claimants. 56.7(2) The association shall notify the industrial c…

56.8(1) The certificate of approval issued by the commissioner to a workers’ compensation self- insurance association authorizes the association to provide workers’ compensation benefits. The certificate of approval remains in effect until terminated at the request of the associa…

records and assets of each association as often as the commissioner deems advisable. The expense of such examinations shall be assessed against the association in the same manner that insurers are assessed for examinations.

57.1(1) The purpose of this chapter is to provide general guidelines for the approval of self-insurance for workers’ compensation liability for individual employers. 57.1(2) The authority to promulgate these rules is found in Iowa Code section 505.8. 57.1(3) Certificates of relie…

as often as it deems necessary. Cost of the examination is to be paid by the employer. Examination shall include but not be limited to adequacy of loss reserves and claims handling practices.

The following constitute grounds for nonrenewal or revocation of a certificate of relief from insurance: 57.11(1) Failure to comply with any provisions of these rules or of Iowa Code chapter 85, 85A, 85B, 86 or 87; 57.11(2) Failure to comply with any lawful order of the commissio…

issued under this chapter, a certificate holder shall be given a hearing and a right to appeal as provided in 7—Chapter 2506. [Editorial change: IAC Supplement 8/19/26]

57.13(1) All individual employers which were given a certificate of relief from insurance or some other approval to self-insure from the division prior to the effective date of these rules shall bring themselves into full compliance with these rules within 90 days after their eff…

person or circumstance, is subsequently held to be invalid, such invalidity shall not affect other provisions or applications of this chapter. These rules are intended to implement Iowa Code sections 87.11 and 87.20. [Filed 6/1/84, Notice 4/11/84—published 6/20/84, effective 8/1/…

57.2(1) “Commissioner” shall mean the commissioner of the insurance division of Iowa, appointed by the governor pursuant to Iowa Code section 505.2. 57.2(2) “Division” shall mean the insurance division of Iowa. 57.2(3) “Employer” shall be defined as set forth in Iowa Code section…

insurance, an employer must satisfy the following requirements: 57.3(1) File with the division an annual surety bond issued by an insurance company licensed to do business in the state of Iowa in an amount determined by applying the formula below, but in no case shall the bond be…

57.4(1) If at any time the commissioner feels additional security is necessary because any one or more of the following factors are present, the commissioner may require such additional security as provided in subrule 57.4(2): a. Insufficient liquid assets or retained earnings; b…

57.5(1) An applicant for a certificate of relief from insurance shall submit a completed application to the division together with the following: a. A surety bond or other security, in the amount determined under rule 57.3(87,505); b. Parental guarantee from the ultimate controll…

insurance shall be recognized in considering the ability of an applicant to fulfill its financial obligations under the workers’ compensation Act, unless such contract or policy complies with the following: 57.7(1) Is issued by a company: a. Licensed to transact casualty business…

appoint a party to receive funds on the surety bond or other posted security to be dispersed to individual claimants.

57.9(1) Individual employers. a. A certificate of relief from insurance is valid for one year, unless sooner revoked under the provisions of rule 57.11(87,505). Such certificate is effective from August 1 to July 31. b. By June 1 of each year, each individual employer must submit…

510 relating to the regulation of third-party administrators. [ARC 8310B, IAB 11/18/09, effective 12/23/09]

termination notices or other written communications delivered by the insurer to the third-party administrator for delivery to insured parties or covered individuals shall be delivered by the third-party administrator promptly after receipt of delivery instructions from the insure…

58.11(1) Each registered third-party administrator shall file by July 1 an annual report in a form and manner as prescribed by the commissioner. The report shall: a. Be verified by at least two officers of the third-party administrator; b. Include audited financial statements pre…

58.12(1) A third-party administrator shall notify the commissioner within 30 days of any change in the information required to be filed under these rules including, but not limited to, a change of original application content. Reports of changes shall be filed electronically as i…

to inquiries from the commissioner. A third-party administrator’s actions are deemed untimely under this rule if the third-party administrator fails to respond to an inquiry from the commissioner within 30 days of the receipt of the inquiry, unless good cause exists for delay and…

five years. Complaint information shall be made available to the division by the third-party administrator at any time upon the commissioner’s request. [ARC 8310B, IAB 11/18/09, effective 12/23/09]

administrator or require the most recent audited financial statements from the third-party administrator and such other interim evidence as the commissioner deems appropriate. 58.15(1) Reasonable costs of the examination or audited financial statements shall be paid by the third-…

registration. 58.16(1) The commissioner may, at the commissioner’s discretion and without advance notice or hearing, immediately suspend the certificate of registration of a third-party administrator if the commissioner finds that one or more of the following circumstances exist:…

58.17(1) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials or i…

58.18(1) Fees to be paid directly to the division shall be paid by check. Fees accompanying electronic filings shall be paid in a manner as directed by the commissioner. 58.18(2) Fees related to this chapter are as follows: a. The fee to accompany an application for a certificate…

person or circumstance, is subsequently held to be invalid, such invalidity shall not affect other provisions or applications of this chapter. [ARC 8310B, IAB 11/18/09, effective 12/23/09]

shall have the same meaning for the purposes of this chapter. In addition, for purposes of this chapter: “Affiliate” or “affiliates” means an entity or person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control w…

2010. [ARC 8310B, IAB 11/18/09, effective 12/23/09] These rules are intended to implement Iowa Code chapters 505 and 510. [Filed 7/6/90, Notice 5/16/90—published 7/25/90, effective 8/29/90] [Filed ARC 8310B (Notice ARC 8140B, IAB 9/9/09), IAB 11/18/09, effective 12/23/09] [Filed …

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 administrator certificate of registration from the division before operat…

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…

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 administrator of the upcoming renewal date. 58.5(2) The renewal form shall …

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 …

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 insurer’s obligations. Third-party…

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. Additional charges may not be made for services to the extent the in…

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 1/1/23; ARC 6890C, IAB 2/8/23, effective 3/15/23]

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…

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 manager to the penalties of …

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 incorporated by reference. As used in this chapter: “Complaint” means a written…

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…

3/15/23.

managers. 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 th…