Title XIII, COMMERCE (Ch. 505 - 554I)

1. A person shall not act as a third-party administrator without a written agreement between the third-party administrator and the insurer, and the written agreement shall be retained as part of the official records of both the insurer and the third-party administrator for the du…

If an insurer uses the services of a third-party administrator under the terms of a written contract as required in section 510.12 , payment to the third-party administrator of any premiums or charges for insurance by or on behalf of the insured shall be deemed to have been recei…

A third-party administrator shall maintain at its principal administrative office for the duration of the written agreement referred to in section 510.12 plus five years, adequate books and records of all transactions between it, insurers, and insured persons. The third-party adm…

A third-party administrator may use only such advertising pertaining to the business underwritten by an insurer as has been approved by the insurer in advance of its use. 89 Acts, ch 227, §8 ; 2006 Acts, ch 1117, §42 Referred to in §510.12

The agreement shall provide for the underwriting or other standards pertaining to the business underwritten by the insurer. 89 Acts, ch 227, §9 Referred to in §510.12

1. All insurance charges or premiums collected by a third-party administrator on behalf of or for an insurer, and return premiums received from the insurer, shall be held by the third-party administrator in a fiduciary capacity. Such funds shall be immediately remitted to the per…

A claim paid by the third-party administrator from funds collected on behalf of the insurer shall be paid only on a draft, check, or by electronic funds transfer as authorized by the insurer. 89 Acts, ch 227, §11 ; 96 Acts, ch 1122, §1 ; 2006 Acts, ch 1117, §44 Referred to in §51…

The compensation paid to a third-party administrator shall not be contingent on claim experience on policies for which the third-party administrator adjusts or settles claims. This section does not prevent the compensation of a third-party administrator from being based on premiu…

This chapter may be cited as the “Managing General Agents Act.” 91 Acts, ch 26, §1 Referred to in §510.10

As used in this chapter , unless the context otherwise requires: 1. “Actuary” means a person who is a member in good standing of the American academy of actuaries. 2. “Commissioner” means the commissioner of insurance. 3. “Insurer” means a person duly licensed in this state as an…

1. A domestic insurer shall not enter into a contract with a managing general agent unless the domestic insurer notifies the commissioner in writing of its intention to enter into the contract at least thirty days prior to entering into the contract or within a shorter time permi…

When the services of a third-party administrator are used, the third-party administrator shall provide a written notice, approved by the insurer, to insured individuals, advising them of the identity of and relationship among the third-party administrator, the policyholder, and t…

1. A person shall not act as or represent oneself to be a third-party administrator in this state, other than an adjuster licensed in this state for the kinds of business for which the person is acting as a third-party administrator, unless the person holds a current certificate …

The commissioner may waive the requirements of section 510.21 for any person or class of persons. The factors taken into account in granting a waiver shall include, but are not limited to whether: 1. The person acting as a third-party administrator is primarily in a business othe…

1. If, after hearing, the commissioner determines that a third-party administrator has violated this chapter , or chapter 507B , the commissioner may order any one or more of the sanctions or penalties set out in section 507B.7 . 2. If, after hearing, the commissioner determines …

Notwithstanding any obligation of a director or officer of an insolvent insurer to the liquidator of the insolvent insurer, a managing general agent of a domestic insurer against whom an order of liquidation has been entered is liable for fees paid to the managing general agent p…

1. A person shall not act in the capacity of a managing general agent with respect to risks located in this state for an insurer licensed in this state unless the person is a licensed producer in this state. 2. A person shall not act in the capacity of a managing general agent re…

1. A person acting in the capacity of a managing general agent shall not place business with an insurer unless a written contract is in force between the parties which sets forth the responsibilities of each party. If both parties share responsibility for a particular function, t…

A managing general agent is subject to chapter 507B relating to unfair insurance trade practices. 93 Acts, ch 88, §11 Referred to in §510.10

1. An insurer shall have on file an independent financial examination, in a form acceptable to the commissioner, of each managing general agent with which the insurer does or has done business. 2. If a managing general agent establishes loss reserves, the insurer shall annually o…

The acts of a managing general agent are considered to be the acts of the insurer on whose behalf a managing general agent is acting. A managing general agent may be examined as if it were the insurer. 91 Acts, ch 26, §6 Referred to in §510.10

1. If the commissioner finds, after a hearing conducted in accordance with chapter 17A , that any person has violated one or more provisions of this chapter , the commissioner may do one or more of the following: a. For each separate violation, order the imposition of an administ…

The commissioner may adopt rules, pursuant to chapter 17A , as necessary or convenient for the implementation and administration of this chapter . 91 Acts, ch 26, §8 Referred to in §510.10

This chapter shall be known and may be cited as the “Business Producer Controlled Property and Casualty Insurer Act.” 91 Acts, ch 26, §10 ; 92 Acts, ch 1117, §35

As used in this chapter unless the context otherwise requires: 1. “Accredited state” means a state in which the insurance department or regulatory agency has qualified as meeting the minimum financial regulatory standards promulgated and established by the national association of…

This chapter applies to licensed insurers as defined in section 510A.2 , either domiciled in this state or domiciled in a state that is not an accredited state and having a substantially similar law. All provisions of the insurance holding company Act, to the extent those provisi…

1. Applicability of section. a. This section applies if, in any calendar year, the aggregate amount of gross written premium on business placed with a controlled insurer by a controlling producer is equal to or greater than five percent of the admitted assets of the controlled in…

The insurance producer, prior to the effective date of the policy, shall deliver written notice to the prospective insured disclosing the relationship between the insurance producer and the controlled insurer; except that, if the business is placed through a subproducer who is no…

1. If the commissioner believes that a controlling producer or any other person subject to this chapter has not materially complied with this chapter , or any rule adopted or order issued pursuant to this chapter , after notice and opportunity to be heard, the commissioner may or…

As used in this chapter , unless the context otherwise requires: 1. “Clean claim” means a claim that has no defect or impropriety, including a lack of any required substantiating documentation, or other circumstances requiring special treatment, that prevents timely payment from …

1. The commissioner may take any enforcement action under the commissioner’s authority to enforce compliance with this chapter . 2. After notice and hearing, the commissioner may issue any order or impose any penalty pursuant to section 507B.7 , and may suspend or revoke a pharma…

The commissioner may adopt rules pursuant to chapter 17A to administer this chapter . 2022 Acts, ch 1113, §13, 16, 23

If a provision of this chapter or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and to this end the provisions …

A pharmacy benefits manager doing business in this state shall obtain a certificate as a third-party administrator under chapter 510 , and the provisions relating to a third-party administrator pursuant to chapter 510 shall apply to a pharmacy benefits manager. 2007 Acts, ch 193,…

1. A pharmacy benefits manager shall exercise good faith and fair dealing in the performance of the pharmacy benefits manager’s contractual obligations toward a third-party payor or a pharmacy. 2. A pharmacy benefits manager shall notify a health carrier in writing of any activit…

A pharmacy benefits manager shall not retaliate against a pharmacy based on the pharmacy’s exercise of any right or remedy under this chapter , including but not limited to filing a complaint with the commissioner or cooperating with the commissioner pursuant to the commissioner’…

1. A pharmacy benefits manager shall not do any of the following: a. If a pharmacy or pharmacist has agreed to participate in a covered person’s health benefit plan, prohibit or limit the covered person from selecting a pharmacy or pharmacist of the covered person’s choice, or im…

A pharmacy benefits manager, unless authorized pursuant to the terms of its contract with a health carrier, shall not contact any covered person without the express written permission of the health carrier. 2007 Acts, ch 193, §5, 9 ; 2022 Acts, ch 1113, §4, 16, 23

1. The following provisions shall apply if a pharmacy benefits manager requests the dispensing of a substitute prescription drug for a drug prescribed for a covered person: a. The pharmacy benefits manager may request the substitution of a lower priced generic and therapeutically…

A pharmacy benefits manager shall not assess, charge, or collect any form of remuneration that passes from a pharmacy or a pharmacist to the pharmacy benefits manager including but not limited to claim processing fees, performance-based fees, network participation fees, or accred…

1. A covered person shall not be required to make a cost-sharing payment at the point of sale for a prescription drug in an amount that exceeds the total amount that the pharmacy at which the covered person fills the covered person’s prescription drug order is reimbursed. 2. A ph…

1. Prior to placement of a particular prescription drug on a maximum allowable cost list, a pharmacy benefits manager shall ensure that all of the following requirements are met: a. The particular prescription drug must be listed as therapeutically and pharmaceutically equivalent…

1. A pharmacy benefits manager shall not reimburse any pharmacy located in the state in an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for dispensing the same prescription drug as dispensed by the pharmacy. 2. A …

After the date of receipt of a clean claim submitted by a pharmacy in a pharmacy network, a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly except in the following circumstances: 1. The claim is found not to be a clean …

1. All contracts executed, amended, adjusted, or renewed on or after July 1, 2025, that apply to prescription drug benefits on or after January 1, 2026, between a pharmacy benefits manager and a third-party payor, or between a person and a third-party payor, shall include all of …

1. A pharmacy benefits manager shall provide a reasonable process to allow a pharmacy to appeal any matter. 2. The appeals process must include all of the following: a. A dedicated telephone number at which a pharmacy may contact the pharmacy benefits manager and speak directly w…