 |
Iowa Code (Last Updated: December 05, 2016) |
 |
Title XIII. COMMERCE |
|
Chapter 507A. UNAUTHORIZED INSURERS |
Section 507A.4. Transactions where law not applicable.
-
The provisions of this chapter shall not apply to:
1. The lawful transaction of surplus lines insurance as permitted by chapter 515I.
2. The lawful transaction of reinsurance by insurers.
3. Attorneys acting in the ordinary relation of attorney and client in the adjustment of claims or losses.
4. Transactions in this state involving a policy lawfully solicited, written, and delivered outside of this state, covering subjects of insurance not resident located, or expressly to be performed in this state at the time of issue, and which transactions are subsequent to the issuance of the policy.
5. Transactions in this state involving group or blanket insurance and group annuities where the master policy of such groups was lawfully issued and delivered in a state in which the company was authorized to do an insurance business.
6. Transactions in this state involving any policy of insurance issued prior to July 1, 1967.
7. Insurance on vessels, craft or hulls, cargoes, marine builder’s risk, marine protection and indemnity or other risk including strikes and war risks commonly insured under ocean or wet marine forms of policy.
8. Transactions involving risks located in this state where the policy or contract of insurance for such risk was principally negotiated and delivered outside this state and was lawfully issued in a state or foreign country in which the foreign or alien insurer was authorized to do an insurance business, and where such insurer has no contact with this state except in connection with inspections or losses required by virtue of the contract or policy of insurance covering the risk located in this state.
9. a. Transactions involving a multiple employer welfare arrangement, as defined in section 3 of the federal Employee Retirement Income Security Act of 1974, 29 U.S.C. §1002, paragraph 40, if the multiple employer welfare arrangement meets all of the following conditions:
(1) The arrangement is administered by an authorized insurer or an authorized third-party administrator.
(2) The arrangement has been in existence and provided health insurance in Iowa for at least five years prior to July 1, 1997.
(3) The arrangement was established by a trade, industry, or professional association of employers that has a constitution or bylaws, and has been organized and maintained in good faith for at least ten continuous years prior to July 1, 1997.
(4) The arrangement registers with and obtains a certificate of registration issued by the commissioner of insurance.
(5) The arrangement is subject to the jurisdiction of the commissioner of insurance, including regulatory oversight and solvency standards as established by rules adopted by the commissioner of insurance pursuant to chapter 17A.
b. A multiple employer welfare arrangement registered with the commissioner of insurance that does not meet the solvency standards established by rule adopted by the commissioner of insurance is subject to chapter 507C.
c. A multiple employer welfare arrangement that meets all of the conditions of paragraph “a” shall not be considered any of the following:
(1) An insurance company or association of any kind or character under section 432.1.
(2) A member of the Iowa individual health benefit reinsurance association under section 513C.10.
(3) A member insurer of the Iowa life and health insurance guaranty association under section 508C.5, subsection 12.
d. A multiple employer welfare arrangement registered with the commissioner of insurance shall file with the commissioner of insurance on or before March 1 of each year a copy of the report required to be filed with the United States department of labor pursuant to 29 C.F.R. §2520.101-2.
e. When not otherwise provided, a foreign or domestic multiple employer welfare arrangement doing business in this state shall pay to the commissioner of insurance the fees as required in section 511.24.
10. a. A self-funded health benefit plan sponsored by an employer in this state under the federal Employee Retirement Income Security Act of 1974, as codified in 29 U.S.C. §1169, which provides health benefits to independent contractors of the employer and to spouses and dependents of the independent contractors, if the plan is granted a waiver from the provisions of this chapter by the commissioner and meets all of the following conditions:
(1) There is a written contract between the sponsor of the health benefit plan and the independent contractor which establishes the relationship between the parties to the contract and provides for the personal services to be provided by the independent contractor to the sponsor of the health benefit plan pursuant to the contract.
(2) The personal services to be provided by the independent contractor pursuant to the contract are directly related to the principal business of the sponsor of the health benefit plan.
(3) The contract provides that the independent contractor will provide services to the sponsor of the health benefit plan on an exclusive basis.
(4) The inclusion of the independent contractor in the sponsor’s health benefit plan is incidental to the contractual relationship between the sponsor of the health benefit plan and the independent contractor.
(5) Independent contractors and their spouses and dependents included in an employer-sponsored health benefit plan do not in total equal more than forty-nine percent of the total persons covered by the health benefit plan.
(6) The health benefit plan is administered by an authorized insurer or an authorized third-party administrator.
b. The sponsor of the health benefit plan shall file an application for waiver from the provisions of this chapter with the commissioner as prescribed by the commissioner and shall file periodic statements and information as required by the commissioner. The commissioner shall adopt rules pursuant to chapter 17A implementing this subsection. All statements and information filed with or disclosed to the commissioner pursuant to this subsection are confidential records pursuant to chapter 22.
c. If at any time the commissioner determines that a health benefit plan for which a waiver has been granted does not meet all of the conditions of paragraph “a”, and the rules adopted by the commissioner under paragraph “b”, the commissioner may terminate the waiver granted to the health benefit plan.
d. A self-funded employer-sponsored health benefit plan which has a valid waiver from the provisions of this chapter shall not be considered any of the following:
(1) An insurance company or association of any kind or character under section 432.1.
(2) A member insurer of the Iowa life and health insurance guaranty association as defined in section 508C.5, subsection 12.
(3) A carrier under chapter 513B.
(4) A member of the Iowa individual health benefit reinsurance association under section 513C.10.
(5) An entity subject to chapter 514C.
(6) A multiple employer welfare arrangement as defined in subsection 9.
e. A self-funded employer-sponsored health benefit plan which has received a waiver from the provisions of this chapter shall be considered to be a self-funded employer-sponsored health benefit plan under the federal Employee Retirement Income Security Act of 1974, as codified in 29 U.S.C. §1169, and not subject to this title so long as the waiver is in effect.
f. The provision of health benefits to an independent contractor by a self-funded employer-sponsored health benefit plan which meets all of the conditions of paragraph “a” shall not in and of itself create an employer-employee relationship between the independent contractor and the sponsor of the health benefit plan.
[C71, 73, 75, 77, 79, 81, §507A.4]