§ 513c-10

513C.10 Iowa individual health benefit reinsurance association. 1. The Iowa individual health benefit reinsurance association is established as a nonprofit corporation. a. All persons that provide health benefit plans in this state including insurers providing accident and sickness insurance under chapter 509, 514, or 514A, whether on an individualor group basis; fraternal benefit societies providing hospital, medical, or nursing benefitsunder chapter 512B; and health maintenance organizations, other entities providing healthinsurance or health benefits subject to state insurance regulation, and all other insurers asdesignated by the board of directors of the Iowa comprehensive health insurance associationwith the approval of the commissioner shall be members of the association. b. The association shall be incorporated under chapter 504, shall operate under a plan of operation established and approved pursuant to chapter 504, and shall exercise its powersthrough the board of directors established under chapter 514E. 2. a. Rates for basic and standard coverages as provided in this chapter shall be determined by each carrier as the product of a basic and standard factor and the

tors established under chapter 514E. 2. a. Rates for basic and standard coverages as provided in this chapter shall be determined by each carrier as the product of a basic and standard factor and the lowestrate available for issuance by that carrier adjusted for rating characteristics and benefits.Basic and standard factors shall be established annually by the Iowa comprehensive healthinsurance association board with the approval of the commissioner. Multiple basic andstandard factors for a distinct grouping of basic and standard policies may be established. Abasic and standard factor is limited to a minimum value defined as the ratio of the averageof the lowest rate available for issuance and the maximum rate allowable by law divided bythe lowest rate available for issuance. A basic and standard factor is limited to a maximumvalue defined as the ratio of the maximum rate allowable by law divided by the lowest rateavailable for issuance. The maximum rate allowable by law and the lowest rate availablefor issuance is determined based on the rate restrictions under this chapter. For policieswritten after January 1, 2002, rates for the basic and standard coverages as provided in

lowest rate availablefor issuance is determined based on the rate restrictions under this chapter. For policieswritten after January 1, 2002, rates for the basic and standard coverages as provided in thischapter shall be calculated using the basic and standard factors and shall be no lower thanthe maximum rate allowable by law. However, to maintain assessable loss assessments ator below one percent of total health insurance premiums or payments as determined inaccordance with subsection 6, the Iowa comprehensive health insurance association boardwith the approval of the commissioner may increase the value for any basic and standardfactor greater than the maximum value. b. The Iowa individual health benefit reinsurance association may, with the approval of the commissioner, increase cost-sharing provisions including, but not limited to, basic andstandard plan deductibles, coinsurance, or copayments. 3. Following the close of each calendar year, the association, in conjunction with the commissioner, shall require each carrier to report the amount of earned premiums and theassociated paid losses for all basic and standard plans issued by the carrier.

ciation, in conjunction with the commissioner, shall require each carrier to report the amount of earned premiums and theassociated paid losses for all basic and standard plans issued by the carrier. The reportingof these amounts must be certified by an officer of the carrier. 4. The board shall develop procedures and assessment mechanisms and make assessments and distributions as required to equalize the individual carrier gains or losses sothat each carrier receives the same ratio of paid claims to ninety percent of earned premiumsas the aggregate of all basic and standard plans insured by all carriers in the state. 5. If the statewide aggregate ratio of paid claims to ninety percent of earned premiums is greater than one, the dollar difference between ninety percent of earned premiums and thepaid claims shall represent an assessable loss. 6. The assessable loss plus necessary operating expenses for the association, plus any additional expenses as provided by law, shall be assessed by the association to all membersin proportion to their respective shares of total health insurance premiums or paymentsfor subscriber contracts received in Iowa during the second preceding calendar

by the association to all membersin proportion to their respective shares of total health insurance premiums or paymentsfor subscriber contracts received in Iowa during the second preceding calendar year, orwith paid losses in the year, coinciding with or ending during the calendar year, or on anyother equitable basis as provided in the plan of operation. In sharing losses, the associationmay abate or defer any part of the assessment of a member, if, in the opinion of the board,payment of the assessment would endanger the ability of the member to fulfill its contractualobligations. The association may also provide for an initial or interim assessment against Sat Dec 23 00:44:08 2023 Iowa Code 2024, Section 513C.10 (19, 0) §513C.10, INDIVIDUAL HEALTH INSURANCE MARKET REFORM 2 the members of the association to meet the operating expenses of the association until thenext calendar year is completed. For purposes of this subsection, 'total health insurancepremiums' and 'payments for subscriber contracts' include, without limitation, premiumsor other amounts paid to or received by a member for individual and group health plan carecoverage provided under any chapter of the Code or Acts,

iber contracts' include, without limitation, premiumsor other amounts paid to or received by a member for individual and group health plan carecoverage provided under any chapter of the Code or Acts, and 'paid losses' includes, withoutlimitation, claims paid by a member operating on a self-funded basis for individual and grouphealth plan care coverage provided under any chapter of the Code or Acts. For purposes ofcalculating and conducting the assessment, the association shall have the express authorityto require members to report on an annual basis each member’s total health insurancepremiums and payments for subscriber contracts and paid losses. A member is liable for itsshare of the assessment calculated in accordance with this section regardless of whether itparticipates in the individual insurance market. 7. The board shall develop procedures for distributing the assessable loss assessments to each carrier in proportion to the carrier’s respective share of premium for basic and standardplans to the statewide total premium for all basic and standard plans. 8. The board shall ensure that procedures for collecting and distributing assessments are as efficient as possible for

d standardplans to the statewide total premium for all basic and standard plans. 8. The board shall ensure that procedures for collecting and distributing assessments are as efficient as possible for carriers. The board may establish procedures which combine, oroffset, the assessment from, and the distribution due to, a carrier. 9. A carrier may petition the association board to seek remedy from writing a significantly disproportionate share of basic and standard policies in relation to total premiums written inthis state for health benefit plans. Upon a finding that a carrier has written a disproportionateshare, the board may agree to compensate the carrier either by paying to the carrier anadditional fee not to exceed two percent of earned premiums from basic and standard policiesfor that carrier or by petitioning the commissioner for remedy. 10. The commissioner, upon a finding that the acceptance of the offer of basic and standard coverage by individuals pursuant to this chapter would place the carrier in afinancially impaired condition, shall not require the carrier to offer coverage or acceptapplications for any period of time the financial impairment is deemed to exist.

r would place the carrier in afinancially impaired condition, shall not require the carrier to offer coverage or acceptapplications for any period of time the financial impairment is deemed to exist. 95 Acts, ch 5, §12; 2000 Acts, ch 1023, §21; 2001 Acts, ch 125, §4 – 6; 2002 Acts, ch 1119, §66; 2003 Acts, ch 91, §25, 26, 53; 2004 Acts, ch 1049, §191; 2004 Acts, ch 1110, §37, 38; 2004 Acts,ch 1158, §4, 5; 2004 Acts, ch 1175, §394; 2012 Acts, ch 1023, §157; 2017 Acts, ch 148, §57 – 59 Referred to in §507A.4, 513C.9, 513C.11, 513D.1 Sat Dec 23 00:44:08 2023 Iowa Code 2024, Section 513C.10 (19, 0)