Iowa Admin. Code r. 191-58.3 - Registration required
A third-party administrator shall not operate as a third-party 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 operating as a third-party administrator in Iowa.
(1)
Exceptions.
a. The following persons doing the following
corresponding actions shall not be required to have approved certificates of
registration from the division if these are the only actions by the persons
that would otherwise cause the persons to be considered third-party
administrators:
(1) An employer administering
its employee benefit plan or the plan of an affiliated employer under common
management and control;
(2) A trust
exempt from taxation under Section 507(a) of the Internal Revenue Code and its
trustees and employees acting pursuant to such trust, or a custodian and the
custodian's agents or employees acting pursuant to a custodian account that
meets the requirements of Section 401(f) of the Internal Revenue Code;
or
(3) A person licensed as a
managing general agent in this state when acting within the scope of activities
conveyed under such a license.
b. An insurer that underwrites, collects
charges, collateral or premiums from, or adjusts or settles claims for other
than its policyholders, subscribers and certificate holders is not required to
be licensed as a third-party administrator and shall be exempt from rule
191-58.3(505,510), except that the insurer shall comply with paragraphs
58.3(1)"c," "e" and "f" and rules
191-58.6(505,510) and
191-58.7 (505,510), if
applicable.
c. A person shall not
be required to have an approved certificate of registration from the division
if that person is affiliated with a licensed insurer and that person only acts
as a third-party administrator for the direct and assumed insurance business of
the affiliated insurer, provided that the insurer shall provide all of the
third-party administrator's books and records to the insurance commissioner
upon request.
d. A person shall not
be required to have an approved certificate of registration from the division
if that person only acts as a third-party administrator for a group plan based
in another state that has fewer than 100 insureds under the plan residing in
Iowa.
e. A person who is not
required to be registered as a third-party administrator under Iowa Code
chapter 510 or this chapter and who directly or indirectly underwrites,
collects charges or premiums from, or adjusts or settles claims on residents of
this state, only in connection with life, annuity or health coverage provided
by a self-funded plan other than a governmental or church plan, shall file a
statement with the commissioner triennially, verifying the person's status as
described herein. An example of such a statement may be found on the division's
website.
f. An administrator
operating solely as a single-employer trust or Taft-Hartley labor union trust
as defined under ERISA shall be required to file a statement triennially,
verifying the administrator's status as described herein. An example of such a
statement may be found on the division's website.
(2)
Application.
a. All third-party administrators wishing to
do business in Iowa shall electronically file a completed application and any
required attachments in the form prescribed by the division. The division may
require the applicant to identify the following persons affiliated with the
third-party administrator: owners with 10 percent interest or voting interest,
and any partners, officers, directors, members or managers of the business
entity. The application shall be accompanied by a filing fee as stated in rule
191-58.18(510).
b. All third-party
administrator applicants shall submit a completed biographical affidavit, in a
form prescribed by the commissioner, for all individuals identified in
paragraph 58.3(2)"a."
c. Application for resident third-party
administrator certificate of registration.
(1)
All applications shall include evidence of the existence of a surety bond
issued by an insurance company licensed to do business in the state of Iowa.
The bond must be in an amount equivalent to 10 percent of the third-party
administrator's average daily client account balance during the preceding
calendar year. In no case shall the bond be less than $50,000 or more than
$1,000,000. The surety bond shall be in the form prescribed by the
commissioner. The bond shall be payable to the Iowa Insurance Division to
ensure the financial protection of the third-party administrator's customers,
subject to the dollar limitation of the surety bond.
(2) An application by a third-party
administrator that is a corporation, association or benefit society shall be
accompanied by a certified copy of the articles of incorporation or association
or a certification of good standing from the Iowa secretary of state.
d. Application for nonresident
third-party administrator certificate of registration.
(1) A third-party administrator whose home
state is not Iowa shall file with the division, in a manner acceptable to the
division, a completed application and a certification from the home state that
verifies that the applicant is in good standing in the home state.
(2) In lieu of requiring a third-party
administrator to file a certification, the division may verify the nonresident
third-party administrator's home state status through an electronic database
maintained by the National Association of Insurance Commissioners, its
affiliates or subsidiaries.
(3) A
third-party administrator shall not be eligible for a nonresident third-party
administrator certificate of registration under paragraph
58.3(2)"c" if the third-party administrator does not hold a
certificate of registration as a resident in a home state that has adopted a
law governing third-party administrators substantially similar to Iowa Code
chapter 510 and this chapter. A third-party administrator may designate a state
other than the resident state as its home state. If a third-party administrator
is not eligible under paragraph 58.3(2)"c," it must meet the
application requirements for a resident third-party administrator.
e. The division may refuse to
issue a certificate of registration to an applicant as provided in Iowa Code
section
510.21,
or may refuse to issue a certificate of registration if the division determines
that any of the grounds set forth in rule
191-58.16 (510) exist with
respect to the third-party administrator.
f. If an application is approved, the
division will electronically deliver to the third-party administrator a
certificate of registration.
(3)
Validity. A certificate
of registration issued under Iowa Code chapter 510 and this rule shall remain
valid, unless surrendered by the third-party administrator, or suspended,
revoked, or not renewed by the commissioner, for as long as the third-party
administrator continues to renew the certificate of registration timely,
continues in business in this state, and remains in compliance with Iowa Code
chapter 510 and this chapter.
Notes
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