Iowa Admin. Code r. 191-58.6 - Responsibilities of the insurer
(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.
(2) An insurer must supervise its contracted
third-party administrators to ensure that its programs are administered in a
competent and appropriate manner.
(3) In cases where a third-party
administrator administers benefits for more than 100 certificate holders,
subscribers, claimants or policyholders on behalf of an insurer, the insurer
shall, at least annually, conduct a reasonable review of the operations of the
third-party administrator If a third-party administrator has an independent
party conduct a review of the third-party administrator's operations and has
provided that review to the insurer, and the insurer has determined that the
review was reasonable for purposes of this subrule, the review may, at the
discretion of the division, meet the requirement of this subrule.
(4) The requirements of rule 191-58.6
(505,510) also apply to any insurer that contracts with a person exempt from
licensure, pursuant to the exceptions set forth in subrule 58.3(1), to act as a
third-party administrator.
Notes
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