Iowa Admin. Code r. 191-77.4 - Fully insured multiple employer welfare arrangements
(1)
Certificate of
registration. A person shall not establish or maintain a fully insured
employee welfare benefit plan that is a fully insured MEWA in this state unless
the MEWA obtains and maintains a certificate of registration pursuant to this
rule. Such certificate of registration is required for all MEWAs that elect to
offer fully insured employee welfare benefit plans to residents of this state
whether or not the MEWA is domiciled in the state.
(2)
Application for certificate of
registration.
a. A person wishing to
obtain a certificate of registration as a fully insured MEWA pursuant to this
chapter shall submit an application for registration to the commissioner . This
application shall include the following:
(1) A
business plan, including a copy of all health coverage contracts or other
instruments which the fully insured MEWA applicant proposes to make with or
sell to its employer members or its association's or group's members, a copy of
its health coverage description, and the printed matter to be used in the
solicitation of employer members or its association's or group's members to
purchase the health coverage .
(2)
Copies of all articles, bylaws, agreements, or other documents or instruments
describing the rights and obligations of employers, employees, and
beneficiaries with respect to the fully insured MEWA applicant.
(3) A current list of all members of the
employer group or association sponsoring the fully insured MEWA applicant, a
description of the relationship among the employers, a description of how the
relationship serves as the basis for the formation of the association or
employer group, and a description of how the employer group or association
complies with paragraphs 77.4(4) "a" and
77.4(4)"b," if applicable.
(4) A description of the activities of the
association or group of employers on behalf of its employer members or its
association's or group's members other than the sponsorship of the fully
insured MEWA applicant, to further demonstrate compliance with
77.4(4)"a," if applicable.
(5) A statement from an authorized
representative of the fully insured MEWA applicant that certifies all of the
following:
1. The fully insured MEWA applicant
shall be administered by an insurer authorized to do the business of insurance
in this state or by an authorized third-party administrator that holds a
current certificate of registration issued by the commissioner pursuant to Iowa
Code section
51021..
2. The fully insured MEWA applicant is
established by a trade, industry, or professional association of employers that
has a constitution or bylaws, is organized and maintained in good faith, and
meets all membership requirements set forth in subrule 77.4(4).
3. The association or group of employers
sponsoring the fully insured MEWA applicant is engaged in substantial activity
for its members other than sponsorship of an employee welfare benefit
plan .
4. The association is a
nonprofit entity organized or authorized to do business under applicable Iowa
law.
5. No insurance producers or
benefits consultants established, sponsored, administer, or serve as a trustee
or on the governing body of the fully insured MEWA applicant.
(6) A certificate from an
authorized representative of the fully insured MEWA applicant that, to the best
of the authorized representative 's knowledge and belief, the fully insured MEWA
applicant is in compliance with all applicable provisions of the Employee
Retirement Income Security Act of 1974 (
29 U.S.C. Section
1001 et seq.).
(7) A description of and evidence of a
mechanism, approved by the commissioner , to ensure that claims shall be paid in
the event a member of the fully insured MEWA applicant is unable to comply with
the fully insured MEWA applicant's contribution requirements.
(8) A copy of the most recent Form M-l filed
by the fully insured MEWA applicant with the U.S. Department of Labor, Pension
and Welfare Benefits Administration.
(9) Biographical affidavits from all members
of the board of directors of the fully insured MEWA applicant. The affidavits
shall be prepared using the current template for biographical affidavits
prescribed by the National Association of Insurance Commissioners. This
requirement shall not apply to any MEWA registered with the state prior to
January 1, 2018.
(10) Any
additional information requested by the commissioner .
b. The commissioner shall examine the
application and any supporting documents submitted by the fully insured MEWA
applicant. The commissioner may conduct any investigation that the commissioner
may deem necessary and may examine under oath any persons interested in or
connected with the fully insured MEWA applicant.
c. Within a reasonable time, either the
commissioner shall issue to the fully insured MEWA applicant a certificate of
registration upon finding that the fully insured MEWA applicant has met all
requirements or the commissioner shall deny the application for a certificate
of registration and provide notice to the fully insured MEWA applicant setting
forth reasons for finding that the fully insured MEWA applicant does not meet
all the requirements. An unsuccessful applicant may file a new application for
a certificate of registration at any time.
(3)
Filing requirements. A
fully insured MEWA shall annually, on or before the first day of March, file a
certificate of compliance, which shall be signed and dated by the fully insured
MEWA 's authorized representative and shall certify all of the following:
a. That the fully insured MEWA meets the
requirements of this rule and the applicable provisions of Iowa statutes and
regulations; and
b. That the fully
insured MEWA has contracted with an insurer authorized to do the business of
insurance in this state or with a third-party administrator that holds a
current certificate of registration issued by the commissioner pursuant to Iowa
Code section 510.21.
(4)
Membership requirements.
a.
Any employer group or association that intends to form a fully insured MEWA
shall have been established for a good-faith purpose other than for the purpose
of providing insurance or a health plan.
b. The employer group or association that
wishes to form a fully insured MEWA shall have been in existence for a period
of five years at the time it seeks a certificate of registration as a fully
insured MEWA .
c. The employer group
or association sponsoring the fully insured MEWA shall collect annual dues from
its employer members.
d. Each
employer member that participates in an employee welfare benefit plan offered
by the fully insured MEWA may only provide coverage to "eligible employees" as
defined in Iowa Code section
513B2.. This
requirement only applies to the type of employees permitted to be employed by
an employer member of the fully insured MEWA and has no impact on what type of
rating must be utilized by the fully insured MEWA .
e. Any employer member that participates in
an employee welfare benefit plan offered by a fully insured MEWA shall be a
member of the employer group or association sponsoring the fully insured MEWA .
f. Any employer member that
participates in an employee welfare benefit plan offered by a fully insured
MEWA shall be required to participate in the fully insured MEWA for a period of
not less than five calendar years. Any contract issued by a fully insured MEWA
to an employer shall contain reasonable enforcement provisions, including but
not limited to reasonable fees or assessments for early departure or for
enrollment in another fully insured MEWA during the early-departure
period.
g. The activities of the
fully insured MEWA , including the establishment and maintenance of the employee
welfare benefit plan , shall be controlled by the fully insured MEWA 's employer
members, either directly or indirectly through the regular nomination and
election of directors, trustees, officers, or other similar representatives to
control on the employer members' behalf.
h. The membership requirements set forth in
paragraphs 77.4(4)"a" through 77.4(4)"g" are
not applicable to fully insured MEWAs that received a certificate of
registration from the commissioner prior to January 1, 2018.
(5)
Policy or
contract. Every health benefit plan offered by any insurer to the
fully insured MEWA shall comply with the following:
a.
Notice to purchasers.
Every health benefit plan application for coverage and every policy and
certificate issued by an insurer to the fully insured MEWA shall contain in
14-point type or, if electronic, of equivalent prominence, on the front page
the following notice prominently displayed:
NOTICE
This policy is issued by a fully insured multiple
employer welfare arrangement (
Please review the policy closely to understand the covered benefits.
b.
Guaranteed issue. An
insurer offering a health benefit plan to a fully insured MEWA shall guarantee
acceptance of all eligible individuals who are part of the employer members or
association's or group's members of the fully insured MEWA and, if coverage is
offered to spouses and dependents, to all of the spouses and
dependents.
c.
Types of
benefits that can be offered. Fully insured MEWAs shall offer only
medical, dental, optical, surgical, hospital, accident and sickness,
prescription, life insurance, or disability benefits. A fully insured MEWA that
offers life insurance benefits shall comply with all applicable provisions of
the Iowa Code relating to life insurance and life insurance
companies.
d.
Compliance
with HIPAA. All contracts or policies issued by an insurer to a fully
insured MEWA shall conform to all the provisions of
P.L.
104-191 , the Health Insurance Portability and
Accountability Act of 1996 (HIPAA), including but not limited to guaranteed
issue of all products, preexisting condition limitations, renewability, and
portability provisions as well as the issuance of prior coverage certificates
to enrollees no longer eligible for plan coverage.
e.
Compliance with state
mandates. Every health benefit plan offered by an insurer to a fully
insured MEWA shall comply with all applicable state mandates, including Iowa
Code chapter 514C, as if the health benefit plan were a group health policy
under Iowa Code chapter 509.
f.
Actuarial value. Every health benefit plan offered by an
insurer to a fully insured MEWA must contain a level of coverage equal to or
greater than that designed to provide benefits that are actuarially equivalent
to 60 percent of the full actuarial value of the benefits provided under the
plan.
(6)
Trade
practices and enforcement. A fully insured MEWA is subject to
applicable provisions of Iowa Code chapter 507B, and rules promulgated under
that chapter, as if the fully insured MEWA is a "person " as defined in Iowa
Code section
507B2(1).. The
commissioner may investigate whether a fully insured MEWA or an insurer
providing health benefit plans under the direction of a fully insured MEWA has
violated this rule and, after a hearing conducted pursuant to Iowa Code
chapters 17A and 507B, may enter any orders authorized under Iowa Code chapter
505, 507A, or 507B or any other applicable chapters.
(7)
Filing fee. A filing fee
of $100 shall accompany each application for a certificate of registration as a
fully insured MEWA .
(8)
Suspension or revocation of certificate of registration. The
commissioner may sanction a fully insured MEWA or suspend or revoke any
certificate of registration issued to a fully insured MEWA upon any of the
following grounds:
a. Failure to comply with
any provision of these rules or any applicable provision of the Iowa
Code.
b. Failure to comply with any
lawful order of the commissioner .
c. A finding that the application or any
necessary forms that have been filed with the commissioner contain fraudulent
information or omissions.
Notes
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