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Code · Iowa · Chapter 513B — Small Group Health Coverage

513B.12 Application to become a risk-assuming carrier.

324 words·~1 min read·/ia/chapter-513b-small-group-health-coverage/513b-12·

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1. A small employer carrier may apply to become a risk-assuming carrier by filing an application with the commissioner in a form and manner prescribed by the commissioner.
2. In evaluating an application made pursuant to this section, the commissioner shall consider the following factors:
a. The carrier’s financial condition.
b. The carrier’s history of rating and underwriting small employer groups.
c. The carrier’s commitment to market fairly to all small employers in the state or the carrier’s established geographic service area, as applicable.
d. The carrier’s experience with managing the risk of small employer groups.
3. The commissioner shall provide public notice of an application by a small employer carrier to be a risk-assuming carrier and shall provide at least a sixty-day period for public comment prior to making a decision on the application. If the application is not acted upon within ninety days of the receipt of the application by the commissioner, the carrier may request a hearing.
4. The commissioner may rescind the approval granted to a risk-assuming carrier under this section if the commissioner finds any of the following:
a. The carrier’s financial condition will no longer support the assumption of risk from issuing coverage to small employers in compliance with section 513B.10 without the protection provided by the program.
b. The carrier has failed to market fairly to all small employers in the state or the carrier’s established geographic service area, as applicable.
c. The carrier has failed to provide coverage to eligible small employers as required under section 513B.10.
5. A small employer carrier electing to be a risk-assuming carrier shall not be subject to the provisions of section 513B.13.
6. During the period of time that the operation of the small employer carrier reinsurance program is suspended pursuant to section 513B.13, subsection 14, a small employer carrier is not required to make an application to become a risk-assuming carrier pursuant to this section.
Referred to in §513B.11
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