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.

Terms Used In Iowa Code 513B.12

  • Carrier: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services. See Iowa Code 513B.2
  • Commissioner: means the commissioner of insurance. See Iowa Code 513B.2
  • following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
  • Small employer: means a person actively engaged in business who, on at least fifty percent of the employer's working days during the preceding year, employed at least one and not more than fifty full-time equivalent eligible employees. See Iowa Code 513B.2
  • Small employer carrier: means any carrier which offers health benefit plans covering the employees of a small employer. See Iowa Code 513B.2
  • state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
 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.