Iowa Admin. Code r. 191-58.2

Current through Regsiter Vol. 46, No. 26, June 12, 2024
Rule 191-58.2 - Definitions

The terms defined in Iowa Code section 510.11 and rule 191-1.1 (502,505) shall have the same meaning for the purposes of this chapter In addition, for purposes of this chapter:

"Affiliate" or "affiliates" means an entity or person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, a specified entity or person. For purposes of this definition, "control" (including the terms "controls" or "controlled by") means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing, 10 percent or more of the voting securities of any other person. This presumption may be rebutted by a showing made in the manner provided by Iowa Code section 505.23 and Iowa Code chapter 521A that control does not exist in fact. The commissioner may determine, after furnishing notice and opportunity to be heard to all persons in interest and after making specific findings of fact to support the determination, that control exists in fact notwithstanding the absence of a presumption to that effect.

"Home state" means the United States state or territory or the District of Columbia designated by a third-party administrator as its principal regulator, which shall be either its place of incorporation or its principal place of business within the United States. A third-party administrator may designate as its home state any United States jurisdiction in which it does business and which has adopted a law governing third-party administrators substantially similar to Iowa Code chapter 510 and this chapter

"Insurance producer" means the same as defined in Iowa Code section 522B.1.

"Insurer" means a person engaged in the business of insurance who is regulated under Iowa Code chapter 508, 512B, 514, 514B, 515, or 520.

"Nonresident third-party administrator" means a person whose home state is not Iowa.

"Person" means any individual, aggregation of individuals, trust, association, partnership, or corporation or an affiliate of any of these.

"Stop-loss" or "stop-loss insurance" means insurance protecting an employer or other person responsible for an otherwise self-insured health or life benefit plan against higher than expected obligations under the plan.

"Underwrites" or "underwriting" or "underwritten" means, but is not limited to, the acceptance of employer or individual applications for coverage of individuals in accordance with the written rules of the insurer or self-funded plan, or the overall planning and coordinating of a benefits program.

Iowa Admin. Code r. 191-58.2

ARC 8310B, lAB 11/18/09, effective 12/23/09
Amended by IAB November 4, 2020/Volume XLIII, Number 10, effective 12/9/2020