Senate File 2349 H-8289 Amend the amendment, H-8288, to Senate File 2349, as passed 1 by the Senate, as follows: 2 1. By striking page 1, line 1, through page 3, line 15, and 3 inserting: 4 < Amend Senate File 2349, as passed by the Senate, as follows: 5 ___. By striking everything after the enacting clause and 6 inserting: 7 < Section 1. NEW SECTION . 505.20 Certain agricultural 8 organizations exempt from regulation. 9 1. A health benefit plan, sponsored by a nonprofit 10 agricultural organization domiciled in this state and created 11 primarily to promote programs for the development of rural 12 communities and the economic stability and sustainability of 13 farmers in the state which meets the requirements set forth in 14 subsection 2, shall be deemed to not be insurance and shall 15 not be subject to the provisions of Title XIII, subtitle 1, to 16 the extent such plan, after January 1, 2018, provides health 17 benefits under a self-funded arrangement that is administered 18 by a domestic entity that is registered as a third-party 19 administrator pursuant to chapter 510 and that has continuously 20 provided, either directly or through an affiliate, health 21 care administrative services to the nonprofit agricultural 22 organization or its affiliates for a period in excess of ten 23 years. 24 2. A nonprofit agricultural organization providing a health 25 benefit plan to its members under this section must meet all 26 of the following requirements: 27 a. Have been in existence for twenty-five continuous years 28 prior to the issuance of health benefits to members of the 29 organization. 30 b. Provide membership opportunities for eligible individuals 31 in all ninety-nine counties of the state. 32 c. Collect annual dues from members. 33 d. Hold regular meetings to further the purposes of the 34 members. 35 -1- H8288.4752 (4) 87 ko/rj 1/ 5 #1.

e. Provide the members with representation on its governing 1 board and committees. 2 f. Provide education, mentoring, and financial assistance to 3 grow and expand rural businesses in the state. 4 g. Have contracted with the domestic entity described in 5 subsection 1 to administer the health benefit plan. 6 3. Such nonprofit agricultural organization shall file a 7 certification with the commissioner that the organization meets 8 the foregoing requirements prior to providing health benefits 9 under a self-funded arrangement to its members. 10 Sec. 2. Section 507A.4, subsection 9, Code 2018, is amended 11 to read as follows: 12 9. a. Transactions involving a multiple employer welfare 13 arrangement, as defined in section 3 of the federal Employee 14 Retirement Income Security Act of 1974, 29 U.S.C. §1002, 15 paragraph 40, if the multiple employer welfare arrangement 16 meets all of the following conditions: 17 (1) The arrangement is administered by an authorized 18 insurer or an authorized third-party administrator. 19 (2) The arrangement has been in existence and provided 20 health insurance in Iowa for at least five years prior to July 21 1, 1997. 22 (3) (2) The arrangement was is established by a trade, 23 industry, or professional association of employers that 24 has a constitution or bylaws, and has been is organized and 25 maintained in good faith for at least ten continuous years 26 prior to July 1, 1997 with membership stability as defined by 27 rules adopted by the commissioner . 28 (4) (3) The arrangement registers with and obtains 29 and maintains a certificate of registration issued by the 30 commissioner of insurance . 31 (5) (4) The arrangement is subject to the jurisdiction 32 of the commissioner of insurance, including regulatory 33 oversight and complies with all rules and solvency standards as 34 established by rules adopted by the commissioner of insurance 35 -2- H8288.4752 (4) 87 ko/rj 2/ 5

pursuant to chapter 17A . 1 b. A multiple employer welfare arrangement registered with 2 the commissioner of insurance that does not meet the solvency 3 standards requirements established by rule adopted by the 4 commissioner of insurance is pursuant to chapter 17A shall be 5 subject to chapter 507C . 6 c. A multiple employer welfare arrangement that meets all 7 of the conditions of paragraph “a” shall not be considered any 8 of the following: 9 (1) An insurance company or association of any kind or 10 character under section 432.1 . 11 (2) A member of the Iowa individual health benefit 12 reinsurance association under section 513C.10 . 13 (3) A member insurer of the Iowa life and health insurance 14 guaranty association under section 508C.5, subsection 12 . 15 d. A multiple employer welfare arrangement registered with 16 the commissioner of insurance shall file with the commissioner 17 of insurance on or before March 1 of each year a copy of the 18 report required to be filed by the multiple employer welfare 19 arrangement with the United States department of labor pursuant 20 to 29 C.F.R. §2520.101-2 . A newly formed multiple employer 21 welfare arrangement shall file with the commissioner a copy 22 of the report required to be filed pursuant to 29 C.F.R. 23 §2520.101-2 by a newly formed multiple employer welfare 24 arrangement with the United States department of labor thirty 25 days prior to operating in any state. The copy shall be filed 26 with the commissioner within thirty calendar days of the date 27 that the multiple employer welfare arrangement files the report 28 with the United States department of labor. 29 e. When not otherwise provided, a A foreign or domestic 30 multiple employer welfare arrangement doing business in this 31 state shall pay to the commissioner of insurance the fees 32 as required in pursuant to section 511.24 unless otherwise 33 provided by law . 34 Sec. 3. Section 509.1, Code 2018, is amended by adding the 35 -3- H8288.4752 (4) 87 ko/rj 3/ 5

following new subsection: 1 NEW SUBSECTION . 8A. A policy of group health insurance 2 coverage issued to an associated health plan pursuant 3 to section 513D.1 that is subject to regulation by the 4 commissioner. 5 Sec. 4. Section 509.1, subsection 9, unnumbered paragraph 6 1, Code 2018, is amended to read as follows: 7 A policy issued to a resident of this state under a group 8 life, accident, or health insurance policy issued to a group 9 other than one described in subsections 1 through 8 8A , subject 10 to the following requirements: 11 Sec. 5. NEW SECTION . 513D.1 Association health plans. 12 The commissioner shall adopt rules that allow for the 13 creation of association health plans that are consistent with 14 the United States department of labor’s regulations in 29 15 C.F.R. pt. 2510. 16 Sec. 6. NEW SECTION . 513D.2 Rules and enforcement. 17 1. The commissioner shall adopt rules, as necessary, 18 pursuant to chapter 17A to administer this chapter. 19 2. The commissioner may take any enforcement action under 20 the commissioner’s authority to enforce compliance with this 21 chapter. 22 Sec. 7. EMERGENCY RULES. The commissioner may adopt 23 emergency rules under section 17A.4, subsection 3, and 24 section 17A.5, subsection 2, paragraph “b”, to administer the 25 provisions of this Act. Any rules adopted in accordance with 26 this section shall also be published as a notice of intended 27 action as provided in section 17A.4. > 28 ___. Title page, by striking lines 1 through 3 and inserting 29 < An Act relating to health plans established by associations of 30 employers or sponsored by certain agricultural organizations. >> 31 2. By renumbering as necessary. 32 -4- H8288.4752 (4) 87 ko/rj 4/ 5