Senate File 2349 H-8303 Amend Senate File 2349, as passed by the Senate, as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. NEW SECTION . 505.20 Certain organizations 4 exempt from regulation. 5 1. A health benefit plan, sponsored by an eligible 6 organization domiciled in this state that meets the 7 requirements set forth in subsection 2, shall be deemed to 8 not be insurance pursuant to this subtitle and shall not be 9 subject to the jurisdiction of the commissioner of insurance 10 to the extent such health benefit plan, after January 1, 2019, 11 provides health benefits under a self-funded arrangement that 12 is administered by an eligible third-party administrator that 13 meets the requirements set forth in subsection 3. 14 2. An eligible organization providing a health benefit 15 plan to its members under this section shall meet all of the 16 following requirements: 17 a. Provide membership opportunities for eligible 18 individuals. 19 b. Collect annual dues from members. 20 c. Hold regular meetings to further the purposes of the 21 members. 22 d. Provide members with representation on the organization’s 23 governing board and committees. 24 e. Provide education, mentoring, or financial assistance. 25 f. Contract with an eligible third-party administrator that 26 meets the requirements set forth in subsection 3 to administer 27 the health benefit plan. The contract with the eligible 28 third-party administrator shall provide that the eligible 29 third-party administrator shall not be responsible for paying 30 any claims under the health benefit plan that are not funded 31 by the eligible organization. 32 3. An eligible third-party administrator administering a 33 self-funded arrangement under this section shall meet all of 34 the following requirements: 35 -1- SF2349.4854 (1) 87 ko/rj 1/ 5 #1.

a. Register as a third-party administrator pursuant to 1 chapter 510. 2 b. Offer individual health insurance products either 3 directly or through an affiliate organization. 4 4. Prior to providing a health benefit plan to its 5 members under this section an eligible organization shall 6 file a certification with the commissioner that the eligible 7 organization meets all requirements of this section. 8 5. The commissioner shall ensure expedited processing of 9 a third-party administrator registration pursuant to chapter 10 510 for a third-party administrator administering a self-funded 11 arrangement under this section. 12 Sec. 2. Section 507A.4, subsection 9, Code 2018, is amended 13 to read as follows: 14 9. a. Transactions involving a multiple employer welfare 15 arrangement, as defined in section 3 of the federal Employee 16 Retirement Income Security Act of 1974, 29 U.S.C. §1002, 17 paragraph 40, if the multiple employer welfare arrangement 18 meets all of the following conditions: 19 (1) The arrangement is administered by an authorized 20 insurer or an authorized third-party administrator. 21 (2) The arrangement has been in existence and provided 22 health insurance in Iowa for at least five years prior to July 23 1, 1997. 24 (3) (2) The arrangement was is established by a trade, 25 industry, or professional association of employers that 26 has a constitution or bylaws, and has been is organized and 27 maintained in good faith for at least ten continuous years 28 prior to July 1, 1997 with membership stability as defined by 29 rules adopted by the commissioner . 30 (4) (3) The arrangement registers with and obtains 31 and maintains a certificate of registration issued by the 32 commissioner of insurance . 33 (5) (4) The arrangement is subject to the jurisdiction 34 of the commissioner of insurance, including regulatory 35 -2- SF2349.4854 (1) 87 ko/rj 2/ 5

oversight and complies with all rules and solvency standards as 1 established by rules adopted by the commissioner of insurance 2 pursuant to chapter 17A . 3 b. A multiple employer welfare arrangement registered with 4 the commissioner of insurance that does not meet the solvency 5 standards requirements established by rule adopted by the 6 commissioner of insurance is pursuant to chapter 17A shall be 7 subject to chapter 507C . 8 c. A multiple employer welfare arrangement that is 9 recognized as tax-exempt under Internal Revenue Code section 10 501(c)(9) and that meets all of the conditions of paragraph “a” 11 shall not be considered any of the following: 12 (1) An insurance company or association of any kind or 13 character under section 432.1 . 14 (2) A member of the Iowa individual health benefit 15 reinsurance association under section 513C.10 . 16 (3) A member insurer of the Iowa life and health insurance 17 guaranty association under section 508C.5, subsection 12 . 18 d. A multiple employer welfare arrangement registered with 19 the commissioner of insurance shall file with the commissioner 20 of insurance on or before March 1 of each year a copy of the 21 report required to be filed by the multiple employer welfare 22 arrangement with the United States department of labor pursuant 23 to 29 C.F.R. §2520.101-2 . A newly formed multiple employer 24 welfare arrangement shall file with the commissioner a copy 25 of the report required to be filed pursuant to 29 C.F.R. 26 §2520.101-2 by a newly formed multiple employer welfare 27 arrangement with the United States department of labor thirty 28 days prior to operating in any state. The copy shall be filed 29 with the commissioner within thirty calendar days of the date 30 that the multiple employer welfare arrangement files the report 31 with the United States department of labor. 32 e. When not otherwise provided, a A foreign or domestic 33 multiple employer welfare arrangement doing business in this 34 state shall pay to the commissioner of insurance the fees 35 -3- SF2349.4854 (1) 87 ko/rj 3/ 5

as required in pursuant to section 511.24 unless otherwise 1 provided by law . 2 Sec. 3. Section 509.1, Code 2018, is amended by adding the 3 following new subsection: 4 NEW SUBSECTION . 8A. A policy of group health insurance 5 coverage issued to an associated health plan pursuant 6 to section 513D.1 that is subject to regulation by the 7 commissioner. 8 Sec. 4. Section 509.1, subsection 9, unnumbered paragraph 9 1, Code 2018, is amended to read as follows: 10 A policy issued to a resident of this state under a group 11 life, accident, or health insurance policy issued to a group 12 other than one described in subsections 1 through 8 8A , subject 13 to the following requirements: 14 Sec. 5. NEW SECTION . 513D.1 Association health plans. 15 The commissioner shall adopt rules that allow for the 16 creation of association health plans that are consistent with 17 the United States department of labor’s regulations in 29 18 C.F.R. pt. 2510. A multiple employer welfare arrangement that 19 is recognized as tax-exempt under Internal Revenue Code section 20 501(c)(9) and that is registered with the commissioner prior 21 to January 1, 2018, shall not be considered an association 22 health plan unless the multiple employer welfare arrangement 23 affirmatively elects to be treated as an association health 24 plan. 25 Sec. 6. NEW SECTION . 513D.2 Rules and enforcement. 26 1. The commissioner shall adopt rules, as necessary, 27 pursuant to chapter 17A to administer this chapter. 28 2. The commissioner may take any enforcement action under 29 the commissioner’s authority to enforce compliance with this 30 chapter. > 31 2. Title page, by striking lines 1 through 3 and inserting 32 < An Act relating to health plans established by associations of 33 employers or sponsored by certain organizations. > 34 3. By renumbering as necessary. 35 -4- SF2349.4854 (1) 87 ko/rj 4/ 5 #2.