House Amendment to Senate File 2349 S-5178 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 agricultural 4 organizations exempt from regulation. 5 1. A health benefit plan, sponsored by a nonprofit 6 agricultural organization domiciled in this state and created 7 primarily to promote programs for the development of rural 8 communities and the economic stability and sustainability of 9 farmers in the state which meets the requirements set forth in 10 subsection 2, shall be deemed to not be insurance and shall 11 not be subject to the provisions of Title XIII, subtitle 1, to 12 the extent such plan, after January 1, 2018, provides health 13 benefits under a self-funded arrangement that is administered 14 by a domestic entity that is registered as a third-party 15 administrator pursuant to chapter 510 and that has continuously 16 provided, either directly or through an affiliate, health 17 care administrative services to the nonprofit agricultural 18 organization or its affiliates for a period in excess of ten 19 years. 20 2. A nonprofit agricultural organization providing a health 21 benefit plan to its members under this section must meet all 22 of the following requirements: 23 a. Have been in existence for twenty-five continuous years 24 prior to the issuance of health benefits to members of the 25 organization. 26 b. Provide membership opportunities for eligible individuals 27 in all ninety-nine counties of the state. 28 c. Collect annual dues from members. 29 d. Hold regular meetings to further the purposes of the 30 members. 31 e. Provide the members with representation on its governing 32 board and committees. 33 f. Provide education, mentoring, and financial assistance to 34 grow and expand rural businesses in the state. 35 -1- SF2349.4891 (1) 87 md 1/ 4 #1.

g. Have contracted with the domestic entity described in 1 subsection 1 to administer the health benefit plan. 2 3. Such nonprofit agricultural organization shall file a 3 certification with the commissioner that the organization meets 4 the foregoing requirements prior to providing health benefits 5 under a self-funded arrangement to its members. 6 Sec. 2. Section 507A.4, subsection 9, Code 2018, is amended 7 to read as follows: 8 9. a. Transactions involving a multiple employer welfare 9 arrangement, as defined in section 3 of the federal Employee 10 Retirement Income Security Act of 1974, 29 U.S.C. §1002, 11 paragraph 40, if the multiple employer welfare arrangement 12 meets all of the following conditions: 13 (1) The arrangement is administered by an authorized 14 insurer or an authorized third-party administrator. 15 (2) The arrangement has been in existence and provided 16 health insurance in Iowa for at least five years prior to July 17 1, 1997. 18 (3) (2) The arrangement was is established by a trade, 19 industry, or professional association of employers that 20 has a constitution or bylaws, and has been is organized and 21 maintained in good faith for at least ten continuous years 22 prior to July 1, 1997 with membership stability as defined by 23 rules adopted by the commissioner . 24 (4) (3) The arrangement registers with and obtains 25 and maintains a certificate of registration issued by the 26 commissioner of insurance . 27 (5) (4) The arrangement is subject to the jurisdiction 28 of the commissioner of insurance, including regulatory 29 oversight and complies with all rules and solvency standards as 30 established by rules adopted by the commissioner of insurance 31 pursuant to chapter 17A . 32 b. A multiple employer welfare arrangement registered with 33 the commissioner of insurance that does not meet the solvency 34 standards requirements established by rule adopted by the 35 -2- SF2349.4891 (1) 87 md 2/ 4

commissioner of insurance is pursuant to chapter 17A shall be 1 subject to chapter 507C . 2 c. A multiple employer welfare arrangement that meets all 3 of the conditions of paragraph “a” shall not be considered any 4 of the following: 5 (1) An insurance company or association of any kind or 6 character under section 432.1 . 7 (2) A member of the Iowa individual health benefit 8 reinsurance association under section 513C.10 . 9 (3) A member insurer of the Iowa life and health insurance 10 guaranty association under section 508C.5, subsection 12 . 11 d. A multiple employer welfare arrangement registered with 12 the commissioner of insurance shall file with the commissioner 13 of insurance on or before March 1 of each year a copy of the 14 report required to be filed by the multiple employer welfare 15 arrangement with the United States department of labor pursuant 16 to 29 C.F.R. §2520.101-2 . A newly formed multiple employer 17 welfare arrangement shall file with the commissioner a copy 18 of the report required to be filed pursuant to 29 C.F.R. 19 §2520.101-2 by a newly formed multiple employer welfare 20 arrangement with the United States department of labor thirty 21 days prior to operating in any state. The copy shall be filed 22 with the commissioner within thirty calendar days of the date 23 that the multiple employer welfare arrangement files the report 24 with the United States department of labor. 25 e. When not otherwise provided, a A foreign or domestic 26 multiple employer welfare arrangement doing business in this 27 state shall pay to the commissioner of insurance the fees as 28 required in pursuant to section 511.24 unless otherwise provided 29 by law . 30 Sec. 3. Section 509.1, Code 2018, is amended by adding the 31 following new subsection: 32 NEW SUBSECTION . 8A. A policy of group health insurance 33 coverage issued to an associated health plan pursuant 34 to section 513D.1 that is subject to regulation by the 35 -3- SF2349.4891 (1) 87 md 3/ 4

commissioner. 1 Sec. 4. Section 509.1, subsection 9, unnumbered paragraph 2 1, Code 2018, is amended to read as follows: 3 A policy issued to a resident of this state under a group 4 life, accident, or health insurance policy issued to a group 5 other than one described in subsections 1 through 8 8A , subject 6 to the following requirements: 7 Sec. 5. NEW SECTION . 513D.1 Association health plans. 8 The commissioner shall adopt rules that allow for the 9 creation of association health plans that are consistent with 10 the United States department of labor’s regulations in 29 11 C.F.R. pt. 2510. 12 Sec. 6. NEW SECTION . 513D.2 Rules and enforcement. 13 1. The commissioner shall adopt rules, as necessary, 14 pursuant to chapter 17A to administer this chapter. 15 2. The commissioner may take any enforcement action under 16 the commissioner’s authority to enforce compliance with this 17 chapter. 18 Sec. 7. EMERGENCY RULES. The commissioner may adopt 19 emergency rules under section 17A.4, subsection 3, and 20 section 17A.5, subsection 2, paragraph “b”, to administer the 21 provisions of this Act. Any rules adopted in accordance with 22 this section shall also be published as a notice of intended 23 action as provided in section 17A.4. > 24 2. Title page, by striking lines 1 through 3 and inserting 25 < An Act relating to health plans established by associations of 26 employers or sponsored by certain agricultural organizations. > 27 -4- SF2349.4891 (1) 87 md 4/ 4