505INSURANCE DIVISION505.1Insurance division created.An insurance division is created within the department of insurance and financial services to regulate and supervise the conducting of the business of insurance in the state. The commissioner of insurance is the chief executive officer of the division. As used in this subtitle and chapter 502, “division” means the insurance division.[S13, §1683-r, -r1; C24, 27, 31, 35, 39, §8604; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.1]86 Acts, ch 1245, §745; 93 Acts, ch 60, §6; 94 Acts, ch 1023, §1132023 Acts, ch 19, §2726505.2Appointment and term of commissioner.1The governor shall appoint subject to confirmation by the senate, a commissioner of insurance, who shall be selected solely with regard to qualifications and fitness to discharge the duties of this position, devote the entire time to such duties, and serve for four years beginning and ending as provided by section 69.19. The governor may remove the commissioner for malfeasance in office, or for any cause that renders the commissioner ineligible, incapable, or unfit to discharge the duties of the office.2A vacancy in the office of the commissioner shall be filled for the unexpired portion of the regular term.3The commissioner of insurance shall also serve as the director of the department of insurance and financial services pursuant to section 546.2.[S13, §1683-r; C24, 27, 31, 35, 39, §8605; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.2]86 Acts, ch 1245, §19892023 Acts, ch 19, §2727505.3Vacancies.Vacancies shall be filled as regular appointments are made for the unexpired portion of the regular term.[S13, §1683-r; C24, 27, 31, 35, 39, §8607; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.3]505.4Deputy — assistants — bond.1The commissioner of insurance shall appoint a first and second deputy commissioner and such other clerks and assistants as shall be needed to assist the commissioner in the performance of the commissioner’s duty, all of whom shall serve during the pleasure of the commissioner. Before entering upon the duties of their respective offices, deputy commissioners shall give a bond in the penal sum of ten thousand dollars.2The commissioner may appoint a deputy commissioner for supervision whom the commissioner may appoint as supervisory or special deputy pursuant to chapter 507C and who shall perform such other duties as may be assigned by the commissioner. The deputy commissioner for supervision shall receive a salary to be fixed by the commissioner. The deputy commissioner for supervision shall be exempt from the merit system provisions of chapter 8A, subchapter IV, under section 8A.412, subsection 16.[S13, §1683-r2; C24, 27, 31, 35, 39, §8608; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.4]91 Acts, ch 26, §31; 2003 Acts, ch 145, §269505.5Expenses.The commissioner shall be entitled to reimbursement of actual necessary expenses in attending meetings of insurance commissioners of other states, and in the performance of the duties of the office. [S13, §1683-r2; C24, 27, 31, 35, 39, §8610; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.5]2023 Acts, ch 19, §2728505.6Documents and records.All books, records, files, documents, reports, and securities, and all papers of every kind and character relating to the business of insurance shall be delivered to, and filed or deposited with, the said commissioner of insurance.[S13, §1683-r4; C24, 27, 31, 35, 39, §8611; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.6]505.7Fees — expenses of division — assessments.1All fees and charges which are required by law to be paid by insurance companies, associations, and other regulated entities shall be payable to the commissioner of the insurance division of the department of insurance and financial services or department of revenue, as provided by law, whose duty it shall be to account for and pay over the same to the treasurer of state at the time and in the manner provided by law for deposit in the commerce revolving fund created in section 546.12.2The commissioner shall account for receipts and disbursements according to the separate inspection and examination duties imposed upon the commissioner by the laws of this state and each separate inspection and examination duty shall be fiscally self-sustaining.3Forty percent of the nonexamination revenues payable to the division of insurance or the department of revenue in connection with the regulation of insurance companies or other entities subject to the regulatory jurisdiction of the division shall be deposited in the commerce revolving fund created in section 546.12 and shall be subject to annual appropriation to the division for its operations and is also subject to expenditure under subsection 6. The remaining nonexamination revenues payable to the division of insurance or the department of revenue shall be deposited in the general fund of the state.4Except as otherwise provided in subsection 6, the insurance division may expend additional funds if those additional expenditures are actual expenses which exceed the funds budgeted for statutory duties of the division and directly result from the statutory duties of the division. The amounts necessary to fund the excess division expenses shall be collected from additional fees and other moneys collected by the division. The division shall notify in writing the legislative services agency and the department of management when hiring additional personnel. The written notification shall include documentation that any additional expenditure related to such hiring will be totally reimbursed to the general fund, and shall also include the division’s justification for hiring such personnel. The division must obtain the approval of the department of management only if the number of additional personnel to be hired exceeds the number of full-time equivalent positions authorized by the general assembly.5The insurance division may transfer moneys between budgeted line items of its appropriation, but such transfers may not reduce moneys budgeted for examinations or professional services, including but not limited to actuarial and legal services.6aThe insurance division may expend additional funds, including funds for additional personnel if those additional expenditures are actual expenses which exceed the funds budgeted for insurance solvency oversight under the following conditions:1The division may exceed the line item budgets for examinations and professional services, including but not limited to legal and actuarial services, provided that the division funds the increased expenditures through assessments or increased nonexamination revenues payable to the division under subsection 1 or otherwise. The amounts necessary to fund the excess expenses may be collected from those regulated entities or classes of entities which either cause or benefit from the expenditure or encumbrance.2Before the division expends or encumbers an amount in excess of the funds budgeted for line items other than examinations and professional services, the director of the department of management shall approve the expenditure or encumbrance. Before approval is given, the director of the department of management shall determine that the expenses can be paid from nonexamination revenues payable to the division under subsection 1 or otherwise. Upon the approval of the director of the department of management the division may expend and encumber funds for the excess expenses. The amounts necessary to fund the excess expenses may be collected from those regulated entities or classes of entities which either cause or benefit from the expenditure or encumbrance.bThe annual salaries of the deputy commissioner for supervision and the chief examiner appointed pursuant to section 507.5 shall be expenses of examination of insurance companies and shall be charged to insurance companies examined on a proportionate basis as provided by rule adopted by the commissioner. Insurance companies examined shall pay the proportion of the salaries of the deputy commissioner for supervision and the chief examiner charged to them as part of the costs of examination as provided in section 507.8.7The insurance division shall, by January 15 of each year, prepare estimates of projected receipts, refunds, and reimbursements to be generated by the examinations function of the division during the calendar year in which the report is due, and such receipts, refunds, and reimbursements shall be treated in the same manner as appropriated receipts, as defined in section 8.2, and shall be available to the division to pay the expenses of the division’s examination function.8The commissioner may assess the costs of an audit or examination to a health insurance purchasing cooperative, in the same manner as provided for insurance companies under sections 507.7 through 507.9, and may establish by rule reasonable filing fees to fund the cost of regulatory oversight.9The commissioner may retain funds collected during the fiscal year beginning July 1, 2003, pursuant to any settlement, enforcement action, or other legal action authorized under federal or state law for the purpose of reimbursing costs and expenses of the division.10aThe commissioner shall assess the costs of carrying out the insurance division’s duties pursuant to section 505.8, subsection 18, section 505.17, subsection 2, and sections 505.18 and 505.19 that are directly attributable to the performance of the division’s duties involving specific health insurance carriers licensed to do business in this state. Such expenses shall be charged to and paid by the specific health insurance carrier to whom the expenses are attributable and upon failure or refusal of any such carrier to pay such expenses, the same may be recovered in an action brought in the name of the state. In addition, the commissioner may revoke the certificate of authority of a health insurance carrier licensed to do business in this state that fails to pay such expenses attributable to that carrier.bThe commissioner shall assess the costs of carrying out the insurance division’s duties generally pursuant to section 505.8, subsection 18, section 505.17, subsection 2, and sections 505.18 and 505.19, and for implementation and maintenance of health insurance information for consumers on the insurance division’s internet site, that are not attributable to a specific health insurance carrier, to all health insurance carriers that are licensed to do business in this state on a proportionate basis as provided by rules adopted by the commissioner.[S13, §1683-r5; C24, 27, 31, 35, 39, §8612; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.7]86 Acts, ch 1246, §615; 87 Acts, ch 234, §433; 90 Acts, ch 1247, §12, 13; 91 Acts, ch 26, §32; 91 Acts, ch 260, §1239; 93 Acts, ch 88, §3; 94 Acts, ch 1176, §1, 2; 2002 Acts, 2nd Ex, ch 1003, §32, 352003 Acts, ch 35, §45, 49; 2003 Acts, ch 145, §286; 2003 Acts, ch 179, §135; 2009 Acts, ch 181, §62, 63; 2010 Acts, ch 1121, §4, 33; 2023 Acts, ch 19, §2729; 2024 Acts, ch 1185, §181505.7ACivil penalties.Unless specifically provided for in this subtitle, penalties imposed under this subtitle by order of the commissioner of insurance after hearing shall not exceed one thousand dollars for each act or violation of this subtitle, up to an aggregate of ten thousand dollars, unless the person knew or reasonably should have known the person was in violation of this subtitle, in which case the penalty shall not exceed five thousand dollars for each act or violation, up to an aggregate of fifty thousand dollars in any one six-month period.2004 Acts, ch 1110, §5505.8Commissioner’s general powers and duties — consumer advocate bureau established.1The commissioner of insurance shall be the head of the division, and shall have general control, supervision, and direction over all insurance business transacted in the state, and shall enforce all the laws of the state relating to federal and state insurance business transacted in the state.2The commissioner shall, subject to chapter 17A, establish, publish, and enforce rules not inconsistent with law for the enforcement of this subtitle and for the enforcement of the laws, the administration and supervision of which are imposed on the division, including rules to establish fees sufficient to administer the laws, where appropriate fees are not otherwise provided for in rule or statute.3The commissioner shall supervise all transactions relating to the organization, reorganization, liquidation, and dissolution of domestic insurance corporations, and all transactions leading up to the organization of such corporations.4The commissioner shall also supervise the sale in the state of all stock, certificates, or other evidences of interest, either by domestic or foreign insurance companies or organizations proposing to engage in any insurance business.5The commissioner shall supervise all health insurance purchasing cooperatives providing services or operating within the state and the organization of domestic cooperatives. The commissioner may admit nondomestic health insurance purchasing cooperatives under the same standards as domestic cooperatives.6The commissioner shall provide assistance to the public and to consumers of insurance products and services in this state.aThe commissioner shall accept inquiries and complaints from the public regarding the business of insurance. The commissioner or the commissioner’s designee may respond to inquiries and complaints, and may examine or investigate such inquiries and complaints to determine whether laws in this subtitle and rules adopted pursuant to such laws have been violated.bThe commissioner shall establish a bureau, to be known as the “consumer advocate bureau”, which shall be responsible for ensuring fair treatment of consumers and for preventing unfair or deceptive trade practices in the marketplace and by persons under the jurisdiction of the commissioner.1The commissioner, with the advice of the governor, shall appoint a consumer advocate who shall be knowledgeable in the area of insurance and particularly in the area of consumer protection. The consumer advocate shall be the chief administrator of the consumer advocate bureau.2The consumer advocate bureau may receive and may investigate consumer complaints and inquiries from the public, and may conduct investigations to determine whether any person has violated any provision of the insurance code, including chapters 507B and 522B, and any provisions related to the establishment of insurance rates.3The consumer advocate bureau shall perform other functions as may be assigned to it by the commissioner related to consumer advocacy.4The consumer advocate bureau shall work in conjunction with other areas of the insurance division on matters of mutual interest. The insurance division shall cooperate with the consumer advocate in fulfilling the duties of the consumer advocate bureau. The consumer advocate may also seek assistance from other federal or state agencies or private entities for the purpose of assisting consumers.5When necessary or appropriate to protect the public interest or consumers, the consumer advocate may request that the commissioner conduct rate filing reviews as provided in section 505.15 or administrative hearings as provided in section 505.29.6The commissioner, in cooperation with the consumer advocate, shall prepare and deliver a report to the general assembly by January 15 of each year that contains findings and recommendations regarding the activities of the consumer advocate bureau including but not limited to all of the following:aAn overview of the functions of the bureau.bThe structure of the bureau including the number and type of staff positions.cStatistics showing the number of complaints handled by the bureau, the nature of the complaints including the line of business involved and their disposition, and the disposition of similar issues in other states.dActions commenced by the consumer advocate.eStudies performed by the consumer advocate.fEducational and outreach efforts of the consumer advocate bureau.gRecommendations from the commissioner and the consumer advocate about additional consumer protection functions that would be appropriate and useful for the bureau or the insurance division to fulfill based on observations and analysis of trends in complaints and information derived from national or other sources.hRecommendations from the commissioner and the consumer advocate about any needs for additional funding, staffing, legislation, or administrative rules.cWhen necessary or appropriate to protect the public interest or consumers, the commissioner may conduct, or the commissioner’s designee may request that the commissioner conduct, administrative hearings as provided in this subtitle.dThe commissioner may adopt rules for the administration of this subsection.7The commissioner shall have regulatory authority over health benefit plans and adopt rules under chapter 17A as necessary, to promote the uniformity, cost efficiency, transparency, and fairness of such plans for physicians and osteopathic physicians licensed under chapter 148 and hospitals licensed under chapter 135B, for the purpose of maximizing administrative efficiencies and minimizing administrative costs of health care providers and health insurers.8aNotwithstanding chapter 22, the commissioner shall keep confidential the information submitted to the insurance division or obtained by the insurance division in the course of an investigation or inquiry pursuant to subsection 6, including all notes, work papers, or other documents related to the investigation. Information obtained by the commissioner in the course of investigating a complaint or inquiry may, in the discretion of the commissioner, be provided to the insurance company or insurance producer that is the subject of the complaint or inquiry, to the consumer who filed the complaint or inquiry, and to the individual insured who is the subject of the complaint or inquiry, without waiving the confidentiality afforded to the commissioner or to other persons by this subsection. The commissioner may disclose or release information that is otherwise confidential under this subsection, in the course of an administrative or judicial proceeding.bNotwithstanding chapter 22, the commissioner shall keep confidential both information obtained by or submitted to the insurance division pursuant to chapters 514J and 515D.cThe commissioner shall adopt rules protecting the privacy of information held by an insurer or an agent consistent with the federal Gramm-Leach-Bliley Act, Pub. L. No. 106-102.dNotwithstanding paragraphs “a”, “b”, and “c”, if the commissioner determines that it is necessary or appropriate in the public interest or for the protection of the public, the commissioner may share information with other regulatory authorities or governmental agencies or may publish information concerning a violation of this chapter or a rule or order under this chapter. Such information may be redacted so that personally identifiable information is not made available.eThe commissioner may adopt rules protecting the privacy of information submitted to the insurance division consistent with this section.9Notwithstanding chapter 22, the commissioner may keep confidential any social security number, residence address, and residence telephone number that is contained in a record filed as part of a licensing, registration, or filing process if disclosure is not required in the performance of any duty or is not otherwise required under law.10The commissioner may, after a hearing conducted pursuant to chapter 17A, assess fines or penalties; assess costs of an examination, investigation, or proceeding; order restitution; or take other corrective action as the commissioner deems necessary and appropriate to accomplish compliance with the laws of the state relating to all insurance business transacted in the state.11The commissioner may do any of the following:aConduct public or private investigations within or outside of this state which the commissioner deems necessary or appropriate to determine whether a person has violated, is violating, or is about to violate a provision of any chapter of this subtitle or a rule adopted or order issued under any chapter of this subtitle, or to aid in the enforcement of any chapter of this subtitle or in the adoption of rules and forms under any chapter of this subtitle.bRequire or permit a person to testify, file a statement, or produce a record under oath or otherwise as the commissioner determines, concerning facts and circumstances relating to a matter being investigated or about which an action or proceeding will be instituted.cNotwithstanding subsection 8, publish a record concerning an action, proceeding, or investigation under, or a violation of, any chapter of this subtitle or a rule adopted or order issued under any chapter of this subtitle, if the commissioner determines that such publication is in the public interest and is necessary and appropriate for the protection of the public.12For the purpose of an investigation made under any chapter of this subtitle, the commissioner or the commissioner’s designee may administer oaths and affirmations, subpoena witnesses, seek compulsory attendance, take evidence, require the filing of statements, and require the production of any records that the commissioner considers relevant or material to the investigation, pursuant to rules adopted under chapter 17A. The confidentiality provisions of subsection 8 shall apply to information and material obtained pursuant to this subsection.13If a person does not appear or refuses to testify, or does not file a statement or produce records, or otherwise does not obey a subpoena or order issued by the commissioner under any chapter of this subtitle, the commissioner may, in addition to assessing the penalties contained in sections 505.7A, 507B.6A, 507B.7, 522B.11, and 522B.17, make application to a district court of this state or another state to enforce compliance with the subpoena or order. A court to whom application is made to enforce compliance with a subpoena or order pursuant to this subtitle may do any of the following:aHold the person in contempt.bOrder the person to appear before the commissioner.cOrder the person to testify about the matter under investigation.dOrder the production of records.eGrant injunctive relief, including restricting or prohibiting the offer or sale of insurance or insurance advice.fImpose a civil penalty as set forth in section 505.7A.gGrant any other necessary or appropriate relief.14This section shall not be construed to prohibit a person from applying to a district court of this state or another state for relief from a subpoena or order issued by the commissioner under any chapter of this subtitle.15An individual shall not be relieved of an order to appear, testify, file a statement, produce a record or other evidence, or obey a subpoena or other order of the commissioner made under any chapter of this subtitle on the grounds that fulfillment of the requirement may, directly or indirectly, tend to incriminate the individual or subject the individual to a criminal fine, penalty, or forfeiture. If an individual refuses to obey a subpoena or order by asserting that individual’s privilege against self-incrimination, the commissioner may apply to the district court to compel the individual to obey the subpoena or order of the commissioner. Testimony, records, or other evidence that is compelled by a court enforcing an order of the commissioner shall not be used, directly or indirectly, against that individual in a criminal case, except in a prosecution for perjury or contempt or for otherwise failing to comply with the order.16Upon request of the insurance regulator of another state or foreign jurisdiction, the commissioner may provide assistance in conducting an investigation to determine whether a person has violated, is violating, or is about to violate an insurance law or rule of the other state or foreign jurisdiction administered or enforced by that insurance regulator. The commissioner may provide such assistance pursuant to the powers conferred under this section as the commissioner determines is necessary or appropriate under the circumstances. Such assistance may be provided regardless of whether the conduct being investigated would constitute a violation of this subtitle or any other law of this state if the conduct occurred in this state. In determining whether to provide such assistance the commissioner may consider whether the insurance regulator requesting the assistance is permitted to and has agreed to reciprocate in providing assistance to the commissioner upon request, whether compliance with the request would violate or prejudice the public policy of this state, and the availability of division commissioner resources and employees to provide such assistance.17The commissioner shall utilize the senior health insurance information program to assist in the dissemination of objective and noncommercial educational material and to raise awareness of prudent consumer choices in considering the purchase of various insurance products designed for the health care needs of older Iowans.18The commissioner shall annually convene a work group composed of the consumer advocate, health insurance carriers, health care providers, small employers that purchase health insurance under chapter 513B, and individual consumers in the state for the purpose of considering ways to reduce the cost of providing health insurance coverage and health care services, including but not limited to utilization of uniform billing codes, improvements to provider credentialing procedures, reducing out-of-state care expenses, annually assessing the impact of federal health care reform legislation on health care costs in the state and determining whether such legislation has reduced the cost of health insurance in the state, and the electronic delivery of explanation of benefits statements. The recommendations made by the work group shall be included in the annual report filed with the general assembly pursuant to section 505.18.19The commissioner may propose and promulgate administrative rules to effectuate the insurance provisions of the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, and any amendments thereto, or other applicable federal law.[S13, §1683-r3; C24, 27, 31, 35, 39, §8613; C46, 50, 54, §505.8; C58, 62, §505.8, 522.3; C66, 71, 73, §505.8, 515.150, 522.3; C75, 77, 79, 81, §505.8]83 Acts, ch 27, §10; 88 Acts, ch 1159, §2; 90 Acts, ch 1234, §2; 94 Acts, ch 1176, §3; 97 Acts, ch 23, §61; 98 Acts, ch 1119, §3; 99 Acts, ch 114, §41; 2000 Acts, ch 1023, §4, 5; 2002 Acts, ch 1111, §6; 2003 Acts, ch 91, §2; 2007 Acts, ch 137, §6; 2007 Acts, ch 215, §117; 2008 Acts, ch 1123, §7 – 9; 2008 Acts, ch 1175, §1; 2008 Acts, ch 1188, §21; 2009 Acts, ch 133, §168; 2009 Acts, ch 145, §3; 2010 Acts, ch 1121, §5, 33; 2011 Acts, ch 70, §2, 3; 2013 Acts, ch 124, §7505.9Ex officio receiver.The commissioner of insurance henceforth shall be the receiver and liquidating officer for any insurance company, association, or insurance carrier, and shall serve without compensation other than the stated compensation as commissioner of insurance, but the commissioner shall be allowed clerical and other expenses necessary for the conduct of such receivership.[C31, 35, §8613-c1; C39, §8613.1; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.9]505.10Expenses attending liquidation.All expenses of supervision and liquidation shall be fixed by the commissioner of insurance, subject to approval by the court or a judge thereof, and shall, upon the commissioner’s order, be paid out of the funds of such company, association, or insurance carrier in the commissioner’s hands.[C31, 35, §8613-c2; C39, §8613.2; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.10]505.11Refunds.Whenever it appears to the satisfaction of the commissioner of insurance that, because of error, mistake, or erroneous interpretation of statute, a foreign or domestic insurance corporation has paid to the state of Iowa taxes, fines, penalties, or license fees in excess of the amount legally chargeable against it, the commissioner of insurance shall have power to refund to such corporation any such excess by applying the amount of the excess payment toward the payment of taxes, fines, penalties, or license fees already due or which may become due, until such excess payments have been fully refunded.[C31, 35, §8613-c3; C39, §8613.3; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.11]2001 Acts, ch 69, §2; 2002 Acts, ch 1050, §44505.12Life insurance — annual report.Before the first day of September the commissioner of insurance shall make an annual report to the governor of the general conduct and condition of the life insurance companies doing business in the state, and include therein an aggregate of the estimated value of all outstanding policies in each of the companies; and in connection therewith prepare a separate abstract thereof as to each company, and of all the returns and statements made to the commissioner by them.[C73, §1176; C97, §1781; C24, 27, 31, 35, 39, §8614; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.12]88 Acts, ch 1112, §101505.13Other insurance — annual report by the division.The commissioner shall annually cause the preparation and printing of a report to be delivered to the governor. The report shall contain information from the statements required of insurance companies, other than life insurance companies, organized or doing business in the state. The reports shall be delivered on or before the first day of September each year.[C73, §1158; C97, §1720; S13, §1720-a; C24, 27, 31, 35, 39, §8615; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §505.13]87 Acts, ch 132, §1; 88 Acts, ch 1112, §102; 98 Acts, ch 1119, §4505.14Foreign insurers — reciprocal provisions.When by the laws of any other state a premium or income or other taxes, or fees, fines, penalties, licenses, deposit requirements or other obligations, prohibitions or restrictions are imposed upon Iowa insurance companies actually doing business in the other state, or upon the agents of the Iowa companies, which in the aggregate are in excess of the aggregate of the taxes, fees, fines, penalties, licenses, deposit requirements or other obligations, prohibitions or restrictions directly imposed upon insurance companies of the other state under the statutes of this state, the same obligations, prohibitions or restrictions of whatever kind are in the same manner and for the same purpose imposed upon insurance companies of the other state doing business in Iowa. Insurance premium taxes paid which were not paid under protest shall not be refunded if the refund claim is based upon an alleged error or mistake of law or erroneous interpretation of statute regarding the validity or legality of this section under the laws or constitutions of the United States or this state. For the purpose of this section, an alien insurer is deemed domiciled in a state designated by it wherein it has established its principal office or agency in the United States, or maintains the largest amount of its assets held in trust or on deposit for the security of its policyholders or policyholders and creditors in the United States, or in which it was admitted to do business in the United States. This section does not apply to ad valorem taxes on real or personal property or to personal income taxes.[C46, 50, 54, §432.2; C58, 62, 66, 71, 73, 75, 77, 79, 81, §505.14; 81 Acts, ch 164, §1]505.15Actuarial, professional, and specialist staff.1The commissioner may appoint a staff of actuaries as necessary to carry out the duties of the division. The actuarial staff shall do all of the following:aPerform analyses of rate filings.bPerform audits of submitted loss data.cConduct rate hearings and serve as expert witnesses.dPrepare, review, and dispense data on the insurance business.eAssist in public education concerning the insurance business.fIdentify any impending problem areas in the insurance business.gAssist in examinations of insurance companies.2The commissioner may retain, or the commissioner’s designee may request that the commissioner retain, attorneys, appraisers, independent actuaries, independent certified public accountants, or other professionals or specialists to assist the division or the consumer advocate bureau in carrying out its duties in regard to rate filing reviews. The reasonable cost of retaining such professionals and specialists shall be borne by the insurer which is the subject of the rate filing review.87 Acts, ch 132, §2; 2008 Acts, ch 1123, §10; 2009 Acts, ch 145, §4505.16Applications for insurance — human immunodeficiency virus tests — restrictions.1A person engaged in the business of insurance shall not require a test of an individual in connection with an application for insurance for the presence of an antibody to the human immunodeficiency virus unless the individual provides a written release on a form approved by the insurance commissioner. The form shall include information regarding the purpose, content, use, and meaning of the test, disclosure of test results including information explaining the effect of releasing the information to a person engaged in the business of insurance, the purpose for which the test results may be used, and other information approved by the insurance commissioner. The form shall also authorize the person performing the test to provide the results of the test to the insurance company subject to rules of confidentiality, consistent with section 141A.9, approved by the insurance commissioner. As used in this section, “a person engaged in the business of insurance” includes hospital service corporations organized under chapter 514 and health maintenance organizations subject to chapter 514B.2The insurance commissioner shall approve rules for carrying out this section including rules relating to the preparation of information to be provided before and after a test and the protection of confidentiality of personal and medical records of insurance applicants and policyholders. The rules shall require a person engaged in the business of insurance who receives results of a positive human immunodeficiency virus test of an insurance applicant or policyholder to report those results to a physician or alternative testing site of the applicant’s or policyholder’s choice, or if the applicant or policyholder does not choose a physician or alternative testing site to receive the results, to the department of health and human services.88 Acts, ch 1234, §7; 99 Acts, ch 181, §17; 2006 Acts, ch 1117, §152023 Acts, ch 19, §1182505.17Confidential information.1aInformation, records, and documents utilized for the purpose of, or in the course of, investigation, regulation, or examination of an insurance company, an insurance holding company, an individual insurance producer, or a business entity producer received by the division from some other governmental entity which treats such information, records, and documents as confidential, are confidential and shall not be disclosed by the division and are not subject to subpoena. Such information, records, and documents do not constitute a public record under chapter 22.bThe disclosure of confidential information, administrative or judicial orders which contain confidential information, or information regarding other action of the division which is not a public record subject to disclosure, to other insurance and financial regulatory officials may be permitted by the commissioner provided that those officials are subject to, or agree to comply with, standards of confidentiality comparable to those imposed on the commissioner.2Notwithstanding subsection 1, an application for a rate increase filed by a health insurance carrier and all information, records, and documents accompanying such an application or utilized for the purpose of, or in the course of consideration of the application by the commissioner, shall constitute a public record under chapter 22 except as provided in this subsection.aThe commissioner shall consider the written request of a health insurance carrier to keep confidential certain details of an application or accompanying information, records, and documents. If the request includes a sufficient explanation as to why public disclosure of such details would give an unfair advantage to competitors, the commissioner shall keep such details confidential. If the commissioner elects to keep certain details confidential, the commissioner shall release only the nonconfidential details in response to a request for records made pursuant to chapter 22. If confidential details are withheld from a request for records made pursuant to chapter 22, the commissioner shall release an explanation of why the information was deemed confidential and a summary of the nature of the information withheld and the reasons for withholding the information. bIn considering requests for confidential treatment, the commissioner shall narrowly construe the provisions of this subsection in order to appropriately balance an applicant’s need for confidentiality against the public’s right to information about the application.94 Acts, ch 1176, §4; 99 Acts, ch 165, §1; 2010 Acts, ch 1121, §6, 33; 2024 Acts, ch 1031, §1505.18Health care insurance quality and costs — annual report.1Consumers deserve to know the quality and cost of their health care insurance. Health care insurance transparency provides consumers with the information necessary, and the incentive, to choose health plans based on cost and quality. Reliable cost and quality information about health care insurance empowers consumer choice and consumer choice creates incentives at all levels, and motivates the entire health care delivery system to provide better health care and health care benefits at a lower cost. It is the purpose of this section to make information regarding the costs of health care insurance readily available to consumers through the consumer advocate bureau of the insurance division.2The commissioner in collaboration with the consumer advocate shall prepare and deliver a report to the governor and to the general assembly no later than November 15 of each year that provides findings regarding health spending costs for health insurance carriers in the state for the previous calendar year. The commissioner may contract with outside vendors or entities to assist in providing the information contained in the annual report. The report shall provide, at a minimum, the following information:aAggregate health insurance data concerning loss ratios of health insurance carriers licensed to do business in the state.bRate increase data.cHealth care expenditures in the state and the effect of such expenditures on health insurance premium rates.dA ranking and quantification of those factors that result in higher costs and those factors that result in lower costs for each health insurance carrier in the state.eThe current capital and surplus and reserve amounts held in reserve by each health insurance carrier licensed to do business in the state.fA listing of any apparent medical trends affecting health insurance costs in the state.gAny additional data or analysis deemed appropriate by the commissioner to provide the general assembly with pertinent health insurance cost information.hRecommendations made by the work group convened pursuant to section 505.8, subsection 18.2010 Acts, ch 1121, §7, 33; 2011 Acts, ch 70, §4, 5505.18AState innovation waivers.1The commissioner of insurance may develop by rule a state innovation waiver pursuant to section 1332 of the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148.2The commissioner of insurance may submit an application on behalf of the state to the United States secretary of health and human services and the United States secretary of the treasury for the state innovation waiver developed pursuant to subsection 1.3If a state innovation waiver submitted pursuant to subsection 2 is approved by the United States secretary of health and human services and the United States secretary of the treasury, the commissioner of insurance may implement the state innovation waiver in a manner consistent with applicable state and federal law.4The commissioner of insurance may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this section and the rules shall be effective immediately upon filing unless a later date is specified in the rules. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.2021 Acts, ch 181, §51505.19Health insurance rate increase applications public hearing and comment.1All health insurance carriers licensed to do business in the state shall immediately notify policyholders of any application for a rate increase exceeding the average annual health spending growth rate stated in the most recent national health expenditure projection published by the centers for Medicare and Medicaid services of the United States department of health and human services, that is filed with the insurance division. Such notice shall specify the rate increase proposed that is applicable to each policyholder and shall include the ranking and quantification of those factors that are responsible for the amount of the rate increase proposed. The notice shall include information about how the policyholder can contact the consumer advocate for assistance.2The commissioner shall hold a public hearing at the time a carrier files for proposed health insurance rate increases exceeding the average annual health spending growth rate as provided in subsection 1, prior to approval or disapproval of the proposed rate increases for that carrier by the commissioner.3The consumer advocate shall solicit public comments on each proposed health insurance rate increase application if the increase exceeds the average annual health spending growth rate as provided in subsection 1, and shall post without delay during the normal business hours of the division, all comments received on the insurance division’s internet site prior to approval, disapproval, or modification of the proposed rate increase by the commissioner.4The consumer advocate shall present the public testimony, if any, and public comments received for consideration by the commissioner in determining whether to approve, disapprove, or modify such health insurance rate increase proposals.5aFor the purposes of this section, “health insurance” does not include any of the following:1Coverage for accident-only, or disability income insurance.2Coverage issued as a supplement to liability insurance.3Liability insurance, including general liability insurance and automobile liability insurance.4Workers’ compensation or similar insurance.5Automobile medical-payment insurance.6Credit-only insurance.7Coverage for on-site medical clinic care.8Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance coverage or benefits.bFor the purposes of this section, “health insurance” does not include benefits provided under a separate policy as follows:1Limited scope dental or vision benefits.2Benefits for long-term care, nursing home care, home health care, or community-based care.3Any other similar limited benefits as provided by rule of the commissioner.cFor the purposes of this section, “health insurance” does not include benefits offered as independent noncoordinated benefits as follows:1Coverage only for a specified disease or illness.2A hospital indemnity or other fixed indemnity insurance.dFor the purposes of this section, “health insurance” does not include Medicare supplemental health insurance as defined under section 1882(g)(1) of the federal Social Security Act, coverage supplemental to the coverage provided under 10 U.S.C. ch. 55, and similar supplemental coverage provided to coverage under group health insurance coverage.6The commissioner shall adopt rules pursuant to chapter 17A to implement the provisions of this section.2010 Acts, ch 1121, §8, 33; 2011 Acts, ch 70, §6505.20Certain agricultural organizations exempt from regulation.1A health benefit plan, sponsored by a nonprofit agricultural organization domiciled in this state and created primarily to promote programs for the development of rural communities and the economic stability and sustainability of farmers in the state which meets the requirements set forth in subsection 2, shall be deemed to not be insurance and shall not be subject to the provisions of this subtitle, to the extent such plan, after January 1, 2018, provides health benefits under a self-funded arrangement that is administered by a domestic entity that is registered as a third-party administrator pursuant to chapter 510 and that has continuously provided, either directly or through an affiliate, health care administrative services to the nonprofit agricultural organization or its affiliates for a period in excess of ten years.2A nonprofit agricultural organization providing a health benefit plan to its members under this section must meet all of the following requirements:aHave been in existence for twenty-five continuous years prior to the issuance of health benefits to members of the organization.bProvide membership opportunities for eligible individuals in all ninety-nine counties of the state.cCollect annual dues from members.dHold regular meetings to further the purposes of the members.eProvide the members with representation on its governing board and committees.fProvide education, mentoring, and financial assistance to grow and expand rural businesses in the state.gHave contracted with the domestic entity described in subsection 1 to administer the health benefit plan.3Such nonprofit agricultural organization shall file a certification with the commissioner that the organization meets the foregoing requirements prior to providing health benefits under a self-funded arrangement to its members.2018 Acts, ch 1063, §1505.21Health care access — duties of commissioner — penalties.1The commissioner shall adopt rules establishing a requirement that an employer provide access to health care to the employees of the employer. The rules shall provide that an employer doing business within this state shall offer each employee, at a minimum, access to health insurance. The requirement contained in this section may be satisfied by offering any of the following:aHealth care coverage through an insurer or health maintenance organization authorized to do business in this state.bAccess to health benefits through a health benefits plan qualified under the federal Employee Retirement Income Security Act of 1974.2An employer may financially contribute toward the employee’s health benefit plan. The employer shall offer payroll deduction of employee contributions and direct deposit of premium payments related to a health insurance purchasing cooperative or other health care coverage.3A violation of this section may be reported to the consumer and legal affairs bureau in the insurance division. The division may issue, upon a finding that an employer has failed to offer an employee access to health insurance, any of the following:aA cease and desist order instructing the employer to cure the failure and desist from future violations of this section.bAn order requiring an employer who has previously been the subject of a cease and desist order to pay an employee’s reasonable health insurance premiums necessary to prevent or cure a lapse in health care coverage arising out of the employer’s failure to offer as required.cAn order upon the employer assessing the reasonable costs of the division’s investigation and enforcement action.94 Acts, ch 1176, §6; 98 Acts, ch 1217, §38505.22Certain religious organization activities exempt from regulation.A religious organization which, through its publication to subscribers, solicits funds for the payment of medical expenses of other subscribers, shall not be considered to be engaging in the business of insurance for purposes of this chapter or any other provision of this title, and shall not be subject to the jurisdiction of the commissioner of insurance, if all of the following apply:1The religious publication is provided by a nonprofit charitable organization described in section 501(c)(3) of the Internal Revenue Code.2Participation is limited to subscribers who are members of the same denomination or religion.3The publication is registered with the United States postal service and acts as an organizational clearinghouse for information between subscribers who have financial, physical, or medical needs, and subscribers who choose to assist with those needs, matching subscribers with the present ability to pay with subscribers with a present financial or medical need.4The organization, through its publication, provides for the payment for subscriber financial or medical needs through direct payments from one subscriber to another.5The organization, through its publication, suggests amounts to contribute that are voluntary among the subscribers, with no assumption of risk or promise to pay either among the subscribers or between the subscribers and the publication.95 Acts, ch 185, §3505.23Hearings.If an evidentiary hearing is conducted in a proceeding pursuant to section 508B.7, 515G.7, 521A.3, or 521A.14, or in a proceeding with respect to a merger or consolidation pursuant to chapter 521, the proceeding is a contested case subject to chapter 17A.2000 Acts, ch 1023, §6505.24Sale of policy term information by consumer reporting agency.1For purposes of this section, unless the context otherwise requires, “consumer reporting agency” means any person that for monetary fees, dues, or on a cooperative nonprofit basis regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties and that uses any means or facility of interstate commerce for the purpose of preparing or furnishing consumer reports.2A consumer reporting agency shall not provide or sell data or lists that include any information that in whole or in part was submitted in conjunction with an insurance inquiry about a consumer’s credit information or a request for a credit report or insurance score. Information submitted in conjunction with an insurance inquiry about a consumer includes, but is not limited to, the expiration dates of an insurance policy or any other information that may identify time periods during which a consumer’s insurance may expire and the terms and conditions of the consumer’s insurance coverage.3The restrictions provided in subsection 2 do not apply to data or lists supplied by a consumer reporting agency to an insurance producer from whom information was received, the insurer on whose behalf such producer acted, or such insurer’s affiliates or holding companies.4This section shall not be construed to restrict any insurer from being able to obtain a claims history report or a motor vehicle report.2003 Acts, ch 91, §3505.25Information provided to medical assistance program, Hawki program, and child support services.A carrier, as defined in section 514C.13, shall enter into a health insurance data match program with the department of health and human services for the sole purpose of comparing the names of the carrier’s insureds with the names of recipients of the medical assistance program under chapter 249A, individuals under the purview of child support services pursuant to chapter 252B, or enrollees of the Hawki program under chapter 514I.2004 Acts, ch 1175, §153, 162; 2005 Acts, ch 175, §123; 2006 Acts, ch 1119, §6; 2023 Acts, ch 19, §1183505.26Prior authorization for prescription drug benefits standard process and form — response requirements.1As used in this section:a“Facility”, “health benefit plan”, “health care professional”, “health care provider”, “health care services”, and “health carrier” mean the same as defined in section 514J.102.b“Pharmacy benefits manager” means the same as defined in section 510B.1. 2The commissioner shall develop, by rule, a process for use by each health carrier and pharmacy benefits manager that requires prior authorization for prescription drug benefits pursuant to a health benefit plan, to submit, on or before January 1, 2015, a single prior authorization form for approval by the commissioner, that each health carrier or pharmacy benefits manager shall be required to use beginning on July 1, 2015. The process shall provide that if a prior authorization form submitted to the commissioner by a health carrier or pharmacy benefits manager is not approved or disapproved within thirty days after its receipt by the commissioner, the form shall be deemed approved.3The commissioner shall develop, by rule, a standard prior authorization process which meets all of the following requirements:aHealth carriers and pharmacy benefits managers shall allow health care providers to submit a prior authorization request electronically.bHealth carriers and pharmacy benefits managers shall provide that approval of a prior authorization request shall be valid for a minimum length of time in accordance with the rules adopted under this section. In adopting the rules, the commissioner may consult with health care professionals who seek prior authorization for particular types of drugs, and as the commissioner determines to be appropriate, negotiate standards for such minimum time periods with individual health carriers and pharmacy benefits managers.cHealth carriers and pharmacy benefits managers shall make the following available and accessible on their internet sites:1Prior authorization requirements and restrictions, including a list of drugs that require prior authorization.2Clinical criteria that are easily understandable to health care providers, including clinical criteria for reauthorization of a previously approved drug after the prior authorization period has expired.3Standards for submitting and considering requests, including evidence-based guidelines, when possible, for making prior authorization determinations.dHealth carriers shall provide a process for health care providers to appeal a prior authorization determination as provided in chapter 514J. Pharmacy benefits managers shall provide a process for health care providers to appeal a prior authorization determination that is consistent with the process provided in chapter 514J.4In adopting a standard prior authorization process, the commissioner shall consider national standards pertaining to electronic prior authorization, such as those developed by the national council for prescription drug programs.5A prior authorization form approved by the commissioner shall meet all of the following requirements:aNot exceed two pages in length, except that a prior authorization form may exceed that length as determined to be appropriate by the commissioner.bBe available in electronic format.cBe transmissible in an electronic format or a fax transmission.6Beginning on July 1, 2015, each health carrier and pharmacy benefits manager shall use and accept the prior authorization form that was submitted by that health carrier or pharmacy benefits manager and approved for the use of that health carrier or pharmacy benefits manager by the commissioner pursuant to this section. Beginning on July 1, 2015, health care providers shall use and submit the prior authorization form that has been approved for the use of a health carrier or pharmacy benefits manager, when prior authorization is required by a health benefit plan.7The commissioner shall adopt rules pursuant to chapter 17A that provide requirements, not to exceed seventy-two hours for urgent claims and five calendar days for nonurgent claims, for a health carrier or pharmacy benefits manager to respond to a health care provider’s request for prior authorization of prescription drug benefits or to request additional information from a health care provider concerning such a request.2014 Acts, ch 1140, §98, 101; 2015 Acts, ch 128, §9, 50, 51505.27Medical malpractice insurance — annual claims reports required.1An insurer providing medical malpractice insurance coverage to Iowa health care providers shall file annually on or before June 1 with the commissioner a report of all medical malpractice insurance claims, both open claims and closed claims filed during the reporting period, against any such Iowa insureds during the preceding calendar year.2The report shall be in writing and contain all of the following information aggregated by specialty area and paid loss and paid expense categories established by the commissioner:aThe total number of claims in the reporting period and the nature and substance of such claims.bThe total amounts paid within six months after final disposition of the claims.cThe total amount reserved for the payment of claims incurred and reported but not disposed.dThe expenses, as set forth by rule, related to the claims.eAny other additional information as required by the commissioner by rule.3The commissioner shall compile annually the data included in reports filed by insurers pursuant to this section into an aggregate form by insurer, except that such data shall not include information that directly or indirectly identifies any individual, including a patient, an insured, or a health care provider. The commissioner shall submit a written report summarizing such data along with any recommendations to the general assembly and the governor annually by December 1.4A report prepared pursuant to subsection 1 or 3 shall be open to the public and shall be made available to a requesting party by the commissioner at no charge, except that any identifying information of any individual, including a patient, an insured, or health care provider, shall remain confidential.5For purposes of this section:a“Health care provider” means the same as defined in section 135.61, a hospital licensed pursuant to chapter 135B, or a health care facility licensed pursuant to chapter 135C.b“Insurer” means an insurance company authorized to transact insurance business in this state. “Insurer” does not include a health care provider who maintains professional liability insurance coverage through a self-insurance plan, an unauthorized insurance company transacting business with an insured person in this state, or a person not authorized to transact insurance business in this state.2006 Acts, ch 1128, §3; 2017 Acts, ch 29, §141; 2019 Acts, ch 59, §177; 2025 Acts, ch 120, §71505.27ASale of life insurance to military personnel.Notwithstanding any other provision of this title, the commissioner of insurance shall have the authority to adopt such rules related to the sale of life insurance, other than the servicemembers’ group life insurance program under 38 U.S.C. pt. II, ch. 19, subch. III, as may be necessary to protect military personnel located either on a United States military installation or elsewhere in this state and to carry out the provisions of this title.2007 Acts, ch 137, §7505.28Consent to jurisdiction.A person committing any act governed by chapter 502, 502A, this chapter, chapters 505A through 523G, or 523I constitutes consent by that person to the jurisdiction of the commissioner of insurance and the district courts of this state.2006 Acts, ch 1117, §16; 2011 Acts, ch 25, §61505.29Administrative hearings — authority to appoint hearing officer.The commissioner of insurance shall have the authority to appoint as a hearing officer a designee or an independent administrative law judge. Duties of a hearing officer shall include hearing contested cases arising from conduct governed by chapters 502, 502A, this chapter, chapters 505A through 523G, and 523I. Sections 10A.801 and 17A.11 do not apply to the appointment of a designee or an administrative law judge pursuant to this section.2006 Acts, ch 1117, §17; 2011 Acts, ch 25, §62505.30Service of process made on the commissioner as agent or attorney for service of process rules and fee.1The commissioner may adopt rules pursuant to chapter 17A setting forth procedures related to service of process made on the commissioner as agent or attorney for service of process for an individual or entity within the jurisdiction of the commissioner. The rules shall apply when the individual or entity is required by law to appoint the commissioner to serve, is required by law to consent to have the commissioner serve, is deemed by law to have appointed or to have consented to have the commissioner serve, or elects to appoint or consents to have the commissioner serve as agent or attorney for service of process.2The commissioner may collect a reasonable fee each time service of process is made on the commissioner as set forth in subsection 1 or as otherwise allowed by law. A fee collected by the commissioner under this subsection shall be used and is appropriated to the insurance division to offset the costs of the commissioner acting as agent or attorney for service of process. The party to a proceeding requesting service of process is entitled to recover the fee paid pursuant to this subsection and any rules adopted under this section as costs if the party prevails in the proceeding.3The commissioner shall maintain for ninety days a record of each service of process made on the commissioner pursuant to this section, including the date each service of process is made on the commissioner, the date each service of process is forwarded by mail by the commissioner to the defendant or respondent, and the date each certificate of service is submitted electronically to the court. The records may be maintained electronically.2006 Acts, ch 1117, §18; 2018 Acts, ch 1018, §2505.31Reimbursement accounts — assistance to small employers.The commissioner of insurance shall assist employers with twenty-five or fewer employees with implementing and administering plans under section 125 of the Internal Revenue Code, including medical expense reimbursement accounts and dependent care accounts. The commissioner shall provide information about the assistance available to small employers on the insurance division’s internet site.2008 Acts, ch 1188, §37, 43505.32Iowa insurance information exchange.Repealed by 2018 Acts, ch 1012, §2.505.33Dramshop liability insurance evaluation.The division shall biennially conduct an evaluation concerning minimum coverage requirements of dramshop liability insurance. In conducting the evaluation, the division shall include a comparison of other states’ minimum dramshop liability insurance coverage and any other relevant issues the division identifies. By January 31, 2019, and every two years thereafter, the division shall submit a report, including any findings and recommendations, to the general assembly as provided in chapter 7A.2018 Acts, ch 1172, §52505.34Medical assistance and Hawki programs applicability of subtitle.1The medical assistance program under chapter 249A and the healthy and well kids in Iowa (Hawki) program under chapter 514I shall not be subject to this subtitle unless otherwise provided by law.2A managed care organization acting pursuant to a contract with the department of health and human services to administer the medical assistance program under chapter 249A, or the healthy and well kids in Iowa (Hawki) program under chapter 514I, shall not be subject to this subtitle unless otherwise provided by law.2022 Acts, ch 1131, §63; 2023 Acts, ch 19, §1184505.35Adoption of standards by reference rules.Rules adopted by the commissioner pursuant to chapter 17A that adopt a standard by reference to another publication or portion thereof are exempt from the requirements of section 17A.6, subsection 5, with respect to the following:1Professional standards of practice and membership requirements established by the actuarial standards board, the American academy of actuaries, the American institute of certified public accountants, or their successor organizations.2The following publications of the national association of insurance commissioners:aValuation manual used to establish principle-based reserves for the life insurance industry.bAccounting practices and procedures manual.cFinancial examiners handbook.dFinancial analysis handbook.eAnnual/quarterly financial statement blank and instructions.fModel laws, regulations, and guidelines, including references to federal statutes or regulations contained therein.2023 Acts, ch 70, §13, 14; 2024 Acts, ch 1169, §22