§ 513C.9 — Standards to assure fair marketing

Iowa § 513C.9

• Jurisdiction: Iowa
• Title XIII: COMMERCE
• Ch. 513C: INDIVIDUAL HEALTH INSURANCE MARKET REFORM

Text

1. A carrier or an agent shall not do either of the following:
a. Encourage or direct individuals to refrain from filing an application for coverage
with the carrier because of the health status, claims experience, industry, occupation, or
geographic location of the individuals.
b. Encourage or direct individuals to seek coverage from another carrier because of
§513C.9, INDIVIDUAL HEALTH INSURANCE MARKET REFORM 6
the health status, claims experience, industry, occupation, or geographic location of the
individuals.
2. Subsection 1, paragraph “a”, shall not apply with respect to information provided by a
carrier or an agent to an individual regarding the established geographic service area of the
carrier or the restricted network provision of the carrier.
3. A carrier shall not, directly or indirectly, enter into any contract, agreement, or
arrangement with an agent that provides for, or results in, the compensation paid to an agent
for a sale of a basic or standard health benefit plan to vary because of the health status or
permitted rating characteristics of the individual or the individual’s dependents.
4. Notwithstanding subsection 3, a commission shall be paid to an agent related to
the sale of a basic or standard health benefit plan under this chapter. A commission paid
pursuant to this subsection shall not be considered by the board for purposes of section
513C.10, subsection 5.
5. Subsection 3 does not apply with respect to the compensation paid to an agent on the
basis of percentage of premium, provided that the percentage shall not vary because of the
health status or other permitted rating characteristics of the individual or the individual’s
dependents.
6. Denial by a carrier of an application for coverage from an individual shall be in writing
and shall state the reason or reasons for the denial.
7. A violation of this section by a carrier or an agent is an unfair trade practice under
chapter 507B.
8. If a carrier enters into a contract, agreement, or other arrangement with a third-party
administrator to provide administrative, marketing, or other services related to the offering
of individual health benefit plans in this state, the third-party administrator is subject to this
section as if it were a carrier.