2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514B - HEALTH MAINTENANCE ORGANIZATIONS
514B.25A - INSOLVENCY PROTECTION -- ASSESSMENT.

        514B.25A  INSOLVENCY PROTECTION -- ASSESSMENT.
         1.  Upon a health maintenance organization or organized delivery
      system authorized to do business in this state and licensed by the
      director of public health being declared insolvent by the district
      court, the commissioner may levy an assessment on each health
      maintenance organization or organized delivery system doing business
      in this state and licensed by the director of public health, as
      applicable, to pay claims for uncovered expenditures for enrollees.
      The commissioner shall not assess an amount in any one calendar year
      which is more than two percent of the aggregate premium written by
      each health maintenance organization or organized delivery system.
         2.  The commissioner may use funds obtained through an assessment
      under subsection 1 to pay claims for uncovered expenditures for
      enrollees of an insolvent health maintenance organization or
      organized delivery system and administrative costs.  The
      commissioner, by rule, may prescribe the time, manner, and form for
      filing claims under this section.  The commissioner may require
      claims to be allowed by an ancillary receiver or the domestic
      receiver or liquidator.
         3. a.  A receiver or liquidator of an insolvent health
      maintenance organization or organized delivery system shall allow a
      claim in the proceeding in an amount equal to uncovered expenditures
      and administrative costs paid under this section.
         b.  A person receiving benefits under this section for
      uncovered expenditures is deemed to have assigned the rights under
      the covered health care plan certificates to the commissioner to the
      extent of the benefits received.  The commissioner may require an
      assignment of such rights by a payee, enrollee, or beneficiary, to
      the commissioner as a condition precedent to the receipt of such
      benefits.  The commissioner is subrogated to these rights against the
      assets of the insolvent health maintenance organization or organized
      delivery system that are held by a receiver or liquidator of a
      foreign jurisdiction.
         c.  The assigned subrogation rights of the commissioner and
      allowed claims under this subsection have the same priority against
      the assets of the insolvent health maintenance organization or
      organized delivery system as those claims of persons entitled to
      receive benefits under this section or for similar expenses in the
      receivership or liquidation.
         4.  If funds assessed under subsection 1 are unused following the
      completion of the liquidation of an insolvent health maintenance
      organization or organized delivery system, the commissioner shall
      distribute the remaining amounts, if such amounts are not de minimis,
      to the health maintenance organizations or organized delivery systems
      that were assessed.
         5.  The aggregate coverage of uncovered expenditures under this
      section shall not exceed three hundred thousand dollars with respect
      to one individual.  Continuation of coverage shall cease after the
      lesser of one year after the health maintenance organization or
      organized delivery system is terminated by insolvency or the
      remaining term of the contract.  The commissioner may provide
      continuation of coverage on a reasonable basis, including, but not
      limited to, continuation of the health maintenance organization or
      organized delivery system contract or substitution of indemnity
      coverage in a form as determined by the commissioner.
         6.  The commissioner may waive an assessment of a health
      maintenance organization or organized delivery system if such
      organization or system is impaired financially or would be impaired
      financially as a result of such assessment.  A health maintenance
      organization or organized delivery system that fails to pay an
      assessment within thirty days after notice of the assessment is
      subject to a civil forfeiture of not more than one thousand dollars
      for each day the failure continues, and suspension or revocation of
      its certificate of authority.  An action taken by the commissioner to
      enforce an assessment under this section may be appealed by the
      health maintenance organization or organized delivery system pursuant
      to chapter 17A.  

         2000 Acts, ch 1023, §26