Insurance Regulation and Insurer Classifications

Why States, Not Washington, Regulate Insurance

Almost everything about how an insurance company operates in the United States — what it can sell, who can sell it, what rates it can charge, how it must handle claims — is governed by state law, enforced by a state insurance department. That arrangement is not an accident of history; it was deliberately set in place by Congress.

The McCarran-Ferguson Act of 1945

In 1944, the U.S. Supreme Court ruled in United States v. South-Eastern Underwriters Association that insurance written across state lines was interstate commerce and therefore reachable by federal regulation. The states’ insurance departments — well established by that point — were suddenly at risk of being preempted. The next year, Congress responded with the McCarran-Ferguson Act, which still defines the federal-state relationship today:

• State law controls. The business of insurance is governed by the laws of each state. States set the rules, license the companies and the agents, and supervise the market.
• Federal antitrust laws step aside — to the extent states regulate. The Sherman Act, the Clayton Act, and the Federal Trade Commission Act apply to insurance only where state regulation does not.
• Federal law still governs where Congress has spoken specifically to insurance. McCarran-Ferguson does not exempt insurance from federal statutes that target it by name — ERISA, COBRA, HIPAA, the Affordable Care Act, the No Surprises Act, and Gramm-Leach-Bliley.

The NAIC: Influential, but Not a Regulator

The National Association of Insurance Commissioners is a voluntary body whose members are the chief insurance regulators of all 50 states, the District of Columbia, and the U.S. territories. Its main outputs are:

• Model laws and regulations. Standardized statutory and regulatory language that state legislatures may adopt, modify, or reject. Iowa has adopted versions of many NAIC models — the Producer Licensing Model, the Unfair Trade Practices Act (Iowa Code 507B), the Suitability in Annuity Transactions Model with the 2020 best interest amendment (Iowa Admin Rule 191-15.72–.78), and the LTC Model.
• Data systems and tools. Solvency databases, license verification, complaint records, and the Insurance Regulatory Information System (IRIS) financial ratios.
• Consumer education resources that states and consumers can use, though these have no force of law.

What the NAIC cannot do is also frequently tested: it cannot license a producer, fine or discipline an insurer, pay a claim, or enforce any regulation directly. Those powers belong to the state departments of insurance.

The Iowa Insurance Division

Iowa insurance regulation is centered at the Iowa Insurance Division (IID), a division within the Iowa Department of Commerce. IID administers the Iowa Insurance Code, licenses producers and adjusters, approves policy forms, monitors insurer solvency, runs market conduct examinations, and handles consumer complaints. Iowa is unusual in that its capital, Des Moines, is the third-largest insurance center in the United States (behind New York and Hartford) — home to Principal Financial Group, Nationwide’s regional operations, and dozens of other carriers — which gives IID’s decisions outsized industry weight.

The Iowa Insurance Commissioner (Iowa Code 505.2, 505.8)

The Commissioner heads IID. Two features of the Iowa Commissioner’s office are tested:

• Appointed, not elected. The Governor of Iowa appoints the Commissioner. The Iowa Senate must confirm the appointment.
• Four-year term. The Commissioner serves a four-year term.

The Commissioner’s Powers

The Iowa Insurance Code gives the Commissioner broad enforcement authority:

• Broad powers and duties to administer and enforce the Insurance Code, adopt rules, supervise the conduct of insurers and producers, and protect the public (Iowa Code 505.2, 505.8, 507B.3, 507C).
• Examination of records of any insurer or licensee (Iowa Code 507.1, .2, .3).
• Hearings before taking enforcement action (Iowa Code 507B.6).
• Penalties under Iowa Code 505.7A and 507B.7, with related procedures in Iowa Admin Rule 191-10.20.
• Cease-and-desist orders to halt prohibited activity (Iowa Code 507B.6A, 522B.17; Iowa Admin Rule 191-15.14).

Classifying Insurers

Every insurer doing business in Iowa falls into several classifications at once. The exam tests each independently.

Admitted (Authorized) vs. Non-Admitted (Unauthorized)

An admitted (authorized) insurer holds a Certificate of Authority from IID under Iowa Code 507A.7(1)(b) (life and health insurers) or 515.41 (P&C insurers) and is fully subject to Iowa regulation: rate and form review, premium taxes, market conduct examinations, and mandatory membership in the appropriate guaranty association.

A non-admitted (unauthorized) insurer does not hold an Iowa Certificate of Authority. It may still write coverage in Iowa, but only through a licensed surplus lines producer under Iowa Code Chapter 515I and Iowa Admin Rule 191-21, and only when admitted carriers cannot or will not cover the risk. Non-admitted insurer policyholders are not eligible for guaranty association coverage if the carrier fails.

Domestic, Foreign, and Alien (Iowa Code 521A, 521E.1, 515.70)

All three terms describe where the insurer is chartered, viewed from the perspective of Iowa:

• Domestic. Chartered in Iowa.
• Foreign. Chartered in another U.S. state or territory. A Nebraska-chartered insurer is foreign in Iowa — even though in everyday English “foreign” suggests another country.
• Alien. Chartered outside the United States.

Organizational Form: Stock, Mutual, Fraternal, Reciprocal

• Stock insurer. A for-profit corporation owned by shareholders. Profits flow to shareholders as dividends; policyholders are customers, not owners.

• Mutual insurer. A company owned by its policyholders. Net earnings may be distributed to policyholders as policy dividends — technically a return of unused premium, not an inducement to buy. (Iowa is home to several large mutuals, including Nationwide’s mutual structure and EMC Insurance.)

• Fraternal benefit society (Iowa Code Chapter 512B). A nonprofit organization with a lodge system that issues insurance only to its members. Fraternals are organized around a common purpose (often religious, ethnic, or occupational). Important exam note: fraternal benefit societies are not members of ILHIGA, so fraternal certificates are not covered by the guaranty association.

• Reciprocal exchange. An unincorporated association in which members exchange insurance contracts with each other through an attorney-in-fact. Reciprocals are not common in Iowa but appear as exam vocabulary.