IIHBRA Reporting Form

January 23, 2012

Iowa Individual Health Benefit Reinsurance Program - 2011 Annual Reporting Form

Dear Association Member:

Below, please find the Annual Reporting Form and the Basic and Standard Plan Experience Report for the Iowa Individual Health Benefit Reinsurance Program. The forms must be completed whether your organization is an insurer, fraternal benefit society, health maintenance organization, organized delivery system, a government self-funded plan or a self-insured company that has elected to participate in the Program.

If you are an insurer, health maintenance organization or organized delivery system, you are required to also complete the Basic and Standard Plan Experience Report.

The deadline for returning the annual report and the basic and standard experience report is March 15, 2012.

Return completed form to:

Iowa Individual Health Benefit Reinsurance Association
c/o Nyemaster Law Firm
700 Walnut, Suite 1600
Des Moines, IA  50309

It is important that we receive this information by March 15, 2012 in order to determine by May 1, 2012 whether an assessment of the Association is necessary. If you have any questions, please contact Willard Boyd at 515-283-3172.