Skip to form

Cybersecurity HIPAA Compliance Annual Certification

The Insurance Data Security Act, Iowa Code chapter 507F, as known as the Cybersecurity Act, establishes the exclusive state standards for data security, and the investigation and notification of cybersecurity events, applicable to licensees. 

Licensees that are subject to and in compliance with HIPAA are required to submit an annual written certification to be exempt from the provisions of Iowa Code chapter 507F.

Certification

By signing below, the undersigned authorized individual hereby certifies that as an Iowa Insurance Division licensee, defined by Iowa Code section 507F.3(13), I am compliant with the Health Insurance Portability and Accountability Act (HIPAA). 

I understand that as long as I am compliant with HIPAA, I am subject to the requirements under the federal law and exempt from the requirements of Iowa Code chapter 507F. 

I further understand that I am required to certify to my HIPAA compliance on an annual basis with the Iowa Insurance Division. 

This form is being submitted pursuant to Iowa Code section 507F.13.

Entity Type

Full Name of Authorized Signer

Sign Here

Choose how to sign