Unfair Market Practice Complaint

If you have observed or learned of a business practice or individual conduct that you believe may violate Iowa insurance, securities, or regulated industries law, and you are not the consumer involved in or affected by the practice or conduct, you may advise the Iowa Insurance Division of your concerns and request investigation by completing this form.

Name

Daytime Phone

Email Address

Address

Address 2

City

State

Zip Code

County

Name of Insurance Company, Pharmacy Benefits Manager or Other Company believed to be engaged in unlawful practice

Name of Administrator or any other organizations involved in complaint

Date of Service (from)

Date of Service (to)

Your Market Complaint

Authorization

By submitting this complaint, you verify that your statements are true, and without otherwise waiving the confidentiality protection of Iowa Code Section 505.8, you are authorizing the Iowa Insurance Division to provide a copy of this complaint form and attachments to the insurance company, producer or agent that is the subject of your complaint.

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Unfair Market Practice Complaint