Section 41-5915 – FUNDING OF EXTERNAL REVIEW.
41-5915. FUNDING OF EXTERNAL REVIEW. The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the reasonable cost of the independent review organization for conducting the external review. History: [41-5915, added 2009, ch. 87, sec. 1, p. 256; am. 2011, ch. 122, sec. 8, […]
Section 41-5821 – SEVERABILITY.
41-5821. SEVERABILITY. If any provisions of this chapter, or the application of a provision to any persons or circumstances, shall be held invalid, the remainder of the chapter, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected. History: [41-5821, added 2008, […]
Section 41-5916 – DISCLOSURE REQUIREMENTS.
41-5916. DISCLOSURE REQUIREMENTS. (1) Each health carrier shall include a summary description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to covered persons. The disclosure shall be in a format prescribed by the director. (2) The description required under […]
Section 41-5901 – SHORT TITLE.
41-5901. SHORT TITLE. This chapter shall be known and may be cited as the "Idaho Health Carrier External Review Act." History: [41-5901, added 2009, ch. 87, sec. 1, p. 240.]
Section 41-5917 – SEVERABILITY.
41-5917. SEVERABILITY. The provisions of this act are hereby declared to be severable and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the remaining portions of this act. History: [41-5917, added 2009, […]
Section 41-5902 – PURPOSE AND INTENT.
41-5902. PURPOSE AND INTENT. The purpose of this chapter is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of a final adverse benefit determination, as defined in this chapter. History: [41-5902, added 2009, ch. 87, sec. 1, p. […]
Section 41-6001 – LEGISLATIVE INTENT.
41-6001. LEGISLATIVE INTENT. [EFFECTIVE UNTIL JULY 1, 2024] The intent of the legislature is to provide a supplemental funding mechanism for the Idaho immunization program administered by the Idaho department of health and welfare, by creating a dedicated vaccine fund and an independent board, which board is empowered to assess fees from all carriers. The […]
Section 41-5903 – DEFINITIONS.
41-5903. DEFINITIONS. For purposes of this chapter: (1) "Administrative record" means all nonprivileged documents, records or other health information which was submitted, considered, generated or relied upon by the health carrier in the course of making the adverse benefit determination, including, but not limited to, documents, records or other information that constitutes the plan’s policy […]
Section 41-6002 – DEFINITIONS.
41-6002. DEFINITIONS. [EFFECTIVE UNTIL JULY 1, 2024] As used in this chapter: (1) "Board" means the Idaho immunization assessment board created by section 41-6003, Idaho Code. (2) "Carrier" means: any entity subject to regulation by the department that provides or is authorized to provide health insurance or health benefit plans, or that administers health insurance […]
Section 41-5904 – APPLICABILITY AND SCOPE.
41-5904. APPLICABILITY AND SCOPE. (1) Except as provided in subsection (2) of this section, this chapter shall apply to all health carriers. (2) The provisions of this chapter shall not apply to a plan, policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage; nor shall this chapter apply […]