Section 41-4701 – SHORT TITLE.
41-4701. SHORT TITLE. This chapter shall be known and may be cited as the "Small Employer Health Insurance Availability Act." History: [41-4701, added 1993, ch. 176, sec. 1, p. 435.]
Section 41-4702 – PURPOSE.
41-4702. PURPOSE. The purpose and intent of this chapter is to promote the availability of health insurance coverage to small employers regardless of their health status or claims experience, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules regarding renewability of coverage, to establish limitations on the use […]
Section 41-4703 – DEFINITIONS.
41-4703. DEFINITIONS. As used in this chapter: (1) "Actuarial certification" means a written statement by a member of the American academy of actuaries or other individual acceptable to the director that a small employer carrier is in compliance with the provisions of section 41-4706, Idaho Code, based upon the person’s examination and including a review […]
Section 41-4704 – APPLICABILITY AND SCOPE.
41-4704. APPLICABILITY AND SCOPE. With the exception of a health benefit plan subject to regulation under chapter 52, title 41, Idaho Code, and to the extent permitted by federal law, the provisions of this chapter shall apply to any health benefit plan delivered or issued for delivery in the state of Idaho that provides coverage […]
Section 41-4705 – ESTABLISHMENT OF CLASSES OF BUSINESS.
41-4705. ESTABLISHMENT OF CLASSES OF BUSINESS. (1) A small employer carrier may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons: (a) The small employer carrier uses more than one (1) type of system for the marketing and sale of health […]
Section 41-4706 – RESTRICTIONS RELATING TO PREMIUM RATES.
41-4706. RESTRICTIONS RELATING TO PREMIUM RATES. (1) Premium rates for health benefit plans subject to the provisions of this chapter shall be subject to the following provisions: (a) The index rate for a rating period for any class of business shall not exceed the index rate for any other class of business by more than […]
Section 41-4707 – RENEWABILITY OF COVERAGE.
41-4707. RENEWABILITY OF COVERAGE. (1) A health benefit plan subject to the provisions of this chapter shall be renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases: (a) Nonpayment of the required premiums; (b) Fraud or intentional misrepresentation of material fact […]
Section 41-4708 – AVAILABILITY OF COVERAGE — PREEXISTING CONDITIONS — PORTABILITY.
41-4708. AVAILABILITY OF COVERAGE — PREEXISTING CONDITIONS — PORTABILITY. (1) Every small employer carrier shall, as a condition of offering health benefit plans in this state to small employers, actively offer to small employers all benefit plans, including the small employer basic health benefit plan, the small employer standard health benefit plan, and the small […]
Section 41-4708B – CONVERSION PLAN — WHEN REQUIRED.
41-4708B. CONVERSION PLAN — WHEN REQUIRED. Any group carrier doing business in the state of Idaho that does not have an individual product on file with the department of insurance shall provide a conversion plan to all group insureds. The conversion plan shall provide benefits at least equal to the standard health benefit plan developed […]
Section 41-4709 – NOTICE OF INTENT TO OPERATE AS A RISK-ASSUMING CARRIER OR A REINSURING CARRIER.
41-4709. NOTICE OF INTENT TO OPERATE AS A RISK-ASSUMING CARRIER OR A REINSURING CARRIER. (1) (a) Each small employer carrier shall notify the director within thirty (30) days of the effective date of this chapter of the carrier’s intention to operate as a risk-assuming carrier or a reinsuring carrier. A small employer carrier seeking to […]
Section 41-4710 – APPLICATION TO BECOME A RISK-ASSUMING CARRIER.
41-4710. APPLICATION TO BECOME A RISK-ASSUMING CARRIER. (1) A small employer carrier may apply to become a risk-assuming carrier by filing an application with the director in a form and manner prescribed by the director. (2) The director shall consider the following factors in evaluating an application filed under the provisions of subsection (1) of […]
Section 41-4711 – SMALL EMPLOYER CARRIER REINSURANCE PROGRAM.
41-4711. SMALL EMPLOYER CARRIER REINSURANCE PROGRAM. (1) All carriers shall be subject to the provisions of this section. (2) There is hereby created an independent public body corporate and politic to be known as the Idaho small employer health reinsurance program. The program will perform an essential governmental function in the exercise of powers conferred […]
Section 41-4712 – SMALL EMPLOYER HEALTH BENEFIT PLANS.
41-4712. SMALL EMPLOYER HEALTH BENEFIT PLANS. (1) The board, in addition to its other powers and duties, shall establish the form and level of coverages, including benefit levels, cost-sharing levels, exclusions and limitations for the small employer basic, standard and catastrophic health benefit plans to be made available by small employer carriers pursuant to section […]
Section 41-4713 – PERIODIC MARKET EVALUATION.
41-4713. PERIODIC MARKET EVALUATION. The board, in consultation with members of the committee, shall study and report at least every three (3) years to the director on the effectiveness of chapters 47 and 52, title 41, Idaho Code. The report shall analyze the effectiveness of the chapters in promoting rate stability, product availability, and coverage […]
Section 41-4715 – ADMINISTRATIVE PROCEDURES.
41-4715. ADMINISTRATIVE PROCEDURES. The director shall promulgate rules and regulations in accordance with the provisions of chapter 52, title 67, Idaho Code, for the implementation and administration of the small employer health coverage reform act. History: [41-4715, added 1993, ch. 176, sec. 1, p. 454.]
Section 41-4716 – STANDARDS TO ASSURE FAIR MARKETING.
41-4716. STANDARDS TO ASSURE FAIR MARKETING. (1) Each small employer carrier shall actively market health benefit plan coverage, including the small employer basic, standard and catastrophic health benefit plans, to eligible small employers in the state. (2) (a) Except as provided in subsection (2)(b) of this section, no small employer carrier or agent shall, directly […]