Idaho Code § 41-5911 — Idaho Code / Title 41 / Chapter 59 / Section 41-5911
41-5911 APPROVAL OF INDEPENDENT REVIEW ORGANIZATIONS.
Status: in_force

41-5911. approval of independent review organizations. (1) The director shall approve independent review organizations eligible to be assigned on a random basis to conduct external reviews under this chapter.

(2) In order to be eligible for approval by the director under this section to conduct external reviews under this chapter an independent review organization shall:

(a) Except as otherwise provided in this section, be accredited by a nationally recognized private accrediting entity that the director has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established under section 41-5912, Idaho Code; and

(b) Submit an application for approval in accordance with subsection (4) of this section.

(3) The director shall develop an application form for initially approving and for reapproving independent review organizations to conduct external reviews.

(4) Any independent review organization wishing to be approved to conduct external reviews under this chapter shall submit the application form and include with the form all documentation and information necessary for the director to determine whether the independent review organization satisfies the minimum qualifications established under section 41-5912, Idaho Code.

(5) The director shall publish prominently on the department of insurance website notice of a submitted application or reapplication by an independent review organization to provide external reviews under this chapter.

(a) Any person wishing to comment on an application shall have forty-two (42) days, from the publication of notice by the director, to provide written comments to the director on the application or reapplication submitted by an independent review organization.

(b) The director shall review and consider the written comments received in determining whether to approve the application or reapplication of an independent review organization.

(c) The director may approve independent review organizations that are not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.

(6) The director may charge an application fee that independent review organizations shall submit to the director with an application for approval and reapproval.

(7) An approval is effective for two (2) years, unless the director determines before its expiration that the independent review organization no longer satisfies the minimum qualifications established under section 41-5912, Idaho Code.

(8) The director shall maintain and periodically update a list of approved independent review organizations. Whenever the director determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under section 41-5912, Idaho Code, the director shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations approved to conduct external reviews under this chapter. The director may also establish a standard flat fee schedule for each external review performed by the independent review organization.

(9) The director may promulgate administrative rules to carry out the provisions of this section.

History:

[41-5911, added 2009, ch. 87, sec. 1, p. 252.]
Idaho Code § 41-1306 — Idaho Code / Title 41 / Chapter 13 / Section 41-1306
41-1306 FALSE FINANCIAL STATEMENTS.
Status: in_force

41-1306. False financial statements. (1) No person shall file with any supervisory or other public official, or make, publish, disseminate, circulate or deliver to any person, or place before the public, or cause directly or indirectly to be made, published, disseminated, circulated, delivered to any person, or placed before the public, any false statement of financial condition of an insurer with intent to deceive.

(2) No person shall make any false entry in any book, report or statement of any insurer with intent to deceive any agent or examiner lawfully appointed to examine into its condition or into any of its affairs, or any public official to whom such insurer is required by law to report, or who has authority by law to examine into its condition or into any of its affairs, or, with like intent, wilfully omit to make a true entry of any material fact pertaining to the business of such insurer in any book, report or statement of such insurer.

History:

[41-1306, added 1961, ch. 330, sec. 284, p. 645.]
Idaho Code § 41-118 — Idaho Code / Title 41 / Chapter 1 / Section 41-118
41-118 “CHAPTER” DEFINED.
Status: in_force

41-118. "Chapter" defined. As used in this code and except as otherwise required by context, "chapter" means a particular numbered chapter of this code as indicated by context.

History:

[41-118, added 1961, ch. 330, sec. 804, p. 645.]
Idaho Code § 41-3310 — Idaho Code / Title 41 / Chapter 33 / Section 41-3310
41-3310 COURT'S SEIZURE ORDER.
Status: in_force

41-3310. Court's seizure order. (1) The director may file in the district court of this state a petition alleging, with respect to a domestic insurer:

(a) That any grounds exist that would justify a court order for a formal delinquency proceeding against an insurer under this act;

(b) That the interests of policyholders, creditors, or the public will be endangered by delay; and

(c) The contents of an order deemed necessary by the director.

(2) Upon a filing under subsection (1) of this section, the court may issue forthwith, ex parte and without a hearing, the requested order which shall direct the director to take possession and control of all or a part of the property, books, accounts, documents, and other records of an insurer, and of the premises occupied by it for transaction of its business, and until further order of the court enjoin the insurer and its officers, managers, agents, and employees from disposition of its property and from transaction of its business except with the written consent of the director.

(3) The court shall specify in the order what its duration shall be, which shall be such time as the court deems necessary for the director to ascertain the condition of the insurer. On motion of either party or on its own motion, the court may from time to time hold such hearings as it deems desirable after such notice as it deems appropriate, and may extend, shorten, or modify the terms of the seizure order. The court shall vacate the seizure order if the director fails to commence a formal proceeding under this act after having had a reasonable opportunity to do so. An order of the court pursuant to a formal proceeding under this act shall ipso facto vacate the seizure order.

(4) Entry of a seizure order under the provisions of this section shall not constitute an anticipatory breach of any contract of the insurer.

(5) An insurer subject to an ex parte order under the provisions of this section may petition the court at any time after the issuance of such order for a hearing and review of the order. The court shall hold such a hearing and review not more than fifteen (15) days after the request. A hearing under the provisions of this subsection may be held privately in chambers and it shall be so held if the insurer proceeded against so requests.

(6) If, at any time after the issuance of such an order, it appears to the court that any person whose interest is or will be substantially affected by the order did not appear at the hearing and has not been served, the court may order that notice be given. An order that notice be given shall not stay the effect of any order previously issued by the court.

History:

[41-3310, added 1981, ch. 249, sec. 2, p. 510.]
Idaho Code § 41-6106 — Idaho Code / Title 41 / Chapter 61 / Section 41-6106
41-6106 REPORT.
Status: in_force

41-6106. report. (1) The exchange shall submit a written report of its activities and the condition of the exchange to the director, the governor and the director of the legislative services office for distribution to all legislators on or before January 31, 2014, and annually on or before each January 31 thereafter. The exchange shall also report to the appropriate senate and house of representatives germane committees on any changes to its bylaws or policies and any changes or updates from the federal department of health and human services (HHS) regarding essential health benefits or operation or conditions of the exchange on or before January 31, 2014, and annually on or before each January 31 thereafter.

(2) For any changes by the board to the fee schedule charged to exchange users or participants, the exchange shall, at the next legislative session, report to the appropriate senate and house of representatives germane committees on or before January 31.

History:

[41-6106, added 2013, ch. 170, sec. 1, p. 394.]
Idaho Code § 41-305 — Idaho Code / Title 41 / Chapter 3 / Section 41-305
41-305 CERTIFICATE OF AUTHORITY REQUIRED.
Status: in_force

41-305. Certificate of authority required. (1) No person shall act as an insurer and no insurer or its agents, attorneys, subscribers, or representatives shall directly or indirectly transact insurance in this state except as authorized by a subsisting certificate of authority issued to the insurer by the director, except as to such transactions as are expressly otherwise provided for in this code.

(2) No insurer shall from offices or by personnel or facilities located in this state solicit insurance applications or otherwise transact insurance in another state or country unless it holds a subsisting certificate of authority issued to it by the director authorizing it to transact the same kind or kinds of insurance in this state.

History:

[41-305, added 1961, ch. 330, sec. 69, p. 645.]
Idaho Code § 41-3114 — Idaho Code / Title 41 / Chapter 31 / Section 41-3114
41-3114 INVESTMENTS.
Status: in_force

41-3114. Investments. (1) The insurer may invest and have invested such funds as it may have on hand pursuant to this chapter but not necessary to expend for current expenses and losses, in investments as authorized by the following sections of the Idaho Code only:

(a) Section 41-707 (public obligations);

(b) Section 41-708 (obligations, stock of certain federal agencies);

(c) Section 41-709 (irrigation district bonds);

(d) Section 41-716 (investment trust securities);

(e) Section 41-720 (savings and share accounts);

(f) Sections 41-721 through 41-725 (mortgage loans), as to mortgage loans on Grange halls only; and

(g) Section 41-3115 (site for head office).

(2) The following sections of the Idaho Code shall to the extent applicable, also apply with respect to such an insurer:

(a) Section 41-702 (eligible investments);

(b) Section 41-703 (general qualifications);

(c) Section 41-704 (authorization of investments);

(d) Section 41-705 (record of investments);

(e) Section 41-706(1) (diversification of investments in securities, etc. of any one person);

(f) Section 41-730 (disposal of ineligible property and securities); and

(g) Section 41-731 (prohibited investments and investment underwriting).

History:

[41-3114, added 1961, ch. 330, sec. 672, p. 645; am. 1984, ch. 241, sec. 1, p. 587.]
Idaho Code § 41-716 — Idaho Code / Title 41 / Chapter 7 / Section 41-716
41-716 INVESTMENT TRUST SECURITIES.
Status: in_force

41-716. Investment trust securities. (1) An insurer may invest in the securities of any open-end management type investment company or investment trust registered with the federal securities and exchange commission under the investment company act of 1940 as from time to time amended, if such investment company or trust has been organized for not less than three (3) years and has assets of not less than twenty-five million dollars ($25,000,000) as at the date of investment by the insurer. The aggregate amount invested under this section shall not exceed twenty-five percent (25%) of the insurer's assets with limitations of five percent (5%) of the insurer's assets in any one (1) fund and ten percent (10%) of the insurer's assets in any one (1) fund family.

(2) For the purpose of determining the investment limitation imposed by this section, the insurer shall value securities subject to the provisions of this section at the cost of the security or at the market value of the security, whichever is lower.

History:

[41-716, added 1961, ch. 330, sec. 153, p. 645; am. 1983, ch. 189, sec. 6, p. 513; am. 1997, ch. 226, sec. 1, p. 664; am. 2003, ch. 219, sec. 3, p. 569; am. 2014, ch. 97, sec. 26, p. 288.]
Idaho Code § 41-1401 — Idaho Code / Title 41 / Chapter 14 / Section 41-1401
41-1401 SCOPE OF CHAPTER.
Status: in_force

41-1401. Scope of chapter. (1) Except as provided in section 41-1619 (other provisions applicable, workmen's compensation rates), and except as provided in subsection (3) below, this chapter applies to property, marine and transportation, inland marine, casualty (other than workmen's compensation coverages) and surety (other than the insurance or guaranty of the obligations of employers under workmen's compensation laws) insurances, as such property, marine and transportation, casualty and surety insurances are defined in chapter 5, title 41, Idaho Code, on risks located or operations to be performed in this state.

(2) "Inland marine" insurance shall be deemed to include insurance now or hereafter defined by statute, or by interpretation thereof, or if not so defined or interpreted, by ruling of the director, or as established by general custom of the business, as inland marine insurance.

(3) This chapter shall further not apply as to:

(a) Reinsurance, other than joint reinsurance to the extent stated in section 41-1426;

(b) Insurance of vessels or craft, their cargos, marine builders' risks, marine protection and indemnity; or other risks commonly insured under marine, as distinguished from inland marine, insurance policies;

(c) Insurance against loss of or damage to aircraft or against liability arising out of ownership, maintenance or use of aircraft, nor to insurance of hulls of aircraft, including their accessories and equipment;

(d) Any domestic self-insurer for fire; or

(e) Any reciprocal insurer writing hazards or perils for its members exclusively associated with a single industry.

History:

[41-1401, added 1961, ch. 330, sec. 306, p. 645; am. 1969, ch. 306, sec. 1, p. 917.]
Idaho Code § 41-4931 — Idaho Code / Title 41 / Chapter 49 / Section 41-4931
41-4931 TAXES.
Status: in_force

41-4931. Taxes. (1) The trust fund shall not be subject to chapter 4, title 41, Idaho Code, as it pertains to premium tax.

(2) The state of Idaho hereby preempts the field of imposing excise, privilege, franchise, income, license and similar taxes, licenses and fees upon the trust fund; and no county, city, municipality, district, school district, or other political subdivision or agency of Idaho shall levy upon this trust fund any such tax, license or fee.

History:

[(41-4931) 41-4934, added 1990, ch. 119, sec. 1, p. 284; am. & redesig. 2003, ch. 96, sec. 35, p. 304.]
Idaho Code § 41-1614 — Idaho Code / Title 41 / Chapter 16 / Section 41-1614
41-1614 DEVIATIONS.
Status: in_force

41-1614. Deviations. (1) Every member of a rating organization shall adhere to the filings made on its behalf by such organization except that any such insurer may make written application to the director for permission to file a uniform percentage decrease or increase to be applied to the premiums produced by the rating system so filed for a kind of insurance or for a class of insurance which is found by the director to be a proper rating unit for the application of such uniform percentage decrease or increase, or for a subdivision of a kind of insurance (a) comprised of a group of manual classifications which is treated as a separate unit for rate-making purposes, or (b) for which separate expense provisions are included in the filings of the rating organization. Such applications shall specify the basis for the modification and shall be accompanied by the data upon which the applicant relies. A copy of the application and data shall be sent simultaneously to such rating organization.

(2) The director shall set a time and place for a hearing at which the insurer and such rating organization may be heard and shall give them notice thereof in accordance with chapter 2, title 41, Idaho Code. In the event the director is advised by the rating organization that it does not desire a hearing he may, upon the consent of the applicant, waive such hearing. In permitting or denying such modification with respect to worker's compensation insurance the director shall give consideration to the operating methods and expense provisions of the insurer as compared with the expense provisions included in the rating system filed by such rating organization.

(3) The director shall issue an order permitting the modification for such insurer to be filed if he finds it to be justified and it shall thereupon become effective. He shall issue an order denying such application if he finds that the modification is not justified or that the resulting premiums would be excessive, inadequate or unfairly discriminatory.

(4) Each deviation permitted to be filed shall be effective for a period of one (1) year from the date of such permission unless terminated sooner with the approval of the director.

History:

[41-1614, added 1961, ch. 330, sec. 375, p. 645; am. 2005, ch. 77, sec. 17, p. 266.]
Idaho Code § 41-3925 — Idaho Code / Title 41 / Chapter 39 / Section 41-3925
41-3925 SERVICES PROVIDED BY GOVERNMENTAL ENTITIES.
Status: in_force

41-3925. Services provided by governmental entities. (1) From and after July 1, 1990, no contract shall be issued in Idaho by an organization offering a managed care plan for which a certificate of authority is required which excludes from coverage services rendered the member while a resident in an Idaho state institution, provided the services to the member would be covered by the contract if rendered to him outside an Idaho state institution.

(2) From and after July 1, 1990, no contract issued by an organization offering a managed care plan for which a certificate of authority is required may contain any provision denying or reducing benefits otherwise provided under the policy for the reason that the person insured is receiving health or mental health care or developmental services provided by the department of health and welfare, whether or not the department of health and welfare bases its charges for such services on the recipient's ability to pay. Provided, nothing in this section shall prevent the issuance of a contract which excludes or reduces benefits where the charge level or amount of the charge levied by a governmental entity for such services would vary or be affected in any way by the existence of coverage under the managed care plan.

History:

[(41-3925), added 1990, ch. 300, sec. 4, p. 829; am. and redesig. 1997, ch. 204, sec. 28, p. 599.]
Idaho Code § 41-2867 — Idaho Code / Title 41 / Chapter 28 / Section 41-2867
41-2867 RULES AND REGULATIONS.
Status: in_force

41-2867. Rules and regulations. The director of the department of insurance shall have the power to make such rules and regulations as may be necessary for the execution of the functions invested in him by sections 41-2860—41-2862, and may for such purpose classify domestic stock insurance companies, securities, and other persons or matters within his jurisdiction. No provision of sections 41-2860—41-2862 imposing any liability shall apply to any act done or omitted in good faith in conformity with any rule or regulation of the director of the department of insurance, notwithstanding that such rule or regulation may, after such act or omission, be amended or rescinded or determined by judicial or other authority to be invalid for any reason.

History:

[41-2867, added 1965, ch. 294, sec. 8, p. 782.]
Idaho Code § 41-2850 — Idaho Code / Title 41 / Chapter 28 / Section 41-2850
41-2850 NONASSESSABLE POLICIES — REVOCATION OF AUTHORITY.
Status: in_force

41-2850. Nonassessable policies — Revocation of authority. (1) The director shall revoke the authority of a domestic mutual insurer to issue policies without contingent liability if

(a) At any time the insurer's assets are less than the sum of its liabilities and the surplus required for such authority, or

(b) The insurer, by resolution of its board of directors approved by a majority of its members, requests that the authority be revoked.

(2) During the absence of such authority the insurer shall not issue any policy without providing therein for the contingent liability of the policyholder, nor renew any policy which is then in force without endorsing the same to provide for such contingent liability.

History:

[41-2850, added 1961, ch. 330, sec. 618, p. 645.]
Idaho Code § 41-4702 — Idaho Code / Title 41 / Chapter 47 / Section 41-4702
41-4702 PURPOSE.
Status: in_force

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 of preexisting condition exclusions, to provide for establishment of a reinsurance program, and to improve the overall fairness and efficiency of the small group health insurance market.

This chapter is not intended to provide a comprehensive solution to the problem of affordability of health care or health insurance.

History:

[41-4702, added 1993, ch. 176, sec. 1, p. 435; am. 2000, ch. 472, sec. 1, p. 1603.]
Idaho Code § 41-232 — Idaho Code / Title 41 / Chapter 2 / Section 41-232
41-232 HEARINGS IN GENERAL.
Status: in_force

41-232. Hearings in general. (1) The director may hold a hearing which he deems necessary for any purpose within the scope of this code.

(2) The director shall hold a hearing:

(a) If required by any provision of this code; or

(b) Upon written demand for a hearing by a person aggrieved by any act, threatened act or failure of the director to act, or by any report, rule, regulation or order of the director (other than an order for the holding of a hearing, or an order on a hearing of which hearing such person had actual notice or pursuant to such order).

(3) Any such demand for a hearing shall summarize the information and grounds to be relied upon as a basis for the relief to be sought at the hearing.

(4) The director shall hold such demanded hearing within thirty (30) days after his receipt of the demand, unless postponed by mutual consent. Failure to hold the hearing shall constitute a denial of the relief sought, and shall be the equivalent of an order on hearing for the purpose of an appeal.

(5) In any administrative proceeding of the director where a hearing is otherwise authorized or required by law, if a party with respect to whom the hearing is to be held waives the hearing in writing, or fails to plead, or to defend or prosecute, as the case may be, and that fact is made known to the director by affidavit or otherwise, the right of hearing shall be deemed to have been waived, and, any other provision of this code to the contrary notwithstanding, without holding or concluding a hearing the director may, upon satisfactory proof of service of the petition or complaint upon such a party, enter an order which shall be as lawful as to such party as if all allegations in the petition or complaint relative to or concerning such party were proved or admitted at a hearing. For good cause shown, the director may, in his discretion, set aside any order so entered, and the proceedings may continue as if no waiver or default had existed.

History:

[41-232, added 1961, ch. 330, sec. 49, p. 645; am. 1972, ch. 369, sec. 4, p. 1072; am. 2019, ch. 161, sec. 7, p. 535.]
Idaho Code § 41-4401 — Idaho Code / Title 41 / Chapter 44 / Section 41-4401
41-4401 PURPOSE.
Status: in_force

41-4401. Purpose. The purpose of this chapter shall be to provide reasonable standardization and simplification of terms and coverages of medicare supplement disability insurance policies and enrollee contracts of managed care organizations, to facilitate public understanding and comparison, to eliminate provisions contained in disability insurance policies and enrollee contracts of managed care organizations which may be misleading or unreasonably confusing in connection either with the purchase of such coverages or with the settlement of claims, and to provide for full disclosure in the sale of such coverages.

History:

[41-4401, added 1999, ch. 102, sec. 2, p. 323.]
Idaho Code § 41-4003 — Idaho Code / Title 41 / Chapter 40 / Section 41-4003
41-4003 REGISTRATION REQUIRED — EXEMPTIONS — NOT SUBJECT TO INSURANCE CODE.
Status: in_force

41-4003. Registration required — Exemptions — Not subject to insurance code. (1) No person shall offer or operate a self-funded plan in this state unless the plan is registered with the director as hereinafter provided.

(2) No registration shall be required of:

(a) Any self-funded plan established for the sole purpose of funding the dollar amount of a deductible clause contained in the provisions of an insurance contract issued by an insurer duly authorized to transact disability insurance in this state if the deductible does not exceed an amount applicable to each beneficiary of five thousand dollars ($5,000) per annum and the total of all obligations to all beneficiaries insured under the plan arising out of the application of such a deductible does not exceed the aggregate amount of five hundred thousand dollars ($500,000) in any one (1) year.

(b) Any plan established and maintained for the purpose of complying with any worker's compensation law or unemployment compensation disability insurance law.

(c) Any plan administered by or for the federal government, a federal agency, the state, or any county of this state.

(d) Any plan which is primarily for the purpose of providing first aid care and treatment by an employer for injury or sickness of employees while engaged in their employment.

(e) Any self-funded plan offering only dental and/or vision benefits, where such benefits are limited to no more than a total of five thousand dollars ($5,000) per beneficiary per year. If self-funded dental and/or vision benefits are offered in conjunction with any other self-funded plan for disability or health benefits, the entire benefits are subject to all applicable provisions of chapter 40, title 41, Idaho Code, including registration.

(3) Plans that are registered under chapter 40, title 41, Idaho Code, shall not be deemed to be engaged in the business of insurance and shall not be subject to provisions of the Idaho insurance code except as expressly provided in this chapter. A plan required to register with the department that operates in this state without registering under this chapter shall be deemed to be engaged in the business of insurance without authorization and any person offering or operating an unregistered plan shall be deemed to be transacting insurance without proper licensing and subject to all sanctions as provided by law.

(4) Any self-funded plan providing benefits to more than one (1) employer shall provide to each employer participant and to each prospective employer participant written notice that the plan is not insurance and does not participate in the Idaho life and health guaranty association. Any self-funded plan providing benefits to students of a postsecondary educational institution shall provide to each student participant and to each prospective student participant written notice that the plan is not insurance and does not participate in the Idaho life and health guaranty association. The notice shall also be included as part of all marketing materials used by or on behalf of the plan.

(5) Any plan registered as a single employer plan or as a multiple employer welfare plan shall not operate as or be registered as a postsecondary educational institution student health benefit plan. Any plan registered as a postsecondary educational institution student health benefit plan shall not operate as or be registered as a single employer plan or as a multiple employer welfare plan.

History:

[41-4003, added 1974, ch. 248, sec. 3, p. 1624; am. 2001, ch. 308, sec. 1, p. 1114; am. 2004, ch. 86, sec. 1, p. 321; am. 2006, ch. 414, sec. 3, p. 1259; am. 2013, ch. 181, sec. 3, p. 421; am. 2019, ch. 306, sec. 1, p. 915.]
Idaho Code § 41-4012 — Idaho Code / Title 41 / Chapter 40 / Section 41-4012
41-4012 TAXES.
Status: in_force

41-4012. Taxes. (1) Each self-funded plan required to be registered under this chapter is subject to the tax as provided in this section. Each registered self-funded plan, and each formerly registered plan with respect to beneficiaries in this state while so registered, shall simultaneously with the filing of its annual statement with the director, pay to the director a tax computed at the rate of four cents (4¢) per month per beneficiary covered by the plan during the fiscal year of the annual statement with respect to all beneficiaries working or resident in this state. Any plans operating in Idaho without proper registration shall be subject to back taxes for all years the plan was in operation plus all other sanctions authorized by law.

(2) All excise, privilege, franchise, income, license and similar taxes, licenses and fees are hereby preempted from imposition upon self-funded plans and on the intangible property of their trust funds; and no county, city, municipality, district, school district, or other political subdivision or agency of Idaho shall levy upon such plans or trust funds any such tax, license or fee additional to those set forth in this chapter.

(3) The tax imposed on self-funded plans in subsection (1) of this section, together with the fees imposed on such plans as set forth in this chapter, shall be in lieu of any and all income taxes and other excise taxes, licenses and fees payable to the state of Idaho. No self-funded plan shall be required to file any tax returns or comply with any provisions governing such income taxes and other excise taxes, licenses and fees payable to the state of Idaho.

(4) The director shall promptly remit all such tax payments received by him pursuant to this section to the state treasurer for credit to the state general fund.

History:

[41-4012, added 1974, ch. 248, sec. 12, p. 1624; am. 1982, ch. 252, sec. 3, p. 645; am. 2006, ch. 414, sec. 11, p. 1265; am. 2013, ch. 181, sec. 12, p. 429.]
Idaho Code § 41-4105 — Idaho Code / Title 41 / Chapter 41 / Section 41-4105
41-4105 APPLICATION FOR REGISTRATION.
Status: in_force

41-4105. Application for registration. (1) Application for registration of a joint public agency self-funded plan for public agencies shall be made to the director, on forms furnished and designed by him. The application shall be signed and verified by at least two (2) of the board members.

(2) The application shall be accompanied by:

(a) A copy of the joint powers agreement under which the joint public agency self-funded plan will exist and operate;

(b) A copy of the proposed written statement of benefits referred to in section 41-4104(2), Idaho Code;

(c) A financial statement of the trust fund, if already in existence and operating on July 1, 2006. The statement shall be certified by an independent certified public accountant according to generally accepted accounting principles;

(d) If not already in existence, a written statement of reasonably projected income and disbursements of the trust fund for the twelve (12) month period commencing with date of application and showing also the amount projected as of the end of such period for claims incurred and not paid and incurred and not reported as certified by an actuary having experience in establishing rates for a self-funded plan and the health services being provided, and who is also a fellow of the society of actuaries, a member of the American academy of actuaries, or an enrolled actuary under the employment retirement income security act of 1974;

(e) If not already in existence, a copy of a business plan;

(f) A copy of an actuarial study determining adequate rates for the plan. The rates shall not be less than the sum of projected incurred claims for the year plus costs of operation plus a reasonable portion of any prior year deficiency less any excess surplus; and

(g) Such other relevant documentation and information as the director may reasonably require considering that these entities are public agency plans and not private insurance companies.

(3) At the time of filing the application the applicant shall pay to the director a nonrefundable filing fee as provided for by rule.

(4) The director shall transmit and account for all fees received by him hereunder as provided in section 41-406, Idaho Code.

History:

[41-4105, added 2006, ch. 415, sec. 1, p. 1274.]
Idaho Code § 41-2114 — Idaho Code / Title 41 / Chapter 21 / Section 41-2114
41-2114 PHYSICAL EXAMINATION — AUTOPSY.
Status: in_force

41-2114. Physical examination — Autopsy. There shall be a provision as follows:

"Physical Examinations and Autopsy: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law."

History:

[41-2114, added 1961, ch. 330, sec. 503, p. 645.]
Idaho Code § 41-1938 — Idaho Code / Title 41 / Chapter 19 / Section 41-1938
41-1938 VARIABLE CONTRACTS — AUTHORITY OF INSURER TO ISSUE.
Status: in_force

41-1938. Variable contracts — Authority of insurer to issue. No insurer shall deliver or issue for delivery in this state contracts authorized under section 41-1936, Idaho Code, unless it is authorized or organized to do a life insurance or annuity business in this state, and the director is satisfied that its condition or method of operation in connection with the issuance of such contracts will not render its operation hazardous to the public or its policyholders in this state. In this connection, the director shall consider among other things:

(1) The history and financial condition of the insurer;

(2) The character, responsibility and fitness of the officers and directors of the insurer; and

(3) The law and regulation under which the insurer is authorized in the state of domicile to issue variable contracts.

History:

[41-1938, added 1969, ch. 214, sec. 53, p. 625; am. 1999, ch. 95, sec. 1, p. 297.]
Idaho Code § 41-1813 — Idaho Code / Title 41 / Chapter 18 / Section 41-1813
41-1813 GROUNDS FOR DISAPPROVAL.
Status: in_force

41-1813. Grounds for disapproval. The director shall disapprove any form filed under section 41-1812, or withdraw any previous approval thereof, only on one or more of the following grounds:

(1) Is in any respect in violation of or does not comply with this code.

(2) Contains or incorporates by reference, where such incorporation is otherwise permissible, any inconsistent, ambiguous, or misleading clauses, or exceptions and conditions which deceptively affect the risk purported to be assumed in the general coverage of the contract, or which are unfairly prejudicial to the policy holder.

(3) Has any title, heading, or other indication of its provisions which is misleading.

(4) Is printed or otherwise reproduced in such manner as to render any provision of the form substantially illegible.

History:

[41-1813, added 1961, ch. 330, sec. 405, p. 645; am. 1969, ch. 214, sec. 48, p. 625.]
Idaho Code § 41-3435 — Idaho Code / Title 41 / Chapter 34 / Section 41-3435
41-3435 PRODUCER LICENSING.
Status: in_force

41-3435. Producer licensing. (1) Producers or persons representing a service corporation in the solicitation and negotiation of subscriber's contracts shall qualify for and be licensed as producers of the service corporation in the same manner and in compliance with the same applicable qualifications, licensing procedures and fees as apply under this code as to producers of disability insurers except that:

(a) Any such person who holds a valid license as a producer for a disability insurer issued under chapter 10, title 41, Idaho Code, may be appointed as the agent for such service corporation without further examination or other compliance with chapter 10, title 41, Idaho Code; and

(b) Nothing in this section shall prevent such person from being licensed as a producer and appointed as an agent for a life insurer or insurers under chapter 10, title 41, Idaho Code, and concurrently being licensed as a producer for such a service corporation.

(2) Service corporations may file appointment of agents or representatives in the same manner as provided in section 41-1018, Idaho Code, with respect to producers of insurers.

(3) The exceptions to license requirements set forth in chapter 10, title 41, Idaho Code, shall also apply as to service corporations.

History:

[I.C., sec. 41-3435, as added by 1969, ch. 214, sec. 71, p. 625; am. 1977. ch. 142, sec. 14, p. 314; am. 2001, ch. 296, sec. 7, p. 1064.]
Idaho Code § 41-714 — Idaho Code / Title 41 / Chapter 7 / Section 41-714
41-714 COMMON STOCKS.
Status: in_force

41-714. Common stocks. After satisfying the requirements of section 41-706(3) and (4), Idaho Code, (investment of capital and life reserves), an insurer may invest funds in an aggregate amount not in excess of fifteen percent (15%) of its assets in common shares of stock of any solvent institution existing under the laws of the United States or of any state, district or territory thereof, or of the government of Canada or any province thereof, that qualify as a sound investment, in addition to the shares of a substantially owned or wholly owned subsidiary corporation.

For the purpose of determining the investment limitation imposed by this section, the insurer shall value securities subject to the provisions of this section at the cost of the security or at the market value of the security, whichever is lower. However, investments in the shares of subsidiaries or companion insurance companies shall be governed by sections 41-715 and 41-3803, Idaho Code.

The limitations as to investment in common stocks as provided herein shall not apply to nor limit the right of investments in investment trust securities as provided for in section 41-716, Idaho Code.

History:

[41-714, added 1961, ch. 330, sec. 151, p. 645; am. 1969, ch. 214, sec. 21, p. 625; am. 1971, ch. 122, sec. 5, p. 408; am. 1993, ch. 194, sec. 8, p. 501; am. 2003, ch. 219, sec. 2, p. 568; am. 2006, ch. 27, sec. 2, p. 86; am. 2013, ch. 266, sec. 4, p. 680.]
Idaho Code § 41-2021 — Idaho Code / Title 41 / Chapter 20 / Section 41-2021
41-2021 NOTICE AS TO CONVERSION RIGHT.
Status: in_force

41-2021. Notice as to conversion right. If any individual insured under a group life insurance policy hereafter delivered in this state becomes entitled under the terms of such policy to have an individual policy of life insurance issued to him without evidence of insurability, subject to making of application and payment of the first premium within the period specified in such policy, and if such individual is not given notice of the existence of such right at least fifteen (15) days prior to the expiration date of such period, then, in such event the individual shall have an additional period within which to exercise such right, but nothing herein contained shall be construed to continue any insurance beyond the period provided in such policy. This additional period shall expire fifteen (15) days next after the individual is given such notice but in no event shall such additional period extend beyond sixty (60) days next after the expiration date of the period provided in such policy. Written notice presented to the individual or mailed by the policyholder to the last known address of the individual or mailed by the insurer to the last known address of the individual as furnished by the policyholder shall constitute notice for the purpose of this section.

History:

[41-2021, added 1961, ch. 330, sec. 486, p. 645.]
Idaho Code § 41-3906 — Idaho Code / Title 41 / Chapter 39 / Section 41-3906
41-3906 APPLICATION FOR CERTIFICATE OF AUTHORITY.
Status: in_force

41-3906. Application for certificate of authority. (1) The application for a certificate of authority shall be in writing in the form prescribed by the director. It shall be verified by an officer of an applicant corporation or association, or member of an applicant firm, or by the applicant if an individual. The application shall set forth or be accompanied by:

(a) a copy of the basic organizational document of the applicant, such as articles of incorporation or of association, partnership agreement, trust agreement, or other applicable documents, and all amendments thereto;

(b) a copy of the bylaws, rules, or similar document regulating conduct of the applicant's internal affairs;

(c) a listing of the names, addresses, principal occupations, and official positions of the individuals who are to be responsible for the conduct of applicant's affairs, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers in the case of a corporation, and the partners or members in the case of a partnership or association;

(d) a copy of any contract made or to be made between the applicant and any provider, and the applicant and any person named in subsection (c) hereof;

(e) a statement generally describing the managed care organization, its health care plan or plans, facilities, and personnel;

(f) a copy of each form of health care contract proposed to be issued;

(g) financial statements showing the applicant's audited assets, liabilities, and sources and amount of financial support. A copy of the applicant's most recent regular certified financial statement shall be deemed to satisfy this requirement unless the director directs that additional or more recent financial information is required for proper administration of this chapter;

(h) a financial plan, which includes a three (3) year projection of initial operating results anticipated, and a statement as to the sources of working capital as well as any other source of funding;

(i) a description of the proposed method of marketing the plan;

(j) a statement of the geographic area or areas to be served;

(k) a description of the grievance procedures as required under section 41-3918, Idaho Code;

(l) a description of the system and procedures for monitoring the quality of health care services as required by section 41-3905(6)(a), Idaho Code;

(m) a description of the mechanism by which members will be given an opportunity to participate in matters of policy and operation as required by section 41-3916, Idaho Code;

(n) if the applicant is not domiciled in this state, a power of attorney duly executed by the applicant and irrevocably appointing the director and his successors in office as the applicant's attorney upon whom may be served all lawful process in any legal action or proceeding against the managed care organization on a cause of action arising in this state; and

(o) such other information as the director may reasonably require as to the applicant's qualifications as a managed care organization.

(2) Every organization authorized to offer a managed care plan under a certificate of authority issued prior to July 1, 1997, shall comply with any new or additional requirements, other than applicable capital, surplus and deposit requirements, imposed by this act by January 1, 1998. If the organization does not comply by January 1, 1998, the organization shall no longer be authorized to offer managed care plans on a predetermined and prepaid basis in this state.

History:

[41-3906, added 1974, ch. 177, sec. 6, p. 1444; am. 1980, ch. 197, sec. 31, p. 455; am. 1997, ch. 204, sec. 8, p. 587.]
Idaho Code § 41-2301 — Idaho Code / Title 41 / Chapter 23 / Section 41-2301
41-2301 DECLARATION OF PURPOSE.
Status: in_force

41-2301. Declaration of purpose. The purpose of this chapter is to promote the public welfare by regulating credit life insurance and credit disability insurance. Nothing in this chapter is intended to prohibit or discharge or discourage reasonable competition. The provisions of this chapter shall be liberally construed.

History:

[41-2301, added 1961, ch. 330, sec. 536, p. 645.]
Idaho Code § 41-308 — Idaho Code / Title 41 / Chapter 3 / Section 41-308
41-308 GENERAL ELIGIBILITY FOR CERTIFICATE OF AUTHORITY.
Status: in_force

41-308. General eligibility for certificate of authority. To qualify for and hold authority to transact insurance in this state an insurer must be otherwise in compliance with this code and with its charter powers, and must be an incorporated stock insurer, or an incorporated mutual insurer, or a reciprocal insurer, of the same general type as may be formed as a domestic insurer under this code; except that:

(1) No insurer shall be authorized to transact insurance in this state which does not maintain reserves as required by chapter 6 (assets and liabilities) of this code applicable to the kind or kinds of insurance transacted by such insurer, wherever transacted in the United States.

(2) Before granting authority to an insurer to transact insurance in this state, the director shall take into consideration the length of time the insurer has been transacting insurance; the net profit or loss experienced over the previous five (5) years; or any other factor which for good reason he believes could make the admittance of the insurer not in the best interest of the insurance-buying public.

(3) The director shall not grant or continue authority to transact insurance in this state as to any insurer the management of which is found by him to be untrustworthy, or so lacking in insurance experience as to make the proposed operation hazardous to the insurance-buying public; or which he has good reason to believe is affiliated directly or indirectly through ownership, control, reinsurance transactions or other insurance or business relations, with any person or persons whose business operations are or have been marked, to the detriment of policyholders or stockholders or investors or creditors or of the public, by manipulation or dissipation of assets, or manipulation of accounts, or of reinsurance, or by similar injurious actions.

History:

[41-308, added 1961, ch. 330, sec. 71, p. 645; am. 1986, ch. 42, sec. 1, p. 126; am. 2006, ch. 49, sec. 2, p. 142.]
Idaho Code § 41-3320 — Idaho Code / Title 41 / Chapter 33 / Section 41-3320
41-3320 INSURER — DISSOLUTION.
Status: in_force

41-3320. Insurer — Dissolution. The director may petition for an order dissolving the corporate existence of a domestic insurer or the United States branch of an alien insurer domiciled in this state at the time he applies for a liquidation order. The court shall order dissolution of the corporation upon petition by the director upon or after the granting of a liquidation order. If the dissolution has not previously been ordered, it shall be effected by operation of law upon the discharge of the liquidator if the insurer is insolvent, but may be ordered by the court upon the discharge of the liquidator if the insurer is under a liquidation order for some other reason.

History:

[41-3320, added 1981, ch. 249, sec. 2, p. 516.]
Idaho Code § 41-1817 — Idaho Code / Title 41 / Chapter 18 / Section 41-1817
41-1817 ADDITIONAL POLICY CONTENTS.
Status: in_force

41-1817. Additional policy contents. A policy may contain additional provisions not inconsistent with this code and which are:

(1) Required to be inserted by the laws of the insurer's domicile;

(2) Necessary, on account of the manner in which the insurer is constituted or operated, in order to state the rights and obligations of the parties to the contract, or

(3) Desired by the insurer and neither prohibited by law nor in conflict with any provisions required to be included therein.

History:

[41-1817, added 1961, ch. 330, sec. 409, p. 645.]
Idaho Code § 41-3417 — Idaho Code / Title 41 / Chapter 34 / Section 41-3417
41-3417 SUBSCRIBER'S CONTRACTS.
Status: in_force

41-3417. Subscriber's contracts. (1) Each subscriber's contract hereafter issued by a service corporation shall constitute a direct obligation of the participant licensees and/or participant hospitals to render the professional or hospital services, as the case may be, as agreed to be rendered by such participants in the subscriber's contract.

(2) Each such subscriber's contract or certificate shall in adequate detail set forth provisions from which can be readily determined:

(a) The services to which the subscriber is entitled from participant licensees and/or participant hospitals, as the case may be;

(b) The benefits, if any, to which the subscriber is entitled on an indemnity basis, consistent with sections 41-3413 and 41-3414, Idaho Code, and with this chapter;

(c) The periodic subscription charge, rate or fee payable by or as to the subscriber; or, if not so expressed and such charge, rate or fee is subject to change, the subscriber's contract shall require that not less than thirty (30) days' written notice of the new charge, rate or fee shall be given to the subscriber and/or his remitting agent before the change is effective;

(d) The date when the respective services and benefits become available to the subscriber, date of expiration of the contract, and the terms, if any, under which the contract may be continued or renewed;

(e) All other terms and conditions of the agreement between the parties consistent with the provisions of this chapter; and

(f) That the subscriber's contract and riders and indorsements thereon or thereto, together with application therefor, if any, signed by the subscriber, and identification issued to the subscriber, shall constitute the entire contract between the parties.

(3) No such contract shall restrict the subscriber's right to free choice of hospital or licensee, within the category or categories provided for in the contract. Such contract may provide lesser benefits for services rendered by nonparticipant licensees and/or nonparticipant hospitals than those provided by participant licensees and/or participant hospitals. Provided however, such contract shall permit a subscriber to direct that the payment of dental care benefits to which the subscriber is entitled, pursuant to the contract, be made in the name of the nonparticipant licensee providing covered dental care services authorized by the subscriber's contract.

(4) All exceptions and exclusions in the contract shall be printed and otherwise set forth as prominently as the services or benefits to which they apply.

(5) No provision in this code shall be construed to prohibit a service corporation from issuing contracts to groups of persons under a master contract. In this event, however, each subscriber covered under the master contract shall be issued an individual certificate which shall set forth in adequate detail the provisions itemized in subsection (2) above.

(6) All proposed forms of subscriber's contracts shall be filed with the director and be subject to his approval, as provided in section 41-3419, Idaho Code.

History:

[41-3417, added 1961, ch. 330, sec. 775, p. 645; am. 1967, ch. 399, sec. 9, p. 1194; am. 1971, ch. 252, sec. 11, p. 1008; am. 1992, ch. 185, sec. 1, p. 576.]
Idaho Code § 41-3903 — Idaho Code / Title 41 / Chapter 39 / Section 41-3903
41-3903 DEFINITIONS.
Status: in_force

41-3903. Definitions. (1) "Basic health care services" means the following services: preventive care, emergency care, inpatient and outpatient hospital and physician care, hospital-based rehabilitation treatment, diagnostic laboratory and diagnostic and therapeutic radiological services. It does not include mental health services or services for alcohol or drug abuse, dental or vision services or long-term rehabilitation treatment.

(2) "Coinsurance" means a percentage amount a member is responsible to pay out-of-pocket for health care services after satisfaction of any applicable deductibles or copayments, or both.

(3) "Copayment" means an amount a member must pay to a provider in payment for a specific health care service which is not fully prepaid.

(4) "Deductible" means the amount of expense a member must first incur before the managed care organization begins payment for covered services.

(5) "Director" means the director of the department of insurance of the state of Idaho.

(6) "Emergency facility" means any hospital or other facility where emergency services are provided to a member including, but not limited to, a physician's office.

(7) "Emergency services" means those health care services that are provided in a hospital or other emergency facility after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity including, but not limited to, severe pain, that the absence of immediate medical attention could reasonably be expected by a prudent person who possesses an average knowledge of health and medicine, to result in:

(a) Placing the patient's health in serious jeopardy;

(b) Serious impairment to bodily functions; or

(c) Serious dysfunction of any bodily organ or part.

(8) "Employer" means any person, firm, corporation, partnership or association.

(9) "Enrollee" means a person who either individually or through a group has entered into a contract for services under a managed care plan.

(10) "General managed care plan" means a managed care plan which provides directly or arranges to provide, at a minimum, basic health care services. A general managed care plan shall include basic health care services.

(11) "Health care contract" means a contract entered into by a managed care organization and an enrollee.

(12) "Health care services" means those services offered or provided by health care facilities and health care providers relating to the prevention, cure or treatment of illness, injury or disease.

(13) "Limited managed care plan" means a managed care plan which provides dental care services, vision care services, mental health services, substance abuse services, pharmaceutical services, podiatric care services or such other services as the director may establish by rule to be limited health care services. Limited health care services shall not include hospital, medical, surgical or emergency services except as those services are provided incident to limited health care services.

(14) "Managed care organization" means a public or private person or organization which offers a managed care plan. Unless otherwise specifically stated, the provisions of this chapter shall apply to any person or organization offering a managed care plan, whether or not a certificate of authority to offer the plan is required under this chapter.

(15) "Managed care plan" means a contract of coverage given to an individual, family or group of covered individuals pursuant to which a member is entitled to receive a defined set of health care benefits through an organized system of health care providers in exchange for defined consideration and which requires the member to use, or creates financial incentives for the member to use, health care providers owned, managed, employed by or under contract with the managed care organization. A person holding a license to transact disability insurance offering a health plan that creates financial incentives to use contracting providers may elect to file the plan as a nonmanaged care plan not subject to the provisions of this chapter if the health plan reimburses providers solely on a fee for service basis and does not require the selection of a primary care provider. The election to file a health plan as a nonmanaged care plan shall be made in writing at the time the plan is filed with the director pursuant to chapter 18, title 41, Idaho Code.

(16) "Member" means a policyholder, enrollee or other individual participating in a managed care plan.

(17) "Person" means any natural or artificial person including, but not limited to, individuals, partnerships, associations, corporations or other legally recognized entities.

(18) "Provider" means any physician, hospital, or other person licensed or otherwise authorized to furnish health care services.

(19) "Utilization management program" means a system of reviewing the medical necessity, appropriateness, or quality of health care services and supplies provided under a managed care plan using specified guidelines. Such a system may include, but is not limited to, preadmission certification, the application of practice guidelines, continued stay review, discharge planning, preauthorization of ambulatory procedures and retrospective review.

History:

[41-3903, added 1997, ch. 204, sec. 5, p. 582; am. 1998, ch. 142, sec. 1, p. 505; am. 2004, ch. 283, sec. 2, p. 799.]
Idaho Code § 41-1315A — Idaho Code / Title 41 / Chapter 13 / Section 41-1315A
41-1315A DISCOUNTS TO EMPLOYEES.
Status: in_force

41-1315A. Discounts to employees. No provision of title 41, Idaho Code, shall be deemed to prohibit allowance by an insurer, agent, or broker to the insurer's or licensee's bona fide full-time salaried employee of a discount from the premium otherwise payable for insurance on the employee's life or health or those of his dependents, or on the employee's property or risks other than property or risks used or involved in business operations of the employee other than as an employee of the insurer, agent, or broker. The amount of discount shall in no event exceed the amount of the agent's commission that the employer insurer may otherwise pay or the amount of commission to be received by the employer agent or broker, with respect to the insurance. Title insurers and title insurance agents may provide reimbursements or discounts of escrow fees or title insurance premiums in accordance with chapter 27, title 41, Idaho Code.

History:

[41-1315A, added 1972, ch. 369, sec. 9, p. 1072; am. 2001, ch. 296, sec. 6, p. 1063; am. 2018, ch. 213, sec. 1, p. 481.]
Idaho Code § 41-4005 — Idaho Code / Title 41 / Chapter 40 / Section 41-4005
41-4005 APPLICATION FOR REGISTRATION — FEE.
Status: in_force

41-4005. Application for registration — Fee. (1) Application for registration of a self-funded plan shall be made to the director, on forms prescribed by the director, seeking such information concerning whether, in the opinion of the director, the plan is qualified for registration. The application shall require the applicant to designate whether the plan is applying for registration as a single employer plan or multiple employer welfare plan or as a postsecondary educational institution student health benefit plan. The application shall be signed and verified by at least one (1) employer or, if applicable, by a person authorized by a postsecondary educational institution to sign the application and at least one (1) plan trustee. If the employer, postsecondary educational institution, or trustee is a corporation, the verification shall be by a duly authorized corporate officer or by a managing member of the plan sponsor if the plan sponsor is a limited liability company.

(2) The application shall be accompanied by all plan documents including:

(a) A copy of the irrevocable trust agreement under which the trust fund is to exist and operate;

(b) A copy of the proposed written statement of benefits referenced in section 41-4004(1)(d), Idaho Code;

(c) A financial statement of the trust fund, if already in existence and operating at the time of application, certified by an independent certified public accountant. If the trust fund is not in existence at the time of application, a pro forma balance sheet for the start of operation of the plan and a pro forma balance sheet, by month, for the first twelve (12) months of operation of the plan shall accompany the application, provided that all balance sheets shall include actuarially determined claims liabilities;

(d) A written statement of reasonably projected income and disbursements of the trust fund, by month, for the twelve (12) month period commencing with the effective date of registration of the trust with the department and including changes to claims liabilities fully set forth in the monthly expenses as calculated by a qualified actuary;

(e) A copy of an actuarial study prepared by a qualified actuary certifying that the rates for the plan are sufficient to cover moderately adverse experience and all costs of operation. The study shall include the development and justification of the assumptions used by the actuary in determining the rates. The rates shall not be less than the sum of projected incurred claims for the year, plus costs of operation, plus any prior year deficiency, less any excess surplus prior to the establishment of the contribution deficit reserve;

(f) With regard to a single employer plan or a multiple employer welfare plan, if the plan is domiciled outside this state, a letter or other written evidence of good standing from the plan's regulator in the state of domicile;

(g) A copy of every contract between the plan and any administrator, trustee or service company;

(h) A copy of a stop-loss insurance agreement issued by an insurer authorized to do business in this state providing both specific and aggregate coverage in an amount as annually indicated in the actuarial opinion for the plan, provided the director may waive the requirements for aggregate stop-loss coverage if such coverage is not reasonably available or otherwise deemed appropriate;

(i) A copy of the policy, contract, certificate, summary plan description or other evidence of the benefits and coverages provided to beneficiaries, including a table of the rates charged or proposed to be charged for each form of such contract accompanied by a certification of a qualified actuary that:

(i) The rates are neither inadequate nor excessive nor unfairly discriminatory;

(ii) The rates are appropriate for the classes of risks for which they have been computed; and

(iii) An adequate description of the rating methodology has been filed with the director and the methodology follows consistent and equitable actuarial principles; and

(j) Such other relevant documentation and information as the director may reasonably require.

(3) The application shall be signed under oath by the plan sponsor or the trustee of the plan, and the application shall also include:

(a) A copy of any articles of incorporation and bylaws or any founding documents and bylaws of any entity acting as a plan sponsor;

(b) A list of the names, addresses and official capacities concerning the plan of the individuals who will be responsible for the management and conduct of the affairs of the plan, including all trustees, officers and directors. Biographical affidavits shall be submitted for all trustees and management personnel on a form prescribed by the director. Management personnel of the trust shall be experienced and competent to ensure the trust's compliance with Idaho laws and rules. Such individuals shall fully disclose the extent and nature of any contracts or arrangements between them and the plan, including any possible conflicts of interest; and

(c) A copy of the articles of incorporation, bylaws, if any, and irrevocable trust agreement of the plan, as well as any other document concerning the operation of the plan.

(4) At the time of filing the application the applicant shall pay to the director a nonrefundable filing fee as provided for by rule.

(5) The director shall transmit and account for all fees received by him hereunder as provided in section 41-406, Idaho Code.

History:

[41-4005, added 1974, ch. 248, sec. 5, p. 1624; am. 1979, ch. 122, sec. 8, p. 381; am. 1984, ch. 23, sec. 12, p. 44; am. 2006, ch. 414, sec. 5, p. 1260; am. 2013, ch. 181, sec. 5, p. 423.]
Idaho Code § 41-4943 — Idaho Code / Title 41 / Chapter 49 / Section 41-4943
41-4943 APPLICATION OF CHAPTER.
Status: in_force

41-4943. Application of chapter. All of the provisions of this chapter shall apply to and confer all rights, privileges, exemptions and immunities upon the trust fund established for the purposes contemplated in this chapter, and the administrator, insured owners or operators of petroleum tanks, beneficiaries, and participants thereof. The provisions of this chapter shall not apply to any railroad, railroad corporation, or any employee thereof when such employee is acting in the course of his employment for any such railroad or railroad corporation.

History:

[(41-4943) 41-4946, added 1990, ch. 119, sec. 1, p. 289; am. 1991, ch. 59, sec. 29, p. 136; am. & redesig. 2003, ch. 96, sec. 47, p. 309.]
Idaho Code § 41-1822 — Idaho Code / Title 41 / Chapter 18 / Section 41-1822
41-1822 CONSTRUCTION OF POLICIES.
Status: in_force

41-1822. Construction of policies. Every insurance contract shall be construed according to the entirety of its terms and conditions as set forth in the policy and as amplified, extended, or modified by any rider, endorsement, or application lawfully made a part of the policy.

History:

[41-1822, added 1961, ch. 330, sec. 414, p. 645.]
Idaho Code § 41-5817 — Idaho Code / Title 41 / Chapter 58 / Section 41-5817
41-5817 RECORD RETENTION.
Status: in_force

41-5817. Record retention. (1) A public adjuster shall maintain a complete record of each transaction as a public adjuster. The records required by this section shall include the following:

(a) Name of the insured;

(b) Date, location and amount of the loss;

(c) Copy of the contract between the public adjuster and insured;

(d) Name of the insurer, amount, expiration date and number of each policy carried with respect to the loss;

(e) Itemized statement of the insured's recoveries;

(f) Itemized statement of all compensation received by the public adjuster, from any source whatsoever, in connection with the loss;

(g) A register of all moneys received, deposited, disbursed or withdrawn in connection with a transaction with an insured, including fees, transfers and disbursements from a trust account and all transactions concerning all interest bearing accounts;

(h) Name of public adjuster who executed the contract;

(i) Name of the attorney representing the insured, if applicable, and the name of the claims representatives of the insurance company; and

(j) Evidence of financial responsibility in a format prescribed by the department.

(2) Records shall be maintained for at least five (5) years after the termination of the transaction with an insured and shall be open to examination by the department at all times.

(3) Records submitted to the department in accordance with this section that contain information identified in writing as proprietary by the public adjuster shall be treated as confidential by the department pursuant to section 74-107, Idaho Code.

History:

[41-5817, added 2008, ch. 179, sec. 1, p. 541; am. 2015, ch. 141, sec. 117, p. 466.]
Idaho Code § 41-2801 — Idaho Code / Title 41 / Chapter 28 / Section 41-2801
41-2801 SCOPE OF CHAPTER.
Status: in_force

41-2801. Scope of chapter. This chapter shall apply only to domestic stock insurers and domestic mutual insurers, except that sections 41-2849 (nonassessable policies, mutual insurers), 41-2872 (health care provider contracts) and 41-2873, Idaho Code, (best price — most favored nations clause prohibited) shall also apply as to foreign insurers.

History:

[41-2801, added 1961, ch. 330, sec. 569, p. 645; am. 1995, ch. 289, sec. 14, p. 982; am. 2003, ch. 103, sec. 1, p. 323; am. 2007, ch. 282, sec. 1, p. 813.]
Idaho Code § 41-1045 — Idaho Code / Title 41 / Chapter 10 / Section 41-1045
41-1045 RESPONSIBILITY FOR ACTIONS OF OTHERS.
Status: in_force

41-1045. Responsibility for actions of others. For purposes of licensing and regulation under title 41, Idaho Code, a bail agent is responsible for the actions of the bail agent's employees, contractors and agents acting on the bail agent's behalf in relation to bail transactions and matters arising out of bail transactions.

History:

[41-1045, added 2003, ch. 104, sec. 9, p. 331.]
Idaho Code § 41-2007 — Idaho Code / Title 41 / Chapter 20 / Section 41-2007
41-2007 TRUSTEE GROUPS.
Status: in_force

41-2007. Trustee groups. The lives of a group of individuals may be insured under a policy issued to the trustees of a fund established in this state by two (2) or more employers in the same industry or to the trustees of a fund established by one (1) or more labor unions, or by one (1) or more employers and one (1) or more labor unions, which trustees shall be deemed the policyholder, to insure employees of the employers or members of the unions for the benefit of persons other than the employers or the unions, subject to the following requirements:

(1) The persons eligible for insurance shall be all of the employees of the employers or all of the members of the unions, or all of any class or classes thereof determined by conditions pertaining to their employment, or to membership in the unions, or to both. The policy may provide that the term "employees" shall include retired employees, and the individual proprietor or partners if an employer is an individual proprietor or a partnership. No director of a corporate employer shall be eligible for insurance under the policy unless such person is otherwise eligible as a bona fide employee of the corporation by performing services other than the usual duties of a director. No individual proprietor or partner shall be eligible for insurance under the policy unless he is actively engaged in and devotes a substantial part of his time to the conduct of the business of the proprietor or partnership. The policy may provide that the term "employees" shall include the trustees, or their employees, or both, if their duties are principally connected with such trusteeship.

(2) The premium for the policy shall be paid by the trustees from funds contributed by the employer or employers of the insured persons, or by the union or unions, or from funds contributed by the insured persons, or from any combination of these. A policy on which no part of the premium is to be derived from funds contributed by the insured persons specifically for their insurance must insure all eligible persons, or all except any as to whom evidence of individual insurability is not satisfactory to the insurer, or who have rejected the coverage in writing.

(3) The policy shall not require that, if a participating employer discontinues membership in the association, the insurance of his employees shall cease solely by reason of such discontinuance.

History:

[41-2007, added 1961, ch. 330, sec. 472, p. 645; am. 1971, ch. 122, sec. 11, p. 408; am. 1974, ch. 196, sec. 1, p. 1504; am. 2004, ch. 256, sec. 3, p. 729.]
Idaho Code § 41-268 — Idaho Code / Title 41 / Chapter 2 / Section 41-268
41-268 ARSON, FIRE AND FRAUD PREVENTION ACCOUNT.
Status: in_force

41-268. Arson, fire and fraud prevention account. (1) There is hereby created an account in the agency asset fund in the state treasury, to be designated the "arson, fire and fraud prevention account." The account shall be used by the director of the department of insurance for enforcement of this act, investigation of alleged cases of arson, fraud and related alleged violations of the laws of this state, and prevention of fire, explosions and other conditions necessary for the public safety, health, peace and welfare.

(2) In addition to moneys, if any, appropriated to the account by the legislature, the director shall deposit with the state treasurer for credit to the arson, fire and fraud prevention account:

(a) Penalties collected under the provisions of sections 41-261 and 41-263, Idaho Code;

(b) That portion of the annual continuation fee as determined by the director pursuant to subsection (3) of this section;

(c) Other moneys now or hereinafter in the state fire prevention account;

(d) Other moneys or revenues derived from whatever source for arson or fraud investigation or fire prevention.

(3) A portion of the annual continuation fee, as determined by the director, will be used to fund the arson, fire and fraud account.

(4) All claims against the account shall be examined, audited and allowed in the manner now or hereafter provided by law.

(5) All moneys placed in the account are hereby perpetually appropriated to the department of insurance for the purposes of the provisions of this section.

(6) Pending use for purposes of the provisions of this section, moneys in the account shall be invested by the state treasurer in the same manner as provided under section 67-1210, Idaho Code, with respect to other surplus or idle moneys in the state treasury. Interest earned on the investments shall be returned to the account.

History:

[41-268, added 1982, ch. 120, sec. 17, p. 344; am. 1983, ch. 135, sec. 1, p. 331; am. 1999, ch. 65, sec. 1, p. 168; am. 2001, ch. 85, sec. 2, p. 212.]
Idaho Code § 41-4311 — Idaho Code / Title 41 / Chapter 43 / Section 41-4311
41-4311 DUTIES AND POWERS OF THE DIRECTOR.
Status: in_force

41-4311. duties and powers of the director. In addition to the duties and powers enumerated elsewhere in this chapter:

(1) The director shall:

(a) Upon request of the board of directors, provide the association with a statement of the premiums in this and any other appropriate states for each member insurer; and

(b) When an impairment is declared and the amount of the impairment is determined, serve a demand upon the impaired insurer to make good the impairment within a reasonable time. Notice to the impaired insurer shall constitute notice to its shareholders, if any. The failure of the insurer to promptly comply with such demand shall not excuse the association from the performance of its powers and duties under this chapter.

(2) The director may suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this state of any member insurer that fails to pay an assessment when due or fails to comply with the plan of operation. As an alternative, the director may levy a forfeiture on any member insurer that fails to pay an assessment when due. The forfeiture shall not exceed five percent (5%) of the unpaid assessment per month, but no forfeiture shall be less than one hundred dollars ($100) per month.

(3) A final action of the board of directors or the association may be appealed to the director by a member insurer if the appeal is taken within sixty (60) days of its receipt of notice of the final action being appealed. A final action or order of the director shall be subject to judicial review in a court of competent jurisdiction in accordance with the laws of this state that apply to the actions or orders of the director.

(4) The liquidator, rehabilitator or conservator of an impaired or insolvent insurer may notify all interested persons of the effect of this chapter.

History:

[41-4311, added 2011, ch. 196, sec. 2, p. 574.]
Idaho Code § 41-4810 — Idaho Code / Title 41 / Chapter 48 / Section 41-4810
41-4810 RESTRICTIONS ON INSURANCE PURCHASED BY PURCHASING GROUPS.
Status: in_force

41-4810. Restrictions on insurance purchased by purchasing groups. A purchasing group may not purchase insurance from a risk retention group that is not chartered in a state, nor from an insurer not admitted in the state in which the purchasing group is located, unless the purchase is effected through a licensed agent or broker acting pursuant to the surplus lines laws and regulations of such state.

History:

[41-4810, added 1987, ch. 140, sec. 1, p. 281.]
Idaho Code § 41-4015 — Idaho Code / Title 41 / Chapter 40 / Section 41-4015
41-4015 PROHIBITED PECUNIARY INTERESTS IN PLAN MANAGEMENT.
Status: in_force

41-4015. Prohibited pecuniary interests in plan management. (1) No plan sponsor, trustee, administrator, or other person having responsibility for the management of a self-funded plan or the investment or other handling of trust funds shall:

(a) Receive directly or indirectly or have a pecuniary interest, either directly or indirectly, in any fee, commission, compensation, or emolument, other than salary or other similar compensation regularly fixed and authorized for services duly rendered to the plan, arising out of any transaction to which the trust fund is or may become a party.

(b) Receive compensation as a consultant to the plan while also acting as a trustee or administrator, or as an employee of either the trust fund or the plan.

(c) Have any direct or indirect material pecuniary interest in any loan or investment related to the trust fund.

(2) No consultant to the plan or trust fund shall directly or indirectly receive or have a pecuniary interest, either directly or indirectly, in any commission or other compensation arising out of any contract or transaction between the plan or trust fund and any insurer, health care service corporation, health maintenance organization or other provider of health care services or of drugs or other health care needs and supplies.

(3) The director may, after reasonable notice and the opportunity for a hearing, require removal of a trustee or prohibit the trustee from employing or retaining or continuing to employ or retain any person in the administration of the trust fund or plan, upon finding that continuation of the trustee or such employment or retention involves a conflict of interest or an interest with the potential to adversely affect plan beneficiaries.

History:

[41-4015, added 1974, ch. 248, sec. 15, p. 1624; am. 2006, ch. 414, sec. 14, p. 1266; am. 2013, ch. 181, sec. 15, p. 431.]
Idaho Code § 41-6008 — Idaho Code / Title 41 / Chapter 60 / Section 41-6008
41-6008 RULEMAKING AUTHORITY.
Status: in_force

41-6008. rulemaking authority. [EFFECTIVE UNTIL JULY 1, 2029] Upon consultation with the board, the director shall have the authority to promulgate rules necessary to implement this chapter.

History:

[41-6008, added 2010, ch. 32, sec. 1, p. 63.]
Idaho Code § 41-4016 — Idaho Code / Title 41 / Chapter 40 / Section 41-4016
41-4016 POLITICAL CONTRIBUTIONS PROHIBITED.
Status: in_force

41-4016. Political contributions prohibited. No trustee shall make or knowingly permit the making, directly or indirectly, of any political contribution by or from any self-funded plan trust fund.

History:

[41-4016, added 1974, ch. 248, sec. 16, p. 1624.]
Idaho Code § 41-2827 — Idaho Code / Title 41 / Chapter 28 / Section 41-2827
41-2827 AMENDMENT OF ARTICLES OF INCORPORATION — MUTUAL INSURER.
Status: in_force

41-2827. Amendment of articles of incorporation — Mutual insurer. (1) A domestic mutual insurer heretofore or hereafter formed may amend its articles of incorporation for any lawful purpose by affirmative vote of a majority of those of its members present or represented by proxy at any regular annual meeting of its members, or at any special meeting called for the purpose.

(2) Upon adoption of such an amendment the insurer shall make a certificate thereof in triplicate under its corporate seal, setting forth such amendment and the date and manner of the adoption thereof, which certificate shall be executed by the insurer's president or vice-president and secretary or assistant secretary, and be verified by one of them before a notary public. The insurer shall deliver to the director the triplicate originals of the certificate together with the filing fee specified therefor in section 41-401 (fee schedule). The director shall transmit one (1) original of the proposed amendment to the attorney general for examination. If the director and the attorney general find that the certificate and the amendments comply with law, the director shall endorse his approval upon each of the triplicate originals, place one (1) set on file in his office and return the remaining originals to the insurer. The insurer shall file one (1) of such originals with the secretary of state and retain the third original for its corporate records. The amendment shall be effective when filed with the secretary of state.

(3) If the director or the attorney general find that the proposed amendment or certificate does not comply with law, the director shall not approve the same, and shall return all certificates of amendment to the insurer together with his written statement of reasons for nonapproval. The filing fee shall not be returnable.

History:

[41-2827, added 1961, ch. 330, sec. 595, p. 645; am. 1985, ch. 251, sec. 2, p. 585.]
Idaho Code § 41-2023 — Idaho Code / Title 41 / Chapter 20 / Section 41-2023
41-2023 APPLICATION OF DIVIDENDS — RATE REDUCTIONS.
Status: in_force

41-2023. Application of dividends — Rate reductions. If a policy dividend is hereafter declared or a reduction in rate is hereafter made or continued for the first or any subsequent year of insurance under any policy of group life insurance heretofore or hereafter issued to any policyholder, the excess, if any, of the aggregate dividends or rate reductions under such policy and all other group insurance policies of the policyholder over the aggregate expenditure for insurance under such policies made from funds contributed by the policyholder, or by an employer of insured persons, or by a union or association to which the insured persons belong, including expenditures made in connection with administration of such policies, shall be applied by the policyholder for the sole benefit of insured employees or members.

History:

[41-2023, added 1961, ch. 330, sec. 488, p. 645.]
Idaho Code § 41-1023 — Idaho Code / Title 41 / Chapter 10 / Section 41-1023
41-1023 COUNTERSIGNATURE OF POLICIES — POWER OF ATTORNEY.
Status: in_force

41-1023. Countersignature of policies — Power of attorney. (1) When the signature or countersignature of a property or casualty producer is required on an insurance contract, or rider or endorsement thereto, the producer shall, except as provided in section 41-337(1), Idaho Code, and subsection (2) of this section, affix his original written signature thereon.

(2) The property or casualty producer may grant a power of attorney in writing to an individual who is twenty-one (21) years of age or older, authorizing such person to countersign or cause a facsimile of the agent's signature to be placed on policies and endorsements in his name and on his behalf. The power of attorney shall be acknowledged by the agent under oath before a notary public and shall be kept on file in the agent's office.

History:

[41-1023, added 2001, ch. 296, sec. 3, p. 1061.]
Idaho Code § 41-3214 — Idaho Code / Title 41 / Chapter 32 / Section 41-3214
41-3214 CONSOLIDATIONS AND MERGERS.
Status: in_force

41-3214. Consolidations and mergers. (1) A domestic society may consolidate or merge with any other society by complying with the provisions of this section. It shall file with the director:

(a) A certified copy of the written contract containing in full the terms and conditions of the consolidation or merger;

(b) A sworn statement by the president and secretary or corresponding officers of each society showing the financial condition thereof on a date fixed by the director, but not earlier than December 31 next preceding the date of the contract;

(c) A certificate of such officers, duly verified by their respective oaths, that the consolidation or merger has been approved by a two-thirds (2/3) vote of the supreme governing body of each society, such vote being conducted at a regular or special meeting of each such body, or, if the society's laws so permit, by mail; and

(d) Evidence that at least sixty (60) days prior to the action of the supreme governing body of each society, the text of the contract has been furnished to all members of each society either by mail or by publication in full in the official publication of each society.

(2) If the director finds that the contract is in conformity with the provisions of this section, that the financial statements are correct, and that the consolidation or merger is just and equitable to the members of each society, the director shall approve the contract and issue his certificate to such effect. Upon such approval, the contract shall be in full force and effect unless any society which is a party to the contract is incorporated under the laws of any other state or territory. In such event the consolidation or merger shall not become effective unless and until it has been approved as provided by the laws of such state or territory and a certificate of such approval filed with the director of this state, or, if the laws of such state or territory contain no such provision, then the consolidation or merger shall not become effective unless and until it has been approved by the director of insurance of such state or territory and a certificate of such approval filed with the director.

(3) Upon the consolidation or merger becoming effective as herein provided, all the rights, franchises and interests of the consolidated or merged societies in and to every species of property, real, personal or mixed, and things in action thereunto belonging shall be vested in the society resulting from or remaining after the consolidation or merger without any other instrument, except that conveyances of real property may be evidenced by proper deeds, and the title to any real estate or interest therein, vested under the laws of this state in any of the societies consolidated or merged, shall not revert or be in any way impaired by reason of the consolidation or merger, but shall vest absolutely in the society resulting from or remaining after such consolidation or merger.

(4) The affidavit of any officer of the society or of anyone authorized by it to mail any notice or document, stating that such notice or document has been duly addressed and mailed, shall be prima facie evidence that such notice or document has been furnished the addressees.

History:

[41-3214, added 1995, ch. 213, sec. 2, p. 730.]
Idaho Code § 41-2710 — Idaho Code / Title 41 / Chapter 27 / Section 41-2710
41-2710 REQUIREMENTS FOR AGENTS.
Status: in_force

41-2710. Requirements for agents. (1) A title insurance agent is a person owning or leasing separately or with another licensed agent a complete set of tract indexes and abstract records of each county for which policies are written and authorized in writing by a title insurer to solicit insurance, issue or countersign policies, or otherwise engage in the title insurance business. A title insurer shall not allow or permit any person, firm, association or corporation to act as its agent in relation to the issuance of any certificate, title insurance policy, or other underwriting contract unless such person, firm, association or corporation shall first have obtained a title insurance agent's license for each county for which policies are to be written from the director of the department of insurance. No person, firm, association or corporation shall act within this state as such agent for any title insurer without first having obtained a license from the director of insurance and filed a bond or cash deposit in lieu thereof as required herein.

(2) A separate agent's license for each county shall be issued by the director of the department of insurance upon due showing filed by the applicant upon forms to be provided by the director of the department of insurance and payment of a fee of fifty dollars ($50.00), upon oath, that such applicant if an individual, is a bona fide resident of Idaho, if a firm or association is composed wholly of Idaho residents, or if a corporation is duly authorized or qualified to do business in the state, that the individual agent (or if a corporation or association, its managerial personnel who are going to exercise the license privilege) has reasonable experience or instruction in the field of title examinations and title insurance and the insurance laws of Idaho, that the applicant owns or leases, separately or with another, and maintains an adequate, complete set of tract indexes and abstract records of each county wherein he proposed to do business, and such application shall be endorsed by the title insurer with whom he proposed to do business that the proposed agent is known to have a good reputation and is worthy of public trust and that such title insurer knows of no fact or condition that would disqualify the agent from receiving the permit. An agent's license shall continue from the date issued until the first day of January of each year and shall be automatically renewed thereon upon the payment of the annual fee of fifty dollars ($50.00) by the agent, unless terminated as herein provided by the director of the department of insurance for cause. If the filing fee is not promptly paid, the applicant shall be subject to a late filing fee of two dollars ($2.00) a day up to a maximum of one hundred dollars ($100).

(3) Upon the termination of any agency by a title insurer or by the agent terminating, the title insurer shall immediately notify the director of the department of insurance in writing and a title insurance agent shall forthwith notify the director of the department of insurance of the name of a new title insurer with whom he proposes to do business, with the new title insurer's endorsement upon said notification. No title insurer shall allow the license of an agent for which it has vouched to continue unless all of the foregoing conditions have been complied with.

(4) The license of any title insurance agent may be denied, or the license suspended, revoked or renewal thereof refused, by the director of the department of insurance after notice and hearing if he finds that such license holder has:

(a) Willfully violated any provisions of title 41, Idaho Code, or the rules issued thereunder;

(b) Has intentionally made a material misstatement in the application for such license;

(c) Has obtained or attempted to obtain such license by fraud or misrepresentation;

(d) Has misappropriated or converted to his own use or illegally withheld money belonging to a title insurance company, an insured or any other person;

(e) Has demonstrated his lack of trustworthiness or competence to act as such agent or been guilty of fraudulent or dishonest practices;

(f) Has materially misrepresented the terms and conditions of a title insurance policy or contract, or the condition of the title represented thereby; or

(g) Has failed to maintain a separate and distinct accounting of escrowed funds and has failed to maintain an escrow bank account or account separate and apart from all other accounts.

(5) Before any license is denied, suspended or revoked or renewal refused, the director shall give thirty (30) days' written notice by registered mail to the licensee or applicant and the title insurer represented by the agent, and if said agent or title insurer desires, to set a date of hearing and to allow the production of evidence by said parties or any other interested person as to the matter. The right and remedies of the parties shall be as set forth in chapter 52, title 67, Idaho Code. Any decision of the director of the department of insurance shall be made in writing and filed in his office and mailed to the title insurer and agent involved.

(6) As a condition of obtaining said license, the individual to be licensed for himself or the entity to be licensed for each employee escrow officer shall obtain, file and pay for a surety bond as provided for an escrow officer.

(7) Regular examination of the tract indexes, abstract records, and any other records to ascertain compliance with title 41, Idaho Code, and related rules, of a title agent after the first examination thereof by the director shall be limited to not more than every fifth year, unless the agent otherwise requests or the director has cause to believe the same does not comply with this chapter or the rules thereunder. The director shall prepare an examination report following each examination and shall provide such report to the title agent being examined affording the person up to twenty-eight (28) days within which to review, comment and request a hearing. Unless a hearing is requested in accordance with chapter 2, title 41, Idaho Code, the examination report shall be deemed available to the public notwithstanding the exemptions from disclosure provided in chapter 1, title 74, Idaho Code. In addition, if the title agency affirmatively requests, any reply to the examination report shall be deemed available to the public notwithstanding the exemptions from disclosure provided in chapter 1, title 74, Idaho Code. However, all working papers and other records produced by, obtained by or disclosed to the director or any other person in the course of an examination hereunder shall be made available to the person or company which was the subject of the examination in any proceeding pursuant to chapter 2, title 41, Idaho Code, but shall otherwise be held by the director as an exempt record not required to be made public.

History:

[41-2710, added 1973, ch. 135, sec. 7, p. 252; am. 2010, ch. 96, sec. 1, p. 182; am. 2015, ch. 141, sec. 111, p. 461.]
Idaho Code § 41-3926 — Idaho Code / Title 41 / Chapter 39 / Section 41-3926
41-3926 MAMMOGRAPHY COVERAGE.
Status: in_force

41-3926. Mammography coverage. (1) From and after July 1, 1992, all policies, contracts, plans or certificates issued by an organization offering a managed care plan which provide coverage for the surgical procedure known as a mastectomy which are delivered, issued for delivery, continued or renewed in this state shall provide minimum mammography examination or equivalent examination coverage. Such coverage shall include at least the following benefits:

(a) One (1) baseline mammogram for any woman who is thirty-five (35) through thirty-nine (39) years of age.

(b) A mammogram every two (2) years for any woman who is forty (40) through forty-nine (49) years of age, or more frequently if recommended by the woman's physician.

(c) A mammogram every year for any woman who is fifty (50) years of age or older.

(d) A mammogram for any woman desiring a mammogram for medical cause.

Such coverage shall not exceed the cost of the examination.

(2) As used in this section, "mastectomy" means the removal of all or part of the breast for medically necessary reasons as determined by a licensed physician.

(3) Nothing in this section shall apply to specified accident, specified disease, hospital indemnity, medicare supplement, long-term care or other limited benefit health insurance policies.

History:

[(41-3926), added 1992, ch. 132, sec. 4, p. 415; am. 1993, ch. 113, sec. 4, p. 290; am. and redesig. 1997, ch. 204, sec. 29, p. 599.]
Idaho Code § 41-2872 — Idaho Code / Title 41 / Chapter 28 / Section 41-2872
41-2872 HEALTH CARE PROVIDER CONTRACTS — GRIEVANCE PROCEDURE.
Status: in_force

41-2872. Health care provider contracts — Grievance procedure. (1) Any stock or mutual insurer (hereinafter insurance company) issuing benefits pursuant to the provisions of this chapter shall be ready and willing at all times to enter into health care provider service contracts with all qualified health care providers of the category or categories which are necessary to provide the health care services covered by the insurance company's policy of insurance if such health care providers: are qualified under the laws of the state of Idaho, desire to become participant health care providers of the insurance company, meet the requirements of the insurance company, and practice within the general area served by the insurance company.

(2) Nothing in this section shall preclude an insurance company from refusing to contract with a health care provider who is unqualified or who does not meet the terms and conditions of the participating provider contract of the insurance company or from terminating or refusing to renew the contract of a participating health care provider who is unqualified or who does not comply with, or who refuses to comply with, the terms and conditions of the participating health care provider contract including, but not limited to, practice standards and quality requirements. The contract shall provide for written notice to the participating health care provider setting forth any breach of contract for which the insurance company proposes that the contract be terminated or not renewed and shall provide for a reasonable period of time for the participating health care provider to cure such breach prior to termination or nonrenewal. If the breach has not been cured within such period of time the contract may be terminated or not renewed. Provided however, that if the breach of contract for which the insurance company proposes that the contract be terminated or not renewed is a willful breach, fraud or a breach which poses an immediate danger to the public health or safety, the contract may be terminated or not renewed immediately.

(3) Every insurance company issuing benefits pursuant to this chapter shall establish a grievance system for health care providers. Such grievance system shall provide for arbitration according to chapter 9, title 7, Idaho Code, or for such other system which provides reasonable due process provisions for the resolution of grievances and the protection of the rights of the parties.

(4) Subsections (1) and (2) of this section shall apply to health care provider participation contracts entered into after July 1, 1994.

History:

[41-2872, added 1994, ch. 275, sec. 1, p. 853.]
Idaho Code § 41-4610 — Idaho Code / Title 41 / Chapter 46 / Section 41-4610
41-4610 SEVERABILITY.
Status: in_force

41-4610. Severability. If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby.

History:

[41-4610, added 1999, ch. 98, sec. 2, p. 311.]
Idaho Code § 41-3226 — Idaho Code / Title 41 / Chapter 32 / Section 41-3226
41-3226 LICENSE.
Status: in_force

41-3226. License. (1) No fraternal benefit society shall transact business in this state without a license therefor issued by the director. Such a license issued under this code shall continue in force for as long as the society is entitled thereto under this chapter and until suspended or revoked by the director, or terminated at the request of the society; subject, however, to continuance of the license by the society each year by:

(a) Payment prior to March 1 of the continuation fee provided in section 41-3235, Idaho Code, (fees); and

(b) Due filing by the society of its annual statement for the calendar year preceding as required under section 41-3225, Idaho Code.

(2) If not so continued by the society, its license shall expire at midnight on the March 31 next following such failure of the society to continue it in force. The director shall promptly notify the society of the occurrence of any failure resulting in impending expiration of its license.

(3) The director may, in his discretion, upon the society's request made within three (3) months after expiration, reinstate a license which the society has inadvertently permitted to expire, after the society had fully cured all its failures which resulted in the expiration, and upon payment by the society of an additional fee for reinstatement specified in section 41-3235, Idaho Code (fees). Otherwise the society shall be granted another license only after filing application therefor and meeting all other requirements as for an original license.

(4) For each license the society shall pay the director the fee prescribed in section 41-3235, Idaho Code.

(5) A duly certified copy or duplicate of the license shall be prima facie evidence that the licensee is a fraternal benefit society within the meaning of this chapter.

History:

[41-3226, added 1995, ch. 213, sec. 2, p. 736.]
Idaho Code § 41-2832 — Idaho Code / Title 41 / Chapter 28 / Section 41-2832
41-2832 MEETINGS OF MEMBERS OF MUTUAL INSURER.
Status: in_force

41-2832. Meetings of members of mutual insurer. (1) Meetings of members of a domestic mutual insurer shall be held in the city or town of its registered office in this state, except as may otherwise be provided in the insurer's by-laws with the director's approval.

(2) Each such insurer shall, during the first six (6) months of each calendar year, hold the annual meeting of its members to fill vacancies existing or occurring in the board of directors, receive and consider reports of the insurer's officers as to its affairs and transact such other business as may properly be brought before it.

(3) Notice of the time and place of the annual meeting of members shall be given by imprinting such notice plainly on the policies issued by the insurer. Any change of the date or place of the annual meeting shall be made only by an annual meeting of members. Notice of such change may be given:

(a) By imprinting such new date or place on all policies which will be in effect as of the date of such changed meeting; or

(b) Unless the director otherwise orders, notice of the new date or place need be given only through policies issued after the date of the annual meeting at which such change was made and in premium notices and renewal certificates issued during the twenty-four (24) months immediately following such meeting.

(4) If more than six (6) months are allowed to elapse after an annual meeting of members is due to be held and without such annual meeting being held, the director shall, upon written request of any officer, director, or member of the insurer, cause written notice of such meeting to be given to the insurer's members, and the meeting shall be held as soon as reasonably possible thereafter. The director shall attend the meeting.

(5) Subsections (2) and (3) above shall not apply as to a fraternal insurer, as defined in section 41-3101(2), which shall hold the annual meeting of its members and give notice thereof, at such reasonable time and place and in such reasonable manner as may be provided by the insurer's by-laws with the director's approval.

History:

[41-2832, added 1961, ch. 330, sec. 600, p. 645.]
Idaho Code § 41-1416 — Idaho Code / Title 41 / Chapter 14 / Section 41-1416
41-1416 PERIOD LICENSE EFFECTIVE — RENEWAL — FEE — SUSPENSION OR REVOCATION.
Status: in_force

41-1416. Period license effective — Renewal — Fee — Suspension or revocation. (1) Licenses issued to rating organizations under section 41-1415, Idaho Code, shall remain in effect for one (1) year, unless sooner suspended or revoked by the director, and may be renewed for successive periods of one (1) year each upon application of the rating organization and payment in advance of the license fee.

(2) The fee for the license shall be in the amount set forth by rule pursuant to section 41-401, Idaho Code.

(3) The director may suspend or revoke the license if he finds, after a hearing thereon of which notice was duly given to the rating organization, that the rating organization no longer meets the requirements of section 41-1415, Idaho Code, or for failure to comply with the director's order as provided in section 41-1432, Idaho Code.

History:

[41-1416, added 1961, ch. 330, sec. 321, p. 645; am. 2001, ch. 85, sec. 5, p. 214.]
Idaho Code § 41-1328B — Idaho Code / Title 41 / Chapter 13 / Section 41-1328B
41-1328B DEFINITIONS.
Status: in_force

41-1328B. Definitions. For the purposes of sections 41-1328A through 41-1328D, Idaho Code, the following definitions apply:

(1) "Aftermarket crash part" means a replacement part for any of the nonmechanical sheet metal or plastic parts which generally constitute the exterior of a motor vehicle, including inner and outer panels.

(2) "Installer" means an individual who actually does the work of replacing or repairing parts of a motor vehicle.

(3) "Insurer" means an insurance company and any person authorized to represent the insurer with respect to a claim.

(4) "Nonoriginal equipment manufacturer (non-OEM) aftermarket crash part" means a replacement part not made for or by the manufacturer of the motor vehicle.

(5) "Repair facility" means any motor vehicle dealer, garage, body shop or other commercial entity which undertakes the repair or replacement of those parts that generally constitute the exterior of a motor vehicle.

History:

[41-1328B, added 1990, ch. 156, sec. 1, p. 342.]
Idaho Code § 41-6209 — Idaho Code / Title 41 / Chapter 62 / Section 41-6209
41-6209 LICENSING.
Status: in_force

41-6209. licensing. Motor vehicle service contract providers, and persons marketing, administering, selling or offering to sell motor vehicle service contracts for motor vehicle service contract providers, are not required to obtain a license under title 41, Idaho Code. A motor vehicle service contract provider shall not be subject to regulation under any provision of title 41, Idaho Code, not made expressly applicable to it.

History:

[41-6209, added 2018, ch. 116, sec. 2, p. 246.]
Idaho Code § 41-2833 — Idaho Code / Title 41 / Chapter 28 / Section 41-2833
41-2833 SPECIAL MEETINGS OF MEMBERS OF MUTUAL INSURER.
Status: in_force

41-2833. Special meetings of members of mutual insurer. (1) A special meeting of the members of a mutual insurer may be held for any lawful purpose. The meeting shall be called by the corporate secretary pursuant to request of the insurer's president or of its board of directors, or upon request in writing signed by not less than one-tenth (1/10) of the insurer's members. The meeting shall be held at such time as the secretary may fix, but not less than ten (10) nor more than thirty (30) days after receipt of the request. If the secretary fails to issue such call, the president, directors, or members making the request may do so.

(2) Not less than ten (10) days' written notice of the meeting shall be given. Notice addressed to the insurer's members at their respective post office addresses last of record with the insurer and deposited, postage prepaid, in a letter depository of the United States post office, shall be deemed to have been given when so mailed. In lieu of mailed notice the insurer may publish the notice in such publication or publications as shall afford a majority of its members a reasonable opportunity to have actual advance notice of the meeting. The notice shall state the purposes of the meeting, and no business shall be transacted at the meeting of which notice was not so given.

History:

[41-2833, added 1961, ch. 330, sec. 601, p. 645.]
Idaho Code § 41-5407 — Idaho Code / Title 41 / Chapter 54 / Section 41-5407
41-5407 HEARINGS.
Status: in_force

41-5407. Hearings. Upon any of the following the insurer shall have the right to a confidential departmental hearing, on a record, at which the insurer may challenge any determination or action by the director. The insurer shall notify the director of its request for a hearing within five (5) days after the notification by the director under subsection (1), (2), (3) or (4) of this section. Upon receipt of the insurer's request for a hearing, the director shall set a date for the hearing, which date shall be no less than ten (10) nor more than thirty (30) days after the date of the insurer's request.

(1) Notification to an insurer by the director of an adjusted RBC report; or

(2) Notification to an insurer by the director that:

(a) The insurer's RBC plan or revised RBC plan is unsatisfactory; and

(b) Such notification constitutes a regulatory action level event with respect to such insurer; or

(3) Notification to any insurer by the director that the insurer has failed to adhere to its RBC plan or revised RBC plan and that such failure has a substantial adverse effect on the ability of the insurer to eliminate the company action level event with respect to the insurer in accordance with its RBC plan or revised RBC plan; or

(4) Notification to an insurer by the director of a corrective order with respect to the insurer.

History:

[41-5407, added 1996, ch. 96, sec. 1, p. 290.]
Idaho Code § 41-4110 — Idaho Code / Title 41 / Chapter 41 / Section 41-4110
41-4110 RESERVES.
Status: in_force

41-4110. Reserves. (1) A joint public agency self-funded plan shall establish and maintain in its trust fund the following reserves:

(a) A reserve in an amount as certified by a member of the American academy of actuaries as being necessary for payment of claims against the trust fund for benefits, including both claims reported and not yet paid and claims incurred but not yet reported. Any joint public agency self-funded plan in existence as of July 1, 2006, shall also have three (3) years from the effective date of this act to fund the applicable reserves.

(b) If under the plan periodic contributions of either the employer or employees to the trust fund are payable less frequently than monthly, there shall be a reserve for unearned contributions as computed pro rata on the basis of the unexpired portion of the period for which the contribution has been paid.

(2) In any determination of the financial condition of the trust fund, the claims reserve and reserve for unearned contributions shall constitute liabilities.

(3) Upon request of a plan, the director shall have the authority to annually waive the requirement that the plan maintain aggregate stop-loss coverage if:

(a) The joint public agency self-funded plan established by a joint powers agreement is governed by a board of trustees and is operating as a public agency;

(b) Enrollment under the plan averages a minimum of one thousand (1,000) covered persons in each of the preceding twelve (12) months;

(c) The plan establishes and maintains, in its trust fund, reserves as set forth in subsection (1)(a) of this section; and

(d) The plan establishes and maintains, in its trust fund, surplus of at least the amount certified annually by a member of the American academy of actuaries as sufficient without aggregate stop-loss coverage, but no less than three (3) months of contributions.

History:

[41-4110, added 2006, ch. 415, sec. 1, p. 1276; am. 2018, ch. 61, sec. 3, p. 152.]
Idaho Code § 41-6506 — Idaho Code / Title 41 / Chapter 65 / Section 41-6506
41-6506 DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS.
Status: in_force

41-6506. deductible, coinsurance, and copayment requirements. Benefits may be made subject to a deductible, coinsurance, or copayment requirement comparable to other deductible, coinsurance, or copayment requirements applicable under the health benefit plan.

History:

[41-6506, added 2019, ch. 192, sec. 1, p. 605.]
Idaho Code § 41-3211 — Idaho Code / Title 41 / Chapter 32 / Section 41-3211
41-3211 AMENDMENTS TO LAWS.
Status: in_force

41-3211. Amendments to laws. (1) A domestic society may amend its laws in accordance with the provisions thereof by action of its supreme governing body at any regular or special meeting thereof or, if its laws so provide, by referendum. Such referendum may be held in accordance with the provisions of its laws by the vote of the voting members of the society, by the vote of delegates or representatives of voting members or by the vote of local lodges. A society may provide for voting by mail. No amendment submitted for adoption by referendum shall be adopted unless, within six (6) months from the date of submission thereof, a majority of the members voting shall have signified their consent to such amendment by one (1) of the methods herein specified.

(2) No amendment to the laws of any domestic society shall take effect unless approved by the director who shall approve such amendment if the director finds that it has been duly adopted and is not inconsistent with any requirement of the laws of this state or with the character, objects and purposes of the society. Unless the director shall disapprove any such amendment within sixty (60) days after the filing of same, such amendment shall be considered approved. The approval or disapproval of the director shall be forwarded in writing, and mailed to the secretary or corresponding officer of the society at its principal office. In case the director disapproves such amendment, the reasons therefor shall be stated in such written notice.

(3) Within ninety (90) days from the approval thereof by the director, all such amendments, or a synopsis thereof, shall be furnished to all members of the society either by mail or by publication in full in the official publication of the society. The affidavit of any officer of the society or of anyone authorized by it to mail any amendments or synopsis thereof, stating facts which show that same have been duly addressed and mailed, shall be prima facie evidence that such amendments or synopsis thereof, have been furnished the addressee.

(4) Every foreign or alien society authorized to do business in this state shall file with the director a duly certified copy of all amendments of, or additions to, its laws within ninety (90) days after the enactment of same.

(5) Printed copies of the laws as amended, certified by the secretary or corresponding officer of the society shall be prima facie evidence of the legal adoption thereof.

History:

[41-3211, added 1995, ch. 213, sec. 2, p. 729.]
Idaho Code § 41-2517 — Idaho Code / Title 41 / Chapter 25 / Section 41-2517
41-2517 SHORT TITLE.
Status: in_force

41-2517. short title. Sections 41-2517 through 41-2521, Idaho Code, shall be known and may be cited as the "Idaho Transportation Network Insurance Act."

History:

[41-2517, added 2015, ch. 316, sec. 1, p. 1232.]
Idaho Code § 41-2864 — Idaho Code / Title 41 / Chapter 28 / Section 41-2864
41-2864 FOREIGN OR DOMESTIC ARBITRAGE TRANSACTIONS EXEMPT.
Status: in_force

41-2864. Foreign or domestic arbitrage transactions exempt. The provisions of sections 41-2860—41-2862 shall not apply to foreign or domestic arbitrage transactions unless made in contravention of such rules and regulations as the director of the department of insurance may adopt in order to carry out the purposes of this act.

History:

[41-2864, added 1965, ch. 294, sec. 5, p. 782.]
Idaho Code § 41-3347 — Idaho Code / Title 41 / Chapter 33 / Section 41-3347
41-3347 REOPENING LIQUIDATION.
Status: in_force

41-3347. Reopening liquidation. After the liquidation proceeding has been terminated and the liquidator discharged, the director or other interested party may at any time petition the district court to reopen the proceedings for good cause, including the discovery of additional assets. If the court is satisfied that there is justification for reopening, it shall so order.

History:

[41-3347, added 1981, ch. 249, sec. 2, p. 535.]
Idaho Code § 41-1804 — Idaho Code / Title 41 / Chapter 18 / Section 41-1804
41-1804 INSURABLE INTEREST — PERSONAL INSURANCE.
Status: in_force

41-1804. Insurable interest — Personal insurance. (1) Any individual of competent legal capacity may procure or effect an insurance contract upon his own life or body for the benefit of any person. But, except as provided in section 41-1805, no person shall procure or cause to be procured any insurance contract upon the life or body of another individual unless the benefits under such contract are payable to the individual insured or his personal representatives, or to a person having, at the time when such contract was made, an insurable interest in the individual insured.

(2) If the beneficiary, assignee, or other payee under any contract made in violation of this section receives from the insurer any benefits thereunder accruing upon the death, disablement, or injury of the individual insured, the individual insured or his executor or administrator, as the case may be, may maintain an action to recover such benefits from the person so receiving them.

(3) "Insurable interest" as to personal insurance means that every individual has an insurable interest in the life, body and health of himself, and of other persons as follows:

(a) In the case of individuals related closely by blood or by law, a substantial interest engendered by love and affection;

(b) In the case of other persons, a lawful and substantial economic interest in having the life, health, or bodily safety of the individual insured continue, as distinguished from an interest which would arise only by, or would be enhanced in value by, the death, disablement or injury of the individual insured; and

(c) An individual heretofore or hereafter party to a contract or option for the purchase or sale of an interest in a business partnership or firm, or of shares of stock of a closed corporation or of an interest in such shares, has an insurable interest in the life of each individual party to such contract and for the purposes of such contract only, in addition to any insurable interest which may otherwise exist as to the life of such individual.

(4) An insurer shall be entitled to rely upon all statements, declarations and representations made by an applicant for insurance relative to the insurable interest of the applicant in the insured; and no insurer shall incur legal liability except as set forth in the policy, by virtue of any untrue statements, declarations or representations so relied upon in good faith by the insurer.

History:

[41-1804, added 1961, ch. 330, sec. 396, p. 645.]
Idaho Code § 41-5202 — Idaho Code / Title 41 / Chapter 52 / Section 41-5202
41-5202 PURPOSE.
Status: in_force

41-5202. Purpose. The purpose and intent of this chapter is to promote the availability of health insurance coverage to persons not covered by employment based insurance 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 of preexisting condition exclusions, and to improve the overall fairness and efficiency of the individual health insurance market.

This chapter is not intended to provide a comprehensive solution to the problem of affordability of health care or health insurance.

History:

[41-5202, added 1994, ch. 427, sec. 1, p. 1338; am. 1997, ch. 321, sec. 19, p. 980; am. 2000, ch. 472, sec. 10, p. 1623.]
Idaho Code § 41-4607 — Idaho Code / Title 41 / Chapter 46 / Section 41-4607
41-4607 NONFORFEITURE BENEFITS.
Status: in_force

41-4607. Nonforfeiture benefits. (1) Except as provided in subsection (2) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. In the event the policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates.

(2) When a group long-term care insurance policy is issued, the offer required in subsection (1) of this section shall be made to the group policyholder. However, if the policy is issued as group long-term care insurance as defined in section 41-4603(4)(d), Idaho Code, other than to a continuing care retirement community or other similar entity, the offering shall be made to each proposed certificate holder.

(3) The director shall promulgate rules specifying the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding a contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse as described in subsection (1) of this section.

History:

[41-4607, added 1999, ch. 98, sec. 2, p. 310.]
Idaho Code § 41-2912 — Idaho Code / Title 41 / Chapter 29 / Section 41-2912
41-2912 ATTORNEY'S BOND.
Status: in_force

41-2912. Attorney's bond. (1) Concurrently with the filing of the declaration provided for in section 41-2908, the attorney of a domestic reciprocal insurer shall file with the director a bond in favor of the state of Idaho for the benefit of all persons damaged as a result of breach by the attorney of the conditions of his bond as set forth in subsection (2) hereof. The bond shall be executed by the attorney and by an authorized corporate surety, and shall be subject to the director's approval.

(2) The bond shall be in the penal sum of twenty-five thousand dollars ($25,000), aggregate in form, conditioned that the attorney will faithfully account for all monies and other property of the insurer coming into his hands, and that he will not withdraw or appropriate to his own use from the funds of the insurer, any moneys or property to which he is not entitled under the power of attorney.

(3) The bond shall provide that it is not subject to cancellation unless thirty (30) days' advance notice in writing of cancellation is given both the attorney and the director.

History:

[41-2912, added 1961, ch. 330, sec. 639, p. 645.]
Idaho Code § 41-5601 — Idaho Code / Title 41 / Chapter 56 / Section 41-5601
41-5601 DEFINITIONS.
Status: in_force

41-5601. Definitions. As used in this chapter:

(1) "Beneficiary" means a policyholder, subscriber, member, employer or other person who is eligible for benefits under a contract providing hospital, surgical, or medical expense coverage or a managed care organization policy or agreement under which a third party payer agrees to reimburse for covered health care services rendered to beneficiaries in accordance with the benefits contract.

(2) "Date of payment" means the date the payment is sent as indicated by the mail stamp on the envelope, by the insurer to the practitioner or facility or to the beneficiary in the event there is not a contract for direct payment by the insurer to the practitioner or facility, or, in the event of a wire or other electronic funds transfer, upon acceptance by the insurer's bank of a payment order.

(3) "Department" means the department of insurance.

(4) "Director" means the director of the department of insurance.

(5) "Electronic claim" means a claim that is transmitted through the use of electronic media, which includes the internet, extranet, leased lines, dial-up lines, private networks, and those transmissions that are physically moved from one (1) location to another using magnetic tape, disk or compact disk media. The claim shall contain the proper format and code sets in accordance with the applicable implementation specifications under 45 CFR 160 et seq., and 45 CFR 162 et seq.

(6) "Insurer" means any insurer that sells hospital, medical, long-term care, or vision insurance policies or certificates and managed care organizations. For the purpose of this chapter only, "insurer" also includes a third party administrator who makes payments to beneficiaries, practitioners or facilities on behalf of an insurer and a hospital or professional service corporation that provides hospital, medical, long-term care or vision health care services.

(7) "Practitioner or facility" means any physician, hospital or other person or facility licensed or otherwise authorized to furnish health care services.

(8) "Receipt of claim" means the date the claim is actually received by the insurer from the practitioner or facility or the beneficiary.

(9) "Submission of claim" means the date the claim is sent as indicated by the mail stamp on the envelope, by the beneficiary, practitioner or facility, to the insurer or the date an electronic claim is transmitted to an insurer.

History:

[41-5601, added 2004, ch. 290, sec. 1, p. 812.]
Idaho Code § 41-5108 — Idaho Code / Title 41 / Chapter 51 / Section 41-5108
41-5108 PROHIBITED ACTS.
Status: in_force

41-5108. Prohibited acts. The RM shall not:

(1) Cede retrocessions on behalf of the reinsurer, except that the RM may cede facultative retrocessions pursuant to obligatory facultative agreements if the contract with the reinsurer contains reinsurance underwriting guidelines for such retrocessions. Such guidelines shall include a list of reinsurers with which such automatic agreements are in effect, and for each such reinsurer, the coverages and amounts or percentages that may be reinsured, and commission schedules.

(2) Commit the reinsurer to participate in reinsurance syndicates.

(3) Appoint any producer without assuring that the producer is lawfully licensed to transact the type of reinsurance for which he is appointed.

(4) Without prior approval of the reinsurer, pay or commit the reinsurer to pay a claim, net of retrocessions, that exceeds the lesser of an amount specified by the reinsurer or one per cent (1%) of the reinsurer's policyholder surplus as of December 31 of the last complete calendar year.

(5) Collect any payment from a retrocessionaire or commit the reinsurer to any claim settlement with a retrocessionaire, without prior approval of the reinsurer. If prior approval is given, a report must be promptly forwarded to the reinsurer.

(6) Jointly employ an individual who is employed by the reinsurer unless such RM is under common control with the reinsurer subject to chapter 38, title 41, Idaho Code.

(7) Appoint a sub-RM.

History:

[41-5108, added 1992, ch. 82, sec. 1, p. 254.]
Idaho Code § 41-3210 — Idaho Code / Title 41 / Chapter 32 / Section 41-3210
41-3210 ORGANIZATION.
Status: in_force

41-3210. Organization. A domestic society organized on or after the effective date of this act shall be formed as follows:

(1) Seven (7) or more citizens of the United States, a majority of whom are citizens of this state, who desire to form a fraternal benefit society, may make, sign and acknowledge before some officer competent to take acknowledgment of deeds, articles of incorporation, in which shall be stated:

(a) The proposed corporate name of the society, which shall not so closely resemble the name of any society or insurance company as to be misleading or confusing;

(b) The purposes for which it is being formed and the mode in which its corporate powers are to be exercised. Such purposes shall not include more liberal powers than are granted in this chapter;

(c) The names and residences of the incorporators and the names, residences and official titles of all the officers, trustees, directors, or other persons who are to have and exercise the general control of the management of the affairs and funds of the society for the first year or until the ensuing election at which all such officers shall be elected by the supreme governing body, which election shall be held not later than one (1) year from the date of issuance of the permanent certificate of authority.

(2) Such articles of incorporation, duly certified copies of the society's bylaws and rules, copies of all proposed forms of certificates, applications therefor, and circulars to be issued by the society and a bond conditioned upon the return to applicants of the advanced payments if the organization is not completed within one (1) year shall be filed with the director, who may require such further information as the director deems necessary. The bond with sureties approved by the director shall be in such amount, not less than three hundred thousand dollars ($300,000), nor more than one million five hundred thousand dollars ($1,500,000), as required by the director. All documents filed are to be in the English language. If the purposes of the society conform to the requirements of this chapter and all provisions of the law have been complied with, the director shall so certify, retain and file the articles of incorporation and shall furnish the incorporators a preliminary certificate of authority authorizing the society to solicit members as hereinafter provided.

(3) No preliminary certificate of authority granted under the provisions of this section shall be valid after one (1) year from its date or after such further period, not exceeding one (1) year, as may be authorized by the director upon cause shown, unless the five hundred (500) applicants hereinafter required have been secured and the organization has been completed as herein provided. The charter and all other proceedings thereunder shall become null and void in one (1) year from the date of the preliminary certificate of authority, or at the expiration of the extended period, unless the society shall have completed its organization and received a certificate of authority to do business as hereinafter provided.

(4) Upon receipt of a preliminary certificate of authority from the director, the society may solicit members for the purpose of completing its organization, shall collect from each applicant the amount of not less than one (1) regular monthly premium in accordance with its table of rates, and shall issue to each such applicant a receipt for the amount so collected. No society shall incur any liability other than for the return of such advance premium, nor issue any certificate, nor pay, allow, or offer or promise to pay or allow, any benefit to any person until:

(a) Actual bona fide applications for benefits have been secured on not less than five hundred (500) applicants, and any necessary evidence of insurability has been furnished to and approved by the society;

(b) At least ten (10) subordinate lodges have been established into which the five hundred (500) applicants have been admitted;

(c) There has been submitted to the director, under oath of the president or secretary, or corresponding officer of the society, a list of such applicants, giving their names, addresses, date each was admitted, name and number of the subordinate lodge of which each applicant is a member, amount of benefits to be granted and premiums therefor; and

(d) It shall have been shown to the director, by sworn statement of the treasurer, or corresponding officer of such society, that at least five hundred (500) applicants have each paid in cash at least one (1) regular monthly premium as herein provided, which premiums in the aggregate shall amount to at least one hundred fifty thousand dollars ($150,000). Said advance premiums shall be held in trust during the period of organization and if the society has not qualified for a certificate of authority within one (1) year, as herein provided, such premiums shall be returned to said applicants.

(5) The director may make such examination and require such further information as the director deems advisable. Upon presentation of satisfactory evidence that the society has complied with all the provisions of law, the director shall issue to the society a certificate of authority to that effect and that the society is authorized to transact business pursuant to the provisions of this chapter. The certificate of authority shall be prima facie evidence of the existence of the society at the date of such certificate. The director shall cause a record of such certificate of authority to be made. A certified copy of such record may be given in evidence with like effect as the original certificate of authority.

(6) Any incorporated society authorized to transact business in this state at the time this act becomes effective shall not be required to reincorporate.

History:

[41-3210, added 1995, ch. 213, sec. 2, p. 727.]
Idaho Code § 41-1233 — Idaho Code / Title 41 / Chapter 12 / Section 41-1233
41-1233 REPORT AND TAX OF INDEPENDENTLY PROCURED COVERAGES.
Status: in_force

41-1233. Report and tax of independently procured coverages. (1) Every insured who in this state procures or causes to be procured or continues or renews insurance in an unauthorized foreign insurer, or any self-insurer who in this state so procures or continues excess loss, catastrophe or other insurance, upon a subject of insurance resident, located or to be performed within this state, other than insurance procured through a surplus line broker pursuant to the surplus line law of this state or exempted from tax pursuant to section 41-1212, Idaho Code, shall within thirty (30) days after the date such insurance policy was so received by the insured, continued or renewed file a written report of the same with the surplus line association on forms designated by the director and furnished to the insured upon request. The report shall show the name and address of the insured or insureds, name and address of the insurer, the subject of the insurance, a general description of the coverage, the amount of premium currently charged therefor, and such additional pertinent information as the director reasonably requests. If the insurance covers also a subject of insurance resident, located or to be performed outside this state, a proper pro rata portion of the entire premium payable for all such insurance shall be allocated to this state for the purposes of this section.

(2) Any insurance in an unauthorized insurer procured through negotiations or an application in whole or in part occurring or made within or from within this state, or for which premiums in whole or in part are remitted directly or indirectly from within this state, shall be deemed to be insurance procured or continued or renewed in this state within the intent of subsection (1) of this section.

(3) The insured with respect to the obligation, chose in action, or right represented by such insurance shall be subject to section 41-1229, Idaho Code, as it pertains to premium tax. Within thirty (30) days after the insurance policy was so received by the insured, continued or renewed, and coincidentally with the filing with the surplus line association of the report provided for in subsection (1) of this section, the insured shall pay the amount of the tax to the director and a stamping fee to the surplus line association.

(4) The tax shall be collectible from the insured by civil action brought by the director, or by distraint.

(5) This section does not abrogate or modify any provision of section 41-1201 (representing or aiding unauthorized insurer prohibited), 41-1202 (representing or aiding unauthorized insurer prohibited — penalty), or 41-1203 (suits by unauthorized insurer prohibited), Idaho Code.

(6) This section does not apply as to life or disability insurances.

History:

[41-1233, added 1961, ch. 330, sec. 277, p. 645; am. 1988, ch. 366, sec. 5, p. 1080; am. 1993, ch. 22, sec. 7, p. 82; am. 2002, ch. 91, sec. 13, p. 232; am. 2004, ch. 387, sec. 2, p. 1164; am. 2021, ch. 42, sec. 2, p. 124.]
Idaho Code § 41-1082 — Idaho Code / Title 41 / Chapter 10 / Section 41-1082
41-1082 DEFINITIONS.
Status: in_force

41-1082. definitions. As used in sections 41-1081 through 41-1089, Idaho Code:

(1) "Customer" means a person who purchases portable electronics or services.

(2) "Enrolled Customer" means a customer who purchases coverage under a portable electronics insurance policy issued to a vendor of portable electronics, which vendor would be the insured under a master or group policy.

(3) "Location" means any physical location in the state of Idaho or any website, call center site or similar location directed to residents of the state of Idaho.

(4) "Portable electronics" means electronic devices that are portable in nature and includes accessories and any services related to the use of such device.

(5) (a) "Portable electronics insurance" means insurance providing coverage for the repair or replacement of portable electronics against any one (1) or more of the following causes of loss: loss of the portable electronic device, theft, inoperability due to mechanical failure, malfunction, damage or other similar causes of loss;

(b) "Portable electronics insurance" does not include:

(i) A service contract as defined in section 41-114A, Idaho Code;

(ii) A policy of insurance covering a seller's or a manufacturer's obligations under a warranty; or

(iii) A homeowner's, renter's, private passenger automobile, commercial multi-peril or similar insurance policy.

(6) "Portable electronics transaction" means:

(a) The sale or lease of portable electronics by a vendor to a customer; or

(b) The sale of a service related to the use of portable electronics by a vendor to a customer.

(7) "Supervising entity" means a business entity that is a licensed insurer or insurance producer that is authorized by an insurer to supervise the administration of a portable electronics insurance program.

(8) "Vendor" means a person in the business of engaging in portable electronics transactions directly or indirectly.

History:

[41-1082, added 2012, ch. 226, sec. 4, p. 621.]
Idaho Code § 41-4806 — Idaho Code / Title 41 / Chapter 48 / Section 41-4806
41-4806 COMPULSORY ASSOCIATIONS.
Status: in_force

41-4806. Compulsory associations. No risk retention group shall be permitted to join or contribute financially to any insurance insolvency guaranty fund or similar mechanism in this state, nor shall any risk retention group, or its insureds, receive any benefit from any such fund for claims arising out of the operations of such risk retention group.

History:

[41-4806, added 1987, ch. 140, sec. 1, p. 280.]
Idaho Code § 41-701 — Idaho Code / Title 41 / Chapter 7 / Section 41-701
41-701 INVESTMENTS.
Status: in_force

41-701. Investments. (1) Funds of a domestic insurer shall be invested, reinvested and used in the manner and subject to the conditions, restrictions and limitations set forth in this chapter.

(2) Investments of a foreign or alien insurer which would be authorized for a like domestic insurer shall be allowed as assets in any determination of its financial condition. Other investments of a foreign or alien insurer which are authorized by the laws of its domicile may be so allowed at the discretion of the director.

(3) The director may adopt rules establishing standards and limitations for investments by insurers that are not otherwise specifically permitted or prohibited in this chapter. In the absence of a rule prohibiting such, all assets shall be valued according to rules promulgated by the national association of insurance commissioners (NAIC), NAIC's valuation of securities office or by NAIC's financial condition subcommittee.

History:

[41-701, added 1961, ch. 330, sec. 138, p. 645; am. 1994, ch. 240, sec. 5, p. 755.]
Idaho Code § 41-2653 — Idaho Code / Title 41 / Chapter 26A / Section 41-2653
41-2653 LIMITS OF RISK.
Status: in_force

CHAPTER 26A

MORTGAGE GUARANTY INSURANCE

41-2653. Limits of risk. (1) The insurer shall not retain risk as to any one (1) loan, or as to all loans secured by properties in a single housing tract or a contiguous tract, in an amount in excess of ten percent (10%) of the insurer's policyholders' surplus. In determining the amount of risk retained, applicable reinsurance in an assuming insurer authorized to transact insurance in this state or approved by the director shall be deducted from the total direct risk insured. For the purposes of this section "contiguous" means not separated by more than one-half (1/2) of a mile.

(2) The insurer shall not at any time have outstanding aggregate risk liability, net of applicable reinsurance, under mortgage guaranty insurance in amount in excess of twenty-five (25) times its policyholders' surplus.

(3) The director may waive the requirement of subsection (2) of this section upon a written request of the insurer and finding that the insurer is in compliance with any requirements or conditions imposed by the insurer's state of domicile and the insurer's policyholder surplus is reasonable in relationship to the insurer's aggregate insured risk and adequate to its financial needs. In reviewing a written request for approval to exceed the twenty-five (25) times its policyholders' surplus limitation, the director may retain outside experts to assist in the review. The insurer shall bear the cost of outside experts retained for the review.

(4) If at any time the insurer's outstanding risk liability as to mortgage guaranty insurance exceeds the limitations stated in subsection (2) of this section and the insurer has not received a written waiver from the director, the insurer shall accept no new mortgage guaranty insurance risks while such excess exists.

(5) The director may suspend or revoke the certificate of authority of an insurer which violates the provisions of this section.

History:

[41-2653, added 1972, ch. 79, sec. 1, p. 159; am. 2010, ch. 131, sec. 1, p. 280; am. 2015, ch. 127, sec. 1, p. 321.]
Idaho Code § 41-2701 — Idaho Code / Title 41 / Chapter 27 / Section 41-2701
41-2701 SCOPE OF CHAPTER.
Status: in_force

41-2701. Scope of chapter. This chapter applies only as to title insurance, as defined in section 41-508.

History:

[41-2701, added 1961, ch. 330, sec. 566, p. 645.]
Idaho Code § 41-328 — Idaho Code / Title 41 / Chapter 3 / Section 41-328
41-328 ORDER AND NOTICE OF SUSPENSION, REVOCATION OR REFUSAL — EFFECT UPON AGENTS' AUTHORITY.
Status: in_force

41-328. Order and notice of suspension, revocation or refusal — Effect upon agents' authority. (1) All suspensions or revocations of, or refusals to continue, an insurer's certificate of authority shall be by the director's order given to the insurer as provided by section 41-212.

(2) Upon suspending or revoking or refusing to continue the insurer's certificate of authority the director shall forthwith give notice thereof to the insurer's agents in this state of record in the department, and shall likewise suspend or revoke the authority of such agents to represent the insurer.

(3) In his discretion the director may likewise publish notice of such suspension, revocation or refusal in one or more newspapers of general circulation in this state.

History:

[41-328, added 1961, ch. 330, sec. 91, p. 645.]
Idaho Code § 41-1850 — Idaho Code / Title 41 / Chapter 18 / Section 41-1850
41-1850 CERTIFICATES OF INSURANCE.
Status: in_force

41-1850. certificates of insurance. (1) For purposes of this section, the following terms have the following meanings:

(a) "Certificate" or "certificate of insurance" means any document or instrument, no matter how titled or described, that is prepared or issued as evidence of property or casualty insurance coverage. "Certificate" or "certificate of insurance" shall not include a policy of insurance, insurance binder, policy endorsement or automobile insurance identification card.

(b) "Certificate holder" means any person, other than a policyholder, that requests, obtains or possesses a certificate of insurance.

(c) "Insurance producer" has the same meaning as provided for in chapter 10, title 41, Idaho Code.

(d) "Insurer" has the same definition as provided for in section 41-103, Idaho Code.

(e) "Person" means any individual, partnership, corporation, association or other legal entity, including any government or governmental subdivision or agency.

(f) "Policyholder" means a person that has contracted with a property or casualty insurer for insurance coverage.

(g) "Group master policy" means an insurance policy that provides coverage to eligible persons on a group basis through a group insurance program.

(2) No person, wherever located, may prepare, issue or knowingly request the issuance of a certificate of insurance unless the form has been filed with the director by or on behalf of an insurer. No person, wherever located, may alter or modify a certificate of insurance form unless the alteration or modification has been filed with the director.

(3) The director shall disapprove the use of any form filed under this section, or withdraw approval of a form, if the form:

(a) Is unfair, misleading or deceptive, or violates public policy;

(b) Fails to comply with the requirements of this section; or

(c) Violates any provision of title 41, Idaho Code, including any rule promulgated by the director.

(4) Each certificate of insurance must contain the following or similar statement: "This certificate of insurance is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not alter, amend or extend the coverage, terms, exclusions and conditions afforded by the policies referenced herein."

(5) The current edition of standard certificate of insurance forms promulgated and filed with the director by the association for cooperative operations research and development (ACORD) or the insurance services office (ISO) are not required to be refiled by individual insurers.

(6) No person, wherever located, shall demand or request the issuance of a certificate of insurance or other document, record or correspondence that the person knows contains any false or misleading information or that purports to affirmatively or negatively alter, amend or extend the coverage provided by the policy of insurance to which the certificate makes reference.

(7) No person, wherever located, may knowingly prepare or issue a certificate of insurance or other document, record or correspondence that contains any false or misleading information or that purports to affirmatively or negatively alter, amend or extend the coverage provided by the policy of insurance to which the certificate makes reference.

(8) The provisions of this section shall apply to all certificate holders, policyholders, insurers, insurance producers and certificate of insurance forms issued as evidence of property or casualty insurance coverages on property, operations or risks located in this state, regardless of where the certificate holder, policyholder, insurer or insurance producer is located.

(9) A certificate of insurance is not a policy of insurance and does not affirmatively or negatively alter, amend or extend the coverage afforded by the policy to which the certificate of insurance makes reference. A certificate of insurance shall not confer to a certificate holder new or additional rights beyond what the referenced policy of insurance provides.

(10) A certificate of insurance may not warrant that the policy of insurance referenced in the certificate comply with the insurance or indemnification requirements of a contract, and the inclusion of a contract number or description, or project number or description, within a certificate of insurance may not be interpreted as doing such. Notwithstanding any requirement, term or condition of any contract or other document with respect to which a certificate of insurance may be issued or may pertain, the insurance afforded by the referenced policy of insurance is subject to all the terms, exclusions and conditions of the policy itself.

(11) A person is entitled to receive notice of cancellation, nonrenewal or any material change or any similar notice concerning a policy of insurance only if the person has such notice rights under the terms of the policy or any endorsement to the policy. The terms and conditions of the notice, including the required timing of the notice, are governed by the policy of insurance or endorsement and may not be altered by a certificate of insurance.

(12) Any certificate of insurance or any other document, record or correspondence prepared, issued or requested in violation of this section shall be null and void and of no force and effect.

(13) Any person that violates this section shall be subject to an administrative penalty imposed by the director in an amount as provided for in section 41-117, Idaho Code, per violation.

(14) The director shall have the power to examine and investigate the activities of any person that the director believes has been or is engaged in an act or practice prohibited by this section. The director shall have the power to enforce the provisions of this section and impose any authorized penalty or remedy against any person that violates this section.

(15) The director may, in accordance with section 41-211, Idaho Code, adopt reasonable rules as are necessary or proper to carry out the provisions of this section.

(16) This section shall not apply to any certificate of insurance prepared and/or issued by an insurer pursuant to any federal law, rule or regulation, or any other law, rule or regulation of this state, in which the specific content and form of said certificate is enumerated therein, or a certificate issued to a person or entity that has purchased coverage under a group master policy.

History:

[41-1850, added 2012, ch. 314, sec. 1, p. 863; am. 2018, ch. 214, sec. 1, p. 483.]
Idaho Code § 41-2139 — Idaho Code / Title 41 / Chapter 21 / Section 41-2139
41-2139 REQUIRED PROVISIONS — COVERAGE OF DEPENDENT CHILD.
Status: in_force

41-2139. Required provisions — Coverage of dependent child. There shall be a provision as follows: a policy delivered or issued for delivery in this state more than one hundred twenty (120) days after the effective date of this act under which coverage of a dependent of an insured terminates at a specified age shall, with respect to an unmarried child who is incapable of self-sustaining employment by reason of intellectual disability or physical disability and who became so incapable prior to attainment of the limiting age and who is chiefly dependent upon such insured for support and maintenance, not so terminate while the policy remains in force and the dependent remains in such condition, if the insured has within thirty-one (31) days of such dependent's attainment of the limiting age submitted proof of such dependent's incapacity as described herein. The insurer may require at reasonable intervals during the two (2) years following the child's attainment of the limiting age subsequent proof of the child's disability and dependency. After the two (2) year period, such subsequent proof may not be required more than once each year.

History:

[41-2139, added 1972, ch. 348, sec. 2, p. 1030; am. 2010, ch. 235, sec. 32, p. 568.]
Idaho Code § 41-6108 — Idaho Code / Title 41 / Chapter 61 / Section 41-6108
41-6108 IDAHO CONTRACTORS IN A HEALTH INSURANCE EXCHANGE.
Status: in_force

41-6108. IDAHO CONTRACTORS IN A HEALTH INSURANCE EXCHANGE. Pursuant to sections 41-6104 and 41-6105, Idaho Code, the board shall, to the fullest extent practicable, enter into contracts with businesses conducting business in Idaho and employing citizens of this state to staff and provide support for the exchange.

History:

[41-6108, added 2013, ch. 170, sec. 1, p. 394.]
Idaho Code § 41-724 — Idaho Code / Title 41 / Chapter 7 / Section 41-724
41-724 “IMPROVED REAL PROPERTY” DEFINED.
Status: in_force

41-724. "Improved real property" defined. For the purpose of section 41-724, Idaho Code, "improved real property" means:

(1) Farmland used for tillage, crop or pasture;

(2) Real estate on which improvements, or improvements under construction or in process of construction, suitable for residence, institutional, commercial or industrial use, are situated; and

(3) Real estate to be developed for the use or uses set forth in subsection (2) of this section on which durable structural improvements, or durable structural improvements under construction or in process of construction, including but not limited to streets, sidewalks, sewers, and utilities which will become an integral part of such development, are situated or abut.

History:

[I.C., sec. 41-724, as added by 1974, ch. 91, sec. 4, p. 1187.]
Idaho Code § 41-1954 — Idaho Code / Title 41 / Chapter 19 / Section 41-1954
41-1954 REPORTING REQUIREMENTS AND PRIVACY.
Status: in_force

41-1954. Reporting Requirements and Privacy. (1) Each life settlement provider shall file with the director, on or before March 1 of each year, an annual statement containing such information on a form prescribed by the director or as prescribed by rule. Such information shall be limited to only those transactions where the owner is a resident of this state.

(2) Except as otherwise allowed or required by law, a life settlement provider, life settlement broker, insurance company, insurance producer, information bureau, rating agency or company, or any other person with actual knowledge of an insured's identity, shall not disclose that identity as an insured, or the insured's financial or medical information to any other person unless the disclosure is:

(a) Necessary to effect a life settlement between the owner and a life settlement provider and the owner and insured have provided prior written consent to the disclosure;

(b) Provided in response to an investigation or examination by the director or any other governmental officer or agency;

(c) A term of or condition to the transfer of a policy by one (1) life settlement provider to another life settlement provider;

(d) Necessary to permit a financing entity, related provider trust or special purpose entity to finance the purchase of policies by a life settlement provider and the owner and insured have provided prior written consent to the disclosure;

(e) Necessary to allow the life settlement provider or life settlement broker or their authorized representatives to make contacts for the purpose of determining health status;

(f) Required to purchase stop loss coverage or financial guaranty insurance; or

(g) Permitted by any other provision of applicable law.

History:

[41-1954, added 2009, ch. 69, sec. 1, p. 197.]
Idaho Code § 41-402 — Idaho Code / Title 41 / Chapter 4 / Section 41-402
41-402 PREMIUM TAX.
Status: in_force

41-402. Premium tax. (1) Each authorized insurer, and each formerly authorized insurer with respect to insurance transacted while an authorized insurer, shall file with the director, on or before the dates in each year set forth in subsections (3) and (4) of this section, a statement (on forms as prescribed and furnished by the director) under oath, for the period set forth in subsections (3) and (4) of this section, and pay the director a tax at the rate set forth in subsection (2) of this section, on the following amounts:

(a) As to life insurers, the amount of all gross premiums received by the insurer on direct risks resident in this state, and also, if a domestic insurer, on direct risks resident in any other jurisdiction or jurisdictions in which the insurer is not licensed and upon which no premium tax is otherwise paid or payable, less returned coupons and dividends paid to or credited to policyholders.

(b) As to all insurers other than life insurers, the amount of gross direct premiums written on policies covering subjects of insurance resident, located or performed in this state, and also, if a domestic insurer, on such premiums in any other jurisdiction or jurisdictions in which the insurer is not licensed and upon which no premium tax is otherwise paid or payable, less returned premiums, premiums on policies not taken and dividends paid or credited to policyholders. As to title insurance, "gross premium" means the insurance risk portion of the amount charged for title insurance.

(2) Subject to section 41-403, Idaho Code, as that section applies through calendar year 2009, the rate of tax shall be as follows:

(a) As to title insurance, the rate of tax shall be one and five-tenths percent (1.5%).

(b) As to all other kinds of insurance, the rate of tax shall be:

(i) For calendar year 2004 and before, two and seventy-five hundredths percent (2.75%);

(ii) For calendar year 2005, two and five-tenths percent (2.5%);

(iii) For calendar year 2006, two and three-tenths percent (2.3%);

(iv) For calendar year 2007, two and one-tenth percent (2.1%);

(v) For calendar year 2008, one and nine-tenths percent (1.9%);

(vi) For calendar year 2009, one and seven-tenths percent (1.7%); and

(vii) For calendar year 2010 and thereafter, one and five-tenths percent (1.5%).

(3) (a) Every insurer with a tax obligation under this section shall make prepayment of the tax obligations for the current calendar year's business if the sum of the tax obligations for the preceding calendar year's business is four hundred dollars ($400) or more.

(b) The director shall credit the prepayments toward the appropriate tax obligations of the insurer for the current calendar year.

(c) The minimum amounts of the prepayments shall be percentages of the insurer's tax obligation based on the preceding calendar year's business and the current year's rate and shall be paid to the director's office by the due dates and in the following amounts:

(i) On or before June 15, sixty percent (60%);

(ii) On or before September 15, twenty percent (20%); and

(iii) On or before December 15, fifteen percent (15%).

(4) On or before March 1, any balance of tax due for the preceding calendar year shall be paid to the director.

(5) The effect of transferring policies of insurance from one insurer to another insurer is to transfer the tax prepayment obligation with respect to the policies.

(6) This section shall not apply as to any reciprocal insurer doing exclusively a worker's compensation business and complying with the provisions of the worker's compensation law of this state and writing worker's compensation only for members under that law, if its representatives or agents or the attorney in fact executing such contracts are not compensated on a commission basis.

(7) This section shall not apply as to life insurance policies issued under pension plans or profit-sharing plans exempt or qualified under section 401(a), 403, 404, 408 or 501(a) of the Internal Revenue Code, as hereafter amended or renumbered from time to time, nor to annuity contracts in general.

(8) This section shall not apply to any reciprocal insurer that exclusively insures members who are governmental entities, as defined by section 6-902(1), (2) and (3), Idaho Code.

(9) Except as otherwise provided in this subsection, this section shall not apply as to any dental care services or as to any dental insurance authorized by title 41, Idaho Code. A tax is hereby imposed upon each contract for dental care services and dental insurance at the rate of four cents (4¢) per contract, per month, such amount to be computed each month. Tax payments shall be made consistent with the documentation requirements and payment dates set forth in this section. The tax imposed in this subsection shall be in lieu of the premium tax provided in this section and in lieu of all other taxes, licenses and fees as provided by section 41-405, Idaho Code; provided however, that this subsection shall not apply to entities governed by chapter 34, title 41, Idaho Code.

(10) The amount of tax due for the current year shall be paid in full in the manner and at the times required in this section without any credit or offset for refunds or other amounts due or claimed to be due by the insurer.

(11) An insurer shall round to the nearest whole dollar any amount shown or required to be shown on any return, form, statement, or other document submitted to the director. Any record or other document prepared or maintained by the director shall express any dollar amount rounded to the nearest whole dollar.

History:

[41-402, added 1977, ch. 303, sec. 2, p. 849; am. 1979, ch. 318, sec. 1, p. 854; am. 1982, ch. 352, sec. 1, p. 872; am. 1983, ch. 4, sec. 12, p. 12; am. 1987, ch. 340, sec. 1, p. 720; am. 1988, ch. 366, sec. 1, p. 1077; am. 1994, ch. 383, sec. 1, p. 1229; am. 2001, ch. 111, sec. 1, p. 400; am. 2004, ch. 356, sec. 1, p. 1063; am. 2007, ch. 151, sec. 1, p. 461; am. 2019, ch. 45, sec. 1, p. 124.]
Idaho Code § 41-6501 — Idaho Code / Title 41 / Chapter 65 / Section 41-6501
41-6501 “ROUTINE PATIENT CARE COSTS” DEFINED.
Status: in_force

41-6501. "ROUTINE PATIENT CARE costs" defined. "Routine patient care costs" means the costs of any medically necessary health care service for which benefits are provided under a health benefit plan, without regard to whether the enrollee is participating in a clinical trial. Routine patient care costs do not include the cost:

(1) Of an investigational new drug or device that is not approved for any indication by the United States food and drug administration;

(2) Of a service that is not a health care service, regardless of whether the service is required in connection with participation in a clinical trial;

(3) Of a service that is inconsistent with widely accepted and established standards of care for a particular diagnosis;

(4) Associated with managing a clinical trial; or

(5) Of a health care service that is specifically excluded from coverage under a health benefit plan.

History:

[41-6501, added 2019, ch. 192, sec. 1, p. 604.]
Idaho Code § 41-3307 — Idaho Code / Title 41 / Chapter 33 / Section 41-3307
41-3307 BONDS.
Status: in_force

41-3307. Bonds. In any proceeding under this act, the director and his deputies shall be responsible on their official bonds for the faithful performance of their duties. If the court deems it desirable for the protection of the assets, it may at any time require an additional bond from the director or his deputies, and such bonds shall be paid for out of the assets of the insurer as a cost of administration.

History:

[41-3307, added 1981, ch. 249, sec. 2, p. 508.]
Idaho Code § 41-806 — Idaho Code / Title 41 / Chapter 8 / Section 41-806
41-806 ASSIGNMENT OF SECURITIES.
Status: in_force

41-806. Assignment of securities. (1) The insurer shall duly assign to the director and his successors in office in trust all securities being deposited through him under this code which are not negotiable by delivery; or, in lieu of such assignment, the insurer may give the director an irrevocable power of attorney authorizing him to transfer the securities or any part thereof for any purpose within the scope of this chapter.

(2) Upon release to the insurer, or other person entitled thereto, of any such security the director shall reassign the same to such insurer or person; or, in the case of power of attorney given pursuant to subsection (1) above, he shall deliver the power of attorney, together with the securities covered thereby, to the insurer or person entitled thereto.

History:

[41-806, added 1961, ch. 330, sec. 175, p. 645.]
Idaho Code § 41-4316 — Idaho Code / Title 41 / Chapter 43 / Section 41-4316
41-4316 TAX EXEMPTIONS.
Status: in_force

41-4316. tax exemptions. The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property.

History:

[41-4316, added 2011, ch. 196, sec. 2, p. 577.]
Idaho Code § 41-287 — Idaho Code / Title 41 / Chapter 2 / Section 41-287
41-287 APPLICATION OF PROVISIONS ADOPTED BY NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS.
Status: in_force

41-287. Application of provisions adopted by national association of insurance commissioners. The department may not require an insurer to comply with any rule, regulation, directive or standard adopted by the national association of insurance commissioners unless application of the rule, regulation, directive or standard, including policy reserves, is authorized by statute and implemented by the director pursuant to chapter 52, title 67, Idaho Code. This section shall not expand or restrict the general powers and authority of the director as set forth in section 41-210, Idaho Code.

History:

[(41-287) 41-286, added 1994, ch. 322, sec. 1, p. 1037; am. and redesig. 2005, ch. 25, sec. 95, p. 120.]
Idaho Code § 41-705 — Idaho Code / Title 41 / Chapter 7 / Section 41-705
41-705 RECORD OF INVESTMENTS.
Status: in_force

41-705. Record of investments. (1) The insurer shall make a written record in permanent form showing the authorization as to each investment or loan of its funds, which record shall be signed by an officer of the insurer or by the chairman of the committee authorizing or approving the investment or loan.

(2) As to each such investment or loan, the insurer's record shall contain:

(a) In the case of loans: The name of the borrower; the location of the property; a physical description and the appraised value of the security; the amount of the loan, rate of interest and terms of repayment.

(b) In the case of securities: The name of the obligor; a description of the security; the amount invested, the rate of interest or dividend, the maturity and yield based upon the purchase price.

(c) In the case of real estate: The location and legal description of the property; a physical description and the appraised value; the purchase price and terms.

(d) In the case of all investments:

(i) The amount of expenses and commissions directly incurred on account of any investment or loan and by whom and to whom payable if not covered by contracts with mortgage loan representatives or correspondents which are part of the insurer's records.

(ii) The name of any officer or director of the insurer with an interest in the investment and the nature of the interest. For purposes of this subparagraph, an officer or a director of an insurer has an interest in an investment if:

1. The insurer acquires or sells the investment directly or indirectly from or to the officer or director; or

2. The officer or director holds a direct, an indirect, or a contingent interest in the securities or loan representing the investment or in the assets of the person in whose behalf the investment or loan is made.

This paragraph shall not apply to an investment by an officer or a director in common stock, preferred stock, or bonds of a United States publicly traded corporation if the director or officer's interest in such publicly traded corporation constitutes less than one percent (1%) of the corporation's total outstanding stock or bonds, in exchange-traded common stock funds or bond funds if listed on a United States regulated exchange, or in mutual funds registered with the securities and exchange commission.

History:

[41-705, added 1961, ch. 330, sec. 142, p. 645; am. 1983, ch. 189, sec. 1, p. 510; am. 2019, ch. 112, sec. 1, p. 369.]
Idaho Code § 41-1208 — Idaho Code / Title 41 / Chapter 12 / Section 41-1208
41-1208 DEFENSE OF ACTION BY UNAUTHORIZED INSURER.
Status: in_force

41-1208. Defense of action by unauthorized insurer. (1) Before any unauthorized foreign or alien insurer shall file or cause to be filed any pleading in any action, suit or proceeding instituted against it, such unauthorized insurer shall:

(a) Deposit with the clerk of the court in which such action, suit or proceeding is pending, cash or securities, or file with such clerk a bond with good and sufficient sureties, to be approved by the court, in an amount determined by the court to be sufficient to secure the payment of any final judgment which may be rendered in such action, provided, however, that the court may in its discretion make an order dispensing with such deposit or bond where the insurer makes a showing satisfactory to such court that it maintains in a state of the United States funds or securities, in trust or otherwise, sufficient and available to satisfy any final judgment which may be entered in such action, suit or proceeding, and that such insurer will pay any final judgment rendered without requiring suit to be brought on such judgment in the state where such securities are located, or

(b) Procure a certificate of authority to transact the business of insurance in this state.

(2) In any action, suit or proceeding in which service is made in the manner provided in section 41-1207, the court may, in its discretion, order such postponement as may be necessary to afford the defendant reasonable opportunity to comply with the provisions of subsection (1) of this section and to defend such action.

(3) Nothing in subsection (1) of this section is to be construed to prevent an unauthorized foreign or alien insurer from filing a motion, in accordance with the applicable rules of civil procedure, to quash a writ or to set aside service thereof made in the manner provided in section 41-1207, hereof on the ground either:

(a) That such unauthorized insurer has not done any of the acts enumerated in section 41-1206, or

(b) That the person on whom service was made pursuant to subsection (2) of section 41-1207 was not doing any of the acts therein enumerated.

History:

[41-1208, added 1961, ch. 330, sec. 252, p. 645.]
Idaho Code § 41-1603 — Idaho Code / Title 41 / Chapter 16 / Section 41-1603
41-1603 RATE-MAKING FACTORS.
Status: in_force

41-1603. Rate-making factors. All rates shall be made in accordance with the following provisions:

(1) Due consideration shall be given to past and prospective loss experience within and outside this state, to catastrophe hazards, if any, to a reasonable margin for underwriting profit and contingencies, to dividends, savings or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members or subscribers, to past and prospective expenses both countrywide and those specially applicable to this state, and to all other relevant factors within and outside this state;

(2) The systems of expense provisions included in the rates for use by any insurer or group of insurers may differ from those of other insurers or groups of insurers to reflect the requirements of the operating methods of any such insurer or group with respect to any kind of insurance, or with respect to any subdivision or combination thereof for which subdivision or combination separate expense provisions are applicable;

(3) Risks may be grouped by classifications for the establishment of rates and minimum premiums. Classification rates may be modified to produce rates on individual risks in accordance with rating plans which establish standards for measuring variations in hazards or expense provisions, or both. Such standards may measure any differences among risks that can be demonstrated to have a probable effect upon losses or expenses.

History:

[41-1603, added 1961, ch. 330, sec. 364, p. 645.]
Idaho Code § 41-5507 — Idaho Code / Title 41 / Chapter 55 / Section 41-5507
41-5507 PREMIUM RATES FOR HIGH RISK POOL PLAN COVERAGE.
Status: in_force

41-5507. Premium rates for high risk pool plan coverage. (1) For high risk pool plans issued prior to April 1, 2017, the board shall establish premium rates for coverage under the individual basic, standard, catastrophic A, catastrophic B, and HSA compatible high risk pool plans.

(2) Separate schedules of premium rates based on age, individual tobacco use, geography as defined by rule of the director, gender and benefit plan design shall apply for individual risks.

(3) The board, with the assistance of the director and in accordance with appropriate actuarial principles, shall determine a standard risk rate by using the average rates that individual standard risks in this state are charged by at least five (5) of the largest health insurance carriers providing individual health insurance coverage to residents of Idaho that is substantially similar to the coverage offered by each high risk pool plan. In determining the average rate or charges of those health insurance carriers, the rates charged by those carriers shall be actuarially adjusted to determine the rate that would have been charged for benefits similar to those provided by each plan. The standard risk rates shall be established using reasonable actuarial techniques and shall reflect anticipated claims experience, expenses, and other appropriate risk factors for such coverage.

(4) Rates for plan coverage shall not be less than one hundred twenty-five percent (125%) nor more than one hundred fifty percent (150%) of rates established as applicable for individual standard risks pursuant to subsection (3) of this section.

(5) Carriers shall not issue high risk pool plans as defined in section 41-5501(9), Idaho Code, after April 1, 2017.

History:

[41-5507, added 2000, ch. 472, sec. 17, p. 1638; am. 2005, ch. 353, sec. 6, p. 1119; am. 2017, ch. 281, sec. 6, p. 738.]
Idaho Code § 41-298 — Idaho Code / Title 41 / Chapter 2 / Section 41-298
41-298 JURISDICTION — CONSTRUCTION OF PROVISIONS.
Status: in_force

41-298. Jurisdiction — Construction of provisions. (1) The provisions of this chapter shall not be construed to affect or repeal any ordinance of any municipality relating to fire prevention or the control of arson or fraud, but the jurisdiction of the state fire marshal, the director, department of insurance, and the director, Idaho state police, in such municipality is to be concurrent with that of the municipal and county authorities.

(2) With the exception of section 41-291(7), Idaho Code, all other provisions of this chapter shall not be construed to impair any existing statutory or common law rights or powers.

History:

[(41-298) 1982, ch. 120, sec. 19, p. 347; am. and redesig. 1994, ch. 219, sec. 10, p. 702; am. 2000, ch. 469, sec. 105, p. 1558.]
Idaho Code § 41-4912 — Idaho Code / Title 41 / Chapter 49 / Section 41-4912
41-4912 STORAGE TANKS ELIGIBLE FOR INSURANCE.
Status: in_force

41-4912. Storage tanks eligible for insurance. (1) Eligible storage tanks are those tanks that meet all of the following criteria:

(a) Appropriate fees required in section 41-4909, Idaho Code, or section 41-4911A, Idaho Code, have been paid;

(b) The tank, if an underground storage tank, is in compliance with applicable federal and state underground storage tank rules and regulations;

(c) The tank is used only for storage of petroleum products;

(d) The tank, if an underground storage tank, passes a tank tightness test;

(e) The tank, if an aboveground storage tank, is in compliance with state and federal rules and regulations including the international fire code. If an aboveground tank is exempt from state or federal rules and regulations and/or the international fire code by virtue of its being installed prior to the effective date of such rules and regulations or the international fire code, such tank is not eligible unless it passes a tank tightness test;

(f) The tank, if a farm tank or residential tank, is in compliance with any applicable state or federal rules and regulations;

(g) Any contamination caused by or released by or from the tank has been cleaned up, or a plan for cleanup or removal approved by the Idaho department of environmental quality, is being implemented; provided, however, that the trust fund shall not pay for any costs associated with prior contamination.

(2) Any tank which is a part of a refiner's terminal or a tank directly supplied by a pipeline shall not be eligible.

History:

[(41-4912) 41-4911, added 1990, ch. 119, sec. 1, p. 277; am. 1991, ch. 59, sec. 9, p. 127; am. 1996, ch. 425, sec. 1, p. 1452; am. 2001, ch. 103, sec. 77, p. 317; am. 2002, ch. 86, sec. 10, p. 203; am. & redesig. 2003, ch. 96, sec. 13, p. 296.]
Idaho Code § 41-1818 — Idaho Code / Title 41 / Chapter 18 / Section 41-1818
41-1818 CHARTER AND BY-LAW PROVISIONS.
Status: in_force

41-1818. Charter and by-law provisions. No policy shall contain any provision purporting to make any portion of the charter, by-laws or other constituent document of the insurer (other than the subscriber's agreement or power of attorney of a reciprocal insurer) a part of the contract unless such portion is set forth in full in the policy. Any policy provision in violation of this section shall be invalid.

History:

[41-1818, added 1961, ch. 330, sec. 410, p. 645.]
Idaho Code § 41-3351 — Idaho Code / Title 41 / Chapter 33 / Section 41-3351
41-3351 LIQUIDATION OF PROPERTY OF FOREIGN OR ALIEN INSURERS FOUND IN THIS STATE.
Status: in_force

41-3351. Liquidation of property of foreign or alien insurers found in this state. (1) If no domiciliary receiver has been appointed, the director may apply to the district court by verified petition for an order directing him to liquidate the assets found in this state of a foreign insurer or an alien insurer not domiciled in this state, on any of the following grounds:

(a) Any of the grounds in sections 41-3312 or 41-3317, Idaho Code; or

(b) Any of the grounds specified in sections 41-3350(1)(b) through (d), Idaho Code.

(2) When an order is sought under subsection (1) of this section, the court shall cause the insurer to be given such notice and time to respond thereto as is reasonable under the circumstances.

(3) If it shall appear to the court that the best interests of creditors, policyholders, and the public require, the court may issue an order to liquidate in whatever terms it shall deem appropriate. The filing or recording of the order with the clerk of the district court or the recorder of deeds of the county in which the principal business of the company is located or the county in which its principal office or place of business is located, shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted.

(4) If a domiciliary liquidator is appointed in a reciprocal state while a liquidation is proceeding under the provisions of this section, the liquidator, under the provisions of this section, shall thereafter act as ancillary receiver under section 41-3353, Idaho Code. If a domiciliary liquidator is appointed in a nonreciprocal state while a liquidation is proceeding under the provisions of this section, the liquidator, under the provisions of this section, may petition the court for permission to act as ancillary receiver under section 41-3353, Idaho Code.

(5) On the same grounds as are specified in subsection (1) of this section, the director may petition any appropriate federal district court to be appointed receiver to liquidate that portion of the insurer's assets and business over which the court will exercise jurisdiction, or any lesser part thereof that the director deems desirable for the protection of the policyholders and creditors in this state.

(6) The court may order the director, when he has liquidated the assets of a foreign or alien insurer under this section, to pay claims of residents of this state against the insurer under such rules as to the liquidation of insurers under this act as are otherwise compatible with the provisions of this section.

History:

[41-3351, added 1981, ch. 249, sec. 2, p. 536.]
Idaho Code § 41-3416 — Idaho Code / Title 41 / Chapter 34 / Section 41-3416
41-3416 HOSPITAL SERVICE AGREEMENTS.
Status: in_force

41-3416. Hospital service agreements. (1) A hospital service corporation shall enter into service agreements with only hospitals duly approved or licensed by the state of Idaho.

(2) Each such service agreement shall require the participant hospital to furnish to subscribers of the service corporation the hospital services which are, under the subscriber's contract, to be furnished by participant hospitals; and this obligation so to furnish such service, as provided for in the subscriber's contract, shall be a direct obligation of the participant hospitals to the subscribers as well as to the service corporation.

(3) Each such service agreement shall further effectively in substance provide that:

(a) The participant hospital shall be compensated for services rendered to a subscriber in accordance with a schedule of charges contained in the agreement or attached to and made a part of the agreement, and that the hospital shall not request or receive from the service corporation any compensation for such services which is not in accord with such schedule.

(b) Compensation for services may be prorated and settled under the circumstances and in the manner referred to in section 41-3431.

(c) If the participant hospital withdraws from the agreement, such withdrawal shall not be effective as to any subscriber's contract in force on the date of such withdrawal until the termination of the subscriber's contract or the next following anniversary of the subscriber's contract, whichever date is the earlier.

(4) The service corporation shall terminate the service agreement as to a particular participant hospital, in addition to other bases of termination provided for in the agreement, if it is determined that the hospital has knowingly charged or attempted to charge the service corporation for any service not actually rendered, or has knowingly violated any material provision of the service agreement.

(5) The proposed form of any such service agreement and of any standard riders and endorsements thereto shall be filed with the director and be subject to his approval, as provided in section 41-3419.

History:

[41-3416, added 1961, ch. 330, sec. 774, p. 645.]
Idaho Code § 41-2846 — Idaho Code / Title 41 / Chapter 28 / Section 41-2846
41-2846 CONTINGENT LIABILITY OF MUTUAL MEMBERS.
Status: in_force

41-2846. Contingent liability of mutual members. (1) Except as provided otherwise in section 41-2849 with respect to nonassessable policies, each member of a domestic mutual insurer shall have a contingent liability, pro rata and not one for another, for the discharge of its obligations, which contingent liability shall be in such maximum amount as is specified in the insurer's articles of incorporation consistent with section 41-2804(3)(a)(v).

(2) Every policy issued by the insurer shall contain a statement of the contingent liability.

(3) Termination of the policy of any such member shall not relieve the member of contingent liability for his proportion of the obligations of the insurer which accrued while the policy was in force as provided in section 41-2847.

(4) Unrealized contingent liability of members does not constitute an asset of the insurer in any determination of its financial condition.

History:

[41-2846, added 1961, ch. 330, sec. 614, p. 645.]
Idaho Code § 41-4202 — Idaho Code / Title 41 / Chapter 42 / Section 41-4202
41-4202 DEFINITIONS.
Status: in_force

41-4202. Definitions. (1) "Form" includes but is not limited to policies, contracts, certificates, riders, endorsements, and applications as provided in sections 41-1812, 41-3419 and 41-3915, Idaho Code.

(2) "Disability Insurance" means insurance written under chapter 21, title 41, Idaho Code, supplemental disability insurance written under chapter 22, title 41, Idaho Code, coverages written under chapter 34, title 41, Idaho Code, and coverages written under chapter 39, title 41, Idaho Code. For purposes of this act, nonprofit hospital, medical and dental service associations, and managed care organizations shall be deemed to be engaged in the business of insurance.

(3) "Policy" means the entire contract between the insurer and the insured, including the policy, certificates, riders, endorsements, and the application, if attached, and also includes nongroup subscriber contracts issued by nonprofit hospital, medical and dental service associations, and nongroup subscriber contracts issued by managed care organizations.

History:

[41-4202, added 1975, ch. 205, sec. 2, p. 569; am. 2009, ch. 66, sec. 2, p. 187.]
Idaho Code § 41-1101 — Idaho Code / Title 41 / Chapter 11 / Section 41-1101
41-1101 SCOPE OF CHAPTER.
Status: in_force

41-1101. Scope of chapter. This chapter applies only as to adjusters, as defined in section 41-1102.

History:

[41-1101, added 1961, ch. 330, sec. 237, p. 645.]
Idaho Code § 41-4804 — Idaho Code / Title 41 / Chapter 48 / Section 41-4804
41-4804 RISK RETENTION GROUPS CHARTERED IN THIS STATE.
Status: in_force

41-4804. Risk retention groups chartered in this state. (1) A risk retention group seeking to be chartered in this state must be chartered and licensed as a liability insurance company authorized by the insurance laws of this state and, except as provided elsewhere in this chapter, must comply with:

(a) All of the laws, rules, regulations and requirements applicable to such insurers chartered and licensed in this state;

(b) Section 41-4805, Idaho Code, to the extent such requirements are not a limitation on laws, rules, regulations or requirements of this state.

(2) Before it may offer insurance in any state, each risk retention group shall also submit for approval to the director of this state a plan of operation or feasibility study and revisions of such plan or study if the group intends to offer any additional lines of liability insurance. Immediately upon receipt of an application for charter, this state shall provide:

(a) Summary information concerning the filing to the national association of insurance commissioners, including the name of the risk retention group, the identity of the initial members of the group, the identity of those individuals who organized the group or who will provide administrative services or otherwise influence or control the activities of the group;

(b) The amount and nature of initial capitalization;

(c) The coverages to be afforded; and

(d) The states in which the group intends to operate.

Providing notification to the national association of insurance commissioners is in addition to and shall not be sufficient to satisfy the requirements of section 41-4805, Idaho Code, or any other sections of this chapter.

History:

[41-4804, added 1987, ch. 140, sec. 1, p. 277.]
Idaho Code § 41-723 — Idaho Code / Title 41 / Chapter 7 / Section 41-723
41-723 APPRAISAL — LIMIT OF AMOUNT LOANED.
Status: in_force

41-723. Appraisal — Limit of amount loaned. (1) The fair value of property shall be determined by appraisal by a competent independent appraiser at the time of the making or acquisition of a mortgage loan or investing in a contract for the deed thereon; except, that as to bonds or notes secured by mortgage or trust deed guaranteed or insured by the federal housing administration, or guaranteed or insured as to principal in full or in part by the administrator of veterans affairs, or guaranteed or insured by the farmers home administration, the valuation made by such administration or administrator shall be deemed to have been made by a competent appraiser for the purposes of this subsection.

(2) An insurer shall not make or acquire a loan or loans upon the security of any one (1) parcel of real property in aggregate amount in excess of ten thousand dollars ($10,000) or more than the amount permissible under section 41-706(1), Idaho Code, (investment in securities, etc., of any one person), whichever is the greater.

History:

[41-723, added 1961, ch. 330, sec. 160, p. 645; am. 2003, ch. 219, sec. 4, p. 569.]
Idaho Code § 41-2510 — Idaho Code / Title 41 / Chapter 25 / Section 41-2510
41-2510 EXCLUSION AND CANCELLATION OF DESIGNATED INDIVIDUALS.
Status: in_force

41-2510. Exclusion and cancellation of designated individuals. Except as respects the legal liability of the named insured, the insurer shall have the right to exclude, cancel or refuse to renew coverage under an automobile insurance policy as to designated individuals. Any such cancellation or refusal to renew shall be acknowledged by the signature of the named insured, and shall be subject to the applicable provisions of sections 41-2506 through 41-2512 of this act as for cancellation or refusal to renew the policy.

History:

[I.C., sec. 41-2510, as added by 1969, ch. 214, sec. 63, p. 625.]
Idaho Code § 41-6301 — Idaho Code / Title 41 / Chapter 63 / Section 41-6301
41-6301 PURPOSE AND SCOPE.
Status: in_force

41-6301. purpose and scope. (1) The purpose of this chapter is to provide the requirements for maintaining a risk management framework and completing an own risk and solvency assessment (ORSA) and provide guidance and instructions for filing an ORSA summary report with the director of the state department of insurance.

(2) The requirements of this chapter shall apply to all insurers domiciled in this state unless exempt pursuant to section 41-6306, Idaho Code.

(3) The legislature finds and declares that the ORSA summary report will contain confidential and sensitive information related to an insurer's or an insurance group's identification of risks material and relevant to the insurer or insurance group filing the report. This information will include proprietary and trade secret information that has the potential for harm and competitive disadvantage to the insurer or insurance group if the information is made public. It is the intent of the legislature that the ORSA summary report shall be a confidential document filed with the director, that the ORSA summary report will be shared only as stated herein and to assist in the performance of the director's duties, and that in no event shall the ORSA summary report be subject to public disclosure.

History:

[41-6301, added 2017, ch. 75, sec. 1, p. 188.]
Idaho Code § 41-3940 — Idaho Code / Title 41 / Chapter 39 / Section 41-3940
41-3940 PREEXISTING CONDITIONS.
Status: in_force

41-3940. Preexisting conditions. A general managed care plan shall comply with the following provisions:

(1) A general managed care plan shall not deny, exclude or limit benefits for a covered individual for covered expenses incurred more than twelve (12) months following the effective date of the individual's coverage due to a preexisting condition. A general managed care plan shall not define a preexisting condition more restrictively than a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received during the six (6) months immediately preceding the effective date of coverage.

(2) Genetic information shall not be considered as a condition described in subsection (1) of this section in the absence of a diagnosis of the condition related to such information.

(3) A managed care organization that does not use preexisting condition limitations in any of its general managed care plans may impose an affiliation period. "Affiliation period" means a period of time not to exceed sixty (60) days for new entrants and not to exceed ninety (90) days for late enrollees during which no premiums shall be collected and coverage issued shall not become effective. Such period shall begin on the enrollment date. This subsection does not preclude application of any waiting period applicable to all new enrollees under the general managed care plan, provided that any carrier-imposed waiting period is no longer than sixty (60) days and is used in lieu of a preexisting condition exclusion. An affiliation period under a plan shall run concurrently with any waiting period under the plan.

History:

[41-3940, added 1997, ch. 321, sec. 6, p. 957.]
Idaho Code § 41-292 — Idaho Code / Title 41 / Chapter 2 / Section 41-292
41-292 DISCLOSURE OF INFORMATION BY INSURERS.
Status: in_force

41-292. Disclosure of information by insurers. (1) The director of the department of insurance, state fire marshal or any authorized agency may, in writing, require the insurance company at interest to release to the requesting agency any or all relevant information or evidence deemed important to the authorized agency, director or state fire marshal which the company may have in its possession, relating to the loss in question. Relevant information may include, without limitation herein:

(a) Pertinent insurance policy information relevant to a loss under investigation and any application for such a policy;

(b) Policy premium payment records which are available;

(c) History of previous claims made by the insured;

(d) Material relating to the investigation of the loss, including statements of any person, proof of loss, and any other evidence relevant to the investigation.

(2) (a) When an insurance company has facts to support a belief that a loss in which it has an interest may be of other than accidental cause, then, for the purpose of notification and for having such loss investigated, the company shall, in writing, notify the director of the department of insurance, or the state fire marshal, and provide any or all material developed from the company's inquiry into the loss.

(b) When an insurance company provides the director of the department of insurance or the state fire marshal with notice of a loss, it shall be sufficient notice for the purpose of this chapter.

(c) Nothing in section 41-292(1), Idaho Code, shall abrogate or impair the rights or powers created under section 41-292(2), Idaho Code.

(3) The director of the department of insurance, the state fire marshal or an authorized agency provided with information pursuant to section 41-248, 41-258, 41-290 or 41-292(1) or (2), Idaho Code, and in furtherance of its own purposes, may release or provide such information to any of the other authorized agencies.

(4) Any insurance company providing information to an authorized agency or agencies pursuant to section 41-258, 41-290 or 41-292(1) or (2), Idaho Code, shall have the right to request relevant information relative to the loss in question and to receive, within a reasonable time, not to exceed thirty (30) days, the information requested, if the information is not otherwise privileged by law.

(5) In the absence of fraud or malice, no person shall be subject to civil liability for libel, slander or any other relevant tort cause of action by virtue of filing reports or furnishing other information required by this chapter or required by the director of the department of insurance under the authority granted in this chapter, and no civil cause of action of any nature shall arise against such person:

(a) For any information relating to suspected fraudulent insurance acts furnished to or received from authorized agencies, their agents and employees; or

(b) For any information relating to suspected fraudulent insurance acts furnished to or received from other persons subject to the provisions of this chapter; or

(c) For any such information furnished in reports to the department of insurance, national association of insurance commissioners, national insurance crime bureau or any organization established to detect and prevent fraudulent insurance acts, their agents, employees or designees, nor shall the director or any employee of the department of insurance, acting without malice in the absence of fraud, be subject to civil liability for libel, slander or any other relevant tort and no civil cause of action of any nature shall arise against such person by virtue of the publication of any report or bulletin related to the official activities of the department of insurance. Nothing herein is intended to abrogate or modify in any way any common law or statutory privilege or immunity heretofore enjoyed by any person.

(6) For purposes of subsection (5) of this section, there shall exist a rebuttable presumption that the person has acted without fraud or malice.

History:

[(41-292) 1982, ch. 120, sec. 19, p. 346; am. and redesig. 1994, ch. 219, sec. 4, p. 698; am. 2005, ch. 74, sec. 2, p. 252.]
Idaho Code § 41-3422 — Idaho Code / Title 41 / Chapter 34 / Section 41-3422
41-3422 SURPLUS FUND.
Status: in_force

41-3422. Surplus fund. (1) Every service corporation shall set aside into a "surplus fund" an amount of money equal to not less than two per cent (2%) of all sums hereafter received by it on account of subscriber's contracts, until such surplus fund amounts to not less than fifty thousand dollars ($50,000) if a professional service corporation or hospital service corporation or one hundred thousand dollars ($100,000) if a combination professional-hospital service corporation.

(2) After such minimum surplus fund is established the service corporation may in like manner increase it to an amount not to exceed the total gross collections from subscribers during the seven (7) months next preceding.

(3) That portion of the surplus fund referred to in subsection (1) above, may be used by the service corporation, by express appropriation therefrom by action of its board of directors, solely if necessary to pay the additional health care costs and expenses under its contracts, resulting from disease, epidemic or catastrophic occurrences in which numerous persons were injured in the same such occurrence.

(4) If at any time depleted below the minimum amount required under subsection (1) above, the service corporation shall replenish the fund by a resumption or continuance of allocations thereto from subscribers' payments, as provided for original accumulation of the fund under subsection (1), or by such other reasonable means as may be approved by the director.

History:

[41-3422, added 1961, ch. 330, sec. 780, p. 645; am. 1967, ch. 399, sec. 13, p. 1194; am. 1971, ch. 252, sec. 13, p. 1008.]
Idaho Code § 41-730 — Idaho Code / Title 41 / Chapter 7 / Section 41-730
41-730 DISPOSAL OF INELIGIBLE PROPERTY AND SECURITIES.
Status: in_force

41-730. Disposal of ineligible property and securities. (1) Any personal property or securities lawfully acquired by an insurer which it could not otherwise have invested in or loaned its funds upon at the time of such acquisition, shall be disposed of by the insurer within one (1) year from date of acquisition, unless within such period the security has attained to the standard for eligibility. The director, upon application and proof that forced sale of any such property or security would be against the best interests of the insurer, may extend the disposal period for an additional reasonable time.

(2) While any such property or security remains so ineligible it shall not be allowed as an asset of the insurer.

(3) Any ineligible property or security unlawfully acquired by an insurer shall be disposed of forthwith, and for failure so to do within thirty (30) days after order of the director requiring such disposal, the director may suspend or revoke the insurer's certificate of authority.

(4) For the purposes of subsection (3) above, an investment otherwise eligible shall not be deemed ineligible for the reason that it is in excess of the amount permitted under this chapter to be invested in the category of investments to which it belongs; and any such excess investment shall be disposed of within the time prescribed in subsection (1) of this section.

History:

[41-730, added 1961, ch. 330, sec. 167, p. 645.]