reglab/housing_qa huggingface dataset:
ID Code § 41-3823 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS|Section 41-3823 - JUDICIAL REVIEW — MANDAMUS.

41-3823. JUDICIAL REVIEW — MANDAMUS. (1) Any person aggrieved by any act, determination, rule or order or any other action of the director pursuant to this chapter may appeal to the fourth judicial district court for Ada county, Idaho. The court shall conduct its review in accordance with the provisions of chapter 52, title 67, Idaho Code, or other applicable provisions of law. (2) The filing of an appeal pursuant to this section shall stay the application of any rule, order or other action of the director to the party pursuing such appeal, unless the court, after providing the party with notice and the opportunity for a hearing, determines that a stay would be detrimental to the interest of policyholders, shareholders, creditors or the public. (3) Any person aggrieved by any failure of the director to act or make a determination required by this chapter may petition the fourth judicial district court for Ada county for a writ in the nature of a mandamus or a peremptory mandamus directing the director to act or make a determination.  History: [41-3823, added 2013, ch. 266, sec. 2, p. 675.]
ID Code § 41-3825 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 38 - ACQUISITIONS OF CONTROL AND INSURANCE HOLDING COMPANY SYSTEMS|Section 41-3825 - SEVERABILITY.

41-3825. SEVERABILITY. The provisions of this chapter are hereby declared to be severable and if any provision of this chapter or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the remaining portions of this chapter.  History: [41-3825, added 2013, ch. 266, sec. 2, p. 679.]
ID Code § 41-3901 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3901 - SHORT TITLE.

41-3901. SHORT TITLE. This chapter may be cited as the Idaho "Managed Care Reform Act."  History: [41-3901, added 1974, ch. 177, sec. 1, p. 1444; am. 1997, ch. 204, sec. 2, p. 582.]
ID Code § 41-3902 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3902 - INTENT AND PURPOSE.

41-3902. INTENT AND PURPOSE. As a guide to the interpretation and application of this chapter, the public policy of this state is declared as follows: The legislature wishes to eliminate legal barriers to the establishment of managed care plans which provide readily available, accessible and quality health care to their members and to encourage their development as an optional method of health care delivery. The state of Idaho must have reasonable assurance that organizations offering managed care plans within this state are financially and administratively sound and responsive to the needs of their members, and that such organizations are, in fact, able to deliver the benefits which they offer.  History: [41-3902, added 1974, ch. 177, sec. 2, p. 1444; am. 1997, ch. 204, sec. 3, p. 582.]
ID Code § 41-3904 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3904 - CERTIFICATE OF AUTHORITY REQUIRED — EXCEPTIONS — APPLICATION OF CERTAIN PROVISIONS.

41-3904. CERTIFICATE OF AUTHORITY REQUIRED — EXCEPTIONS — APPLICATION OF CERTAIN PROVISIONS. (1) No person shall in this state offer a managed care plan on a predetermined and prepaid basis, unless authorized under a certificate of authority issued by the director. A person offering a managed care plan on a predetermined and prepaid basis is deemed to be transacting the business of insurance. (2) An organization proposing to offer a managed care plan on a predetermined and prepaid basis, after it has filed its application for a certificate of authority as provided in section 41-3906, Idaho Code, and while its application is pending, if permitted by and in accordance with rules promulgated by the director, may inform the public concerning its proposed health care services. (3) Entities not offering a managed care plan shall not be subject to the provisions of this chapter. (4) An entity not required to obtain a certificate of authority which holds itself out to the public or markets itself as an organization rendering basic health care services to a specified population through a managed care plan shall be subject to and must comply with the following sections of this chapter but shall not be subject to regulation by the department: 41-3902; 41-3903; 41-3904; 41-3909(1) and (2); 41-3914(1) and (2); 41-3915(1), (2), (3), (4), (5), (6) and (8); 41-3916; 41-3917; 41-3918(1), (2) and (4); 41-3919(1) and (2); 41-3920; 41-3921(2), (3) and (4); 41-3922(2); 41-3926; 41-3927; 41-3928; 41-3930 and 41-3932, Idaho Code.  History: [41-3904, added 1974, ch. 177, sec. 4, p. 1444; am. 1997, ch. 204, sec. 6, p. 584; am. 2003, ch. 304, sec. 14, p. 839.]
ID Code § 41-3909 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3909 - RECORDS.

41-3909. RECORDS. (1) Every managed care organization shall establish and at all times maintain adequate records of its financial and business transactions. (2) The managed care organization shall retain its general records with respect to a particular transaction for a period of not less than seven (7) years after termination of the transaction, and health records shall be retained for a period of seven (7) years after the termination of the member’s contract. (3) The managed care organization shall make all records available to the director or his designee for review at all reasonable times upon the director’s request; provided, however, that the availability of health records shall be subject to any Idaho law limiting or defining such availability.  History: [41-3909, added 1974, ch. 177, sec. 9, p. 1444; am. 1997, ch. 204, sec. 10, p. 588.]
ID Code § 41-3910 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3910 - REPORTS TO THE DIRECTOR.

41-3910. REPORTS TO THE DIRECTOR. (1) Every managed care organization offering a managed care plan for which a certificate of authority is required shall annually, on or before the first day of June, file a report with the director showing its audited financial condition on the last day of the preceding December. The report shall be on forms prescribed by the director and shall be verified by an appropriate officer of the organization. (2) Such report shall include: (a) A financial statement of the organization, including its balance sheet and statement of income and expenditures for the preceding year certified by an independent public accountant; (b) Any changes in the information submitted in connection with its application for certificate of authority; (c) Such other information as is available to the managed care organization relating to the operations of the organization as the director may require by rule to enable him to carry out his duties under this chapter.  History: [41-3910, added 1974, ch. 177, sec. 10, p. 1444; am. 1997, ch. 204, sec. 11, p. 589; am. 2008, ch. 203, sec. 2, p. 653.]
ID Code § 41-3911 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3911 - EXAMINATIONS.

41-3911. EXAMINATIONS. (1) The director shall make an examination of the affairs and operations of any organization offering a managed care plan for which a certificate of authority is required as often as he deems necessary but not less frequently than once every five (5) years. (2) Every such organization shall upon the director’s request submit its books and records relating to its affairs and operations to such examination and shall facilitate the examination. (3) Health records of individuals and records of providers providing services under a contract with the managed care organization shall not be subject to such examination, except as provided in section 41-3909(3), Idaho Code. (4) At the direction of the director, the expenses of examination shall be borne by the organization being examined in accordance with section 41-228, Idaho Code.  History: [41-3911, added 1974, ch. 177, sec. 11, p. 1444; am. 1997, ch. 204, sec. 12, p. 589; am. 2001, ch. 85, sec. 11, p. 219.]
ID Code § 41-3912 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3912 - SUSPENSION OR REVOCATION OF CERTIFICATE OF AUTHORITY.

41-3912. SUSPENSION OR REVOCATION OF CERTIFICATE OF AUTHORITY. The director may initiate proceedings to suspend or revoke a certificate of authority to offer a managed care plan for the reasons and in the manner provided in title 41, Idaho Code, for mutual insurers. In addition to any other penalties, the director may impose a penalty upon the managed care organization of up to fifteen thousand dollars ($15,000) for each and every unlawful act committed.  History: [41-3912, added 1997, ch. 204, sec. 14, p. 590.]
ID Code § 41-3914 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3914 - ANNUAL DISCLOSURES.

41-3914. ANNUAL DISCLOSURES. (1) Every managed care organization shall provide to its enrollees and make available for inspection by the general public on an annual basis: (a) an audited statement of financial condition including a balance sheet and a summary of receipts and disbursements; (b) a description of the accessibility and availability of services, including a list of the providers currently participating in the managed care plan and of the providers who are accepting new patients, the addresses of primary care physicians and participating hospitals and the specialty of each physician and category of the other participating providers; (c) a statement as to whether the plan includes a limited formulary of medications, and a statement that the formulary will be made available to any prospective member or member upon request; (d) a clear and understandable description of the managed care organization’s method of resolving member grievances; (e) a description of how the qualifications of participating providers may be obtained; (f) such other information as the director may by rule prescribe. (2) In addition to matters specified in subsection (1) of this section, each managed care organization shall make available for public inspection a description of the benefit package or packages offered to each class of members and their rates. Such information shall be presented in clear, readable, and concise form and shall include, at a minimum, a description of all of the material elements required of health care contracts. (3) A managed care organization for which a certificate of authority is required shall furnish a copy of the information required by this section to the department upon request of the director.  History: [41-3914, added 1974, ch. 177, sec. 14, p. 1444; am. 1978, ch. 360, sec. 1, p. 947; am. 1997, ch. 204, sec. 16, p. 590; am. 2008, ch. 203, sec. 3, p. 653.]
ID Code § 41-3916 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3916 - ADVISORY PANELS.

41-3916. ADVISORY PANELS. Every managed care organization shall establish a mechanism to provide members an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other reasonable mechanisms. As a minimum, such an advisory panel shall be required to review and comment upon any proposed changes to: (a) the managed care plan’s grievance procedures, and (b) nongroup member benefit packages and prepayments, prior to implementation of such policy. The substance of such comments shall be distributed to the affected members at the time notification of such policy changes are made.  History: [41-3916, added 1974, ch. 177, sec. 16, p. 1444; am. 1978, ch. 361, sec. 1, p. 948; am. 1997, ch. 204, sec. 18, p. 593.]
ID Code § 41-3917 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3917 - CERTAIN WORDS PROHIBITED IN NAME OF ORGANIZATION.

41-3917. CERTAIN WORDS PROHIBITED IN NAME OF ORGANIZATION. No person or organization offering a health care plan not qualified as a managed care plan under the provisions of this chapter shall use in its name, logo, contracts or literature the phrase, "health maintenance organization," "managed care organization," "general managed care organization" or "limited managed care organization" or the initials "HMO," "MCO," "GMCO," or "LMCO."  History: [41-3917, added 1974, ch. 177, sec. 17, p. 1444; am. 1997, ch. 204, sec. 19, p. 593.]
ID Code § 41-3918 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3918 - GRIEVANCE SYSTEM.

41-3918. GRIEVANCE SYSTEM. (1) Every managed care organization shall establish a grievance system to resolve grievances initiated by members concerning health care services. The system shall provide reasonable procedures for the resolution of grievances, and shall include an appeals process which affords the member the right to a prompt review by a grievance panel before whom the member has the right either to appear or be heard, or both. A managed care organization offering a managed care plan for which a certificate of authority is required shall have its grievance system approved by the director and shall submit to the director an annual report in a form prescribed by the director which shall include: (a) A description of the procedures of the grievance system; and (b) The total number of grievances handled through the grievance system and a compilation of causes underlying the grievances filed. (2) Every managed care organization shall maintain records of grievances filed with it concerning health care services and each managed care organization for which a certificate of authority is required shall submit to the director a summary report at such times and in such form as the director may require. Grievances involving other persons shall be referred to such persons with a copy to the director. (3) The director may examine a grievance system of a managed care organization for which a certificate of authority is required, subject to the limitations concerning health records of individuals set forth in section 41-3909(3), Idaho Code. (4) Every managed care organization must show evidence that such grievance procedures have been reviewed and approved by the member representatives through their participation on advisory panels or other reasonable mechanisms as set forth in section 41-3916, Idaho Code.  History: [41-3918, added 1974, ch. 177, sec. 18, p. 1444; am. 1997, ch. 204, sec. 20, p. 593; am. 2008, ch. 203, sec. 4, p. 654.]
ID Code § 41-3919 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3919 - OPEN ENROLLMENT.

41-3919. OPEN ENROLLMENT. (1) Requirement of an open enrollment period is intended to provide the benefits of managed care to the general public or to all members of the class of persons the managed care organization serves. Such requirement is not intended to prohibit a managed care organization from establishing administrative procedures that protect the quality of service to its members or the financial condition of the organization. However, during periods of open enrollment the organization shall not establish any administrative procedure that arbitrarily and unreasonably restricts enrollment. (2) After the initial twenty-four (24) months of operation every managed care organization shall have an annual open enrollment period of at least one (1) month during which it accepts members, without restrictions up to the limits of its capacity except as provided in subsection (3) of this section, as determined by the managed care organization, in the order in which they apply for enrollment. Managed care organizations organized to provide services exclusively to a specified group or groups of individuals may limit such open enrollment to all members of such group(s). (3) A managed care organization may apply to the director for authorization to impose underwriting restrictions upon enrollment. The director shall, within thirty (30) days, approve the application if he determines that such restrictions will: (a) Preserve the financial stability of the managed care organization; or (b) Prevent excessive adverse selection of prospective members; or (c) Avoid unreasonably high or unmarketable charges for member coverage for health care services. If the application cannot be approved the director must deny it within the thirty (30) day period.  History: [41-3919, added 1974, ch. 177, sec. 19, p. 1444; am. 1997, ch. 204, sec. 21, p. 594.]
ID Code § 41-3920 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3920 - DISCRIMINATION AGAINST HEALTH PROFESSIONALS ASSOCIATED WITH MANAGED CARE ORGANIZATIONS.

41-3920. DISCRIMINATION AGAINST HEALTH PROFESSIONALS ASSOCIATED WITH MANAGED CARE ORGANIZATIONS. It shall be unlawful for any health service institution or associations of health professionals to exclude other health professionals from working privileges, membership, or association solely on the basis that such other person is employed by or contracts with a managed care organization pursuant to this chapter.  History: [41-3920, added 1974, ch. 177, sec. 20, p. 1444; am. 1997, ch. 204, sec. 22, p. 595.]
ID Code § 41-3921 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3921 - STATUTORY CONSTRUCTION AND RELATIONSHIP TO OTHER LAWS.

41-3921. STATUTORY CONSTRUCTION AND RELATIONSHIP TO OTHER LAWS. (1) Except as stated in this chapter, provisions of title 41, Idaho Code, applicable to disability insurers shall be applicable to the lawful transactions and business of an organization offering a managed care plan for which a certificate of authority is required pursuant to this chapter. (2) With respect to all managed care organizations, the provision of factually accurate information regarding coverage, rates, locations and hours of service, names of affiliated institutions, and credentials of participating providers by the organization or its personnel to potential members shall not constitute a violation of any law relating to solicitation or advertising by health care professionals. (3) Any managed care organization which contracts with a health care facility or enters into arrangements with one (1) or more groups of providers organized on a group practice or individual practice basis shall not by virtue of such contracts or arrangements be deemed to have entered into a "conspiracy in restraint of trade". (4) Except as expressly and specifically stated in this chapter, the provisions of chapter 34, title 41, Idaho Code, are not amended, repealed or otherwise affected by this chapter.  History: [41-3921, added 1974, ch. 177, sec. 21, p. 1444; am. 1988, ch. 265, sec. 573, p. 871; am. 1997, ch. 204, sec. 23, p. 595; am. 2015, ch. 251, sec. 5, p. 1047.]
ID Code § 41-3922 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3922 - TAXATION — PENALTY FOR FAILURE TO FILE.

41-3922. TAXATION — PENALTY FOR FAILURE TO FILE. (1) Each organization offering a managed care plan for which a certificate of authority is required under this chapter shall be subject to taxation as provided in chapter 4, title 41, Idaho Code. (2) Any managed care organization failing to file any documents required to be filed with the director by this chapter shall be liable to a fine of twenty-five dollars ($25.00) for each day of delinquency. As applicable, the director shall suspend or revoke the certificate of authority of a delinquent managed care organization until the document is filed and the fine, if any, is fully paid.  History: [(41-3922), added 1974, ch. 177, sec. 28, p. 1444; am. 1978, ch. 9, sec. 2, p. 17; am. 1982, ch. 252, sec. 2, p. 644; am. and redesig. 1997, ch. 204, sec. 25, p. 596.]
ID Code § 41-3924 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3924 - LIMITATION OF BENEFITS FOR ELECTIVE ABORTIONS.

41-3924. LIMITATION OF BENEFITS FOR ELECTIVE ABORTIONS. All policies, contracts, plans or certificates delivered, issued for delivery or renewed in this state by an organization offering a managed care plan for which a certificate of authority is required shall exclude coverage for elective abortions. Such exclusion may be waived by endorsement and the payment of a premium therefor. Availability of such coverage shall be at the option of the contractor. For purposes of this section, an "elective abortion" means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed.  History: [(41-3924), added 1983, ch. 94, sec. 4, p. 207; am. and redesig. 1997, ch. 204, sec. 27, p. 598.]
ID Code § 41-3925 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3925 - SERVICES PROVIDED BY GOVERNMENTAL ENTITIES.

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.]
ID Code § 41-3926 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 39 - MANAGED CARE REFORM|Section 41-3926 - MAMMOGRAPHY COVERAGE.

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.]