reglab/housing_qa huggingface dataset:
ID Code § 41-4015 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4015 - PROHIBITED PECUNIARY INTERESTS IN PLAN MANAGEMENT.

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.]
ID Code § 41-4016 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4016 - POLITICAL CONTRIBUTIONS PROHIBITED.

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.]
ID Code § 41-4017 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4017 - RECOVERY OF DEPLETED FUNDS.

41-4017. RECOVERY OF DEPLETED FUNDS. If after notice and the opportunity for a hearing the director finds that any self-funded plan trust fund has been depleted by reason of any wrongful or negligent act or omission of a trustee or any other person, he shall transmit a copy of his findings to the attorney general of this state, who may bring an action in the name of the people of this state, or intervene in any action brought by or on behalf of an employer or beneficiary, for the recovery of the amount of such depletion, for the benefit of the trust fund, and to impose any sanctions as authorized by law.  History: [41-4017, added 1974, ch. 248, sec. 17, p. 1624; am. 2013, ch. 181, sec. 16, p. 431.]
ID Code § 41-4018 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4018 - TERMINATION OF REGISTRATION.

41-4018. TERMINATION OF REGISTRATION. (1) The director shall terminate the registration of a self-funded plan upon written request of the trustee, or if he finds, after an inquiry or an examination, that the trust fund is insolvent. For the purposes of this chapter, "insolvent" means the plan is unable to pay its obligations when they are due or that its assets do not exceed its liabilities. As used in this chapter, "assets" means all investments held in the name of the trust as permitted by section 41-4009, Idaho Code. (2) The director may terminate the registration of a plan for violation of this chapter, or failure of the trustee to timely file with the director the annual statement or actuarial opinion and timely pay the tax required under sections 41-4011 and 41-4012, Idaho Code, or if he finds, after an inquiry or an examination of the trust fund and the plan or notice from the trustee: (a) That the plan no longer meets the qualifications required by sections 41-4004 and 41-4005, Idaho Code, and that such deficiency will not or cannot be remedied within a reasonable time; (b) That there is a pattern of benefits promised by the plan that are not being fairly and promptly paid; (c) That the cost of administering the plan is excessive in relation to the character and volume of service being rendered in the administration;  (d) That the trust fund has been subject to fraudulent, incompetent or dishonest practices on the part of the trustee, administrator, consultant, any participating employer, any postsecondary educational institution, beneficiaries or others; or (e) That the trust fund does not meet the minimum surplus requirements under this chapter. (3) The director shall terminate the plan’s registration by his written order provided to the trustee last of record with the department and to each employer or postsecondary educational institution last of record with the department. Such order shall state the grounds upon which it is based and its effective date. The order shall be subject to judicial review in the same manner as applies to official orders of the director in general.  History: [41-4018, added 1974, ch. 248, sec. 18, p. 1624; am. 2006, ch. 414, sec. 15, p. 1267; am. 2013, ch. 181, sec. 17, p. 431.]
ID Code § 41-4019 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4019 - LIQUIDATION OF TRUST FUND.

41-4019. LIQUIDATION OF TRUST FUND. (1) Upon termination of registration of the plan, the trust fund of a self-funded plan shall be liquidated as soon as practicable. (2) Liquidation of a solvent self-funded plan shall be conducted by its trustee under a plan of liquidation in writing filed with and approved by the director as fair and equitable to all persons having a pecuniary interest in the trust fund. Any balance remaining after payment or adequate provision for all claims and charges against the trust fund shall be disposed of in such manner as is provided for in the plan of liquidation. Unless the plan of liquidation provides that liability for all unpaid claims and obligations of the trust fund has been unconditionally assumed by other financially responsible person or persons and the third party contract has been submitted to the department for its review, the existence of surplus funds for such disposition shall not be determined prior to expiration of two (2) years after termination of the registration. (3) The liquidation of an insolvent self-funded plan shall be carried out by the director in accordance with chapter 33, title 41, Idaho Code (rehabilitation and liquidation). For this purpose, the self-funded plan shall be deemed to be an insolvent domestic insurer and subject to all statutes and rules applicable to the same.  History: [41-4019, added 1974, ch. 248, sec. 19, p. 1624; am. 2006, ch. 414, sec. 16, p. 1268; am. 2013, ch. 181, sec. 18, p. 432.]
ID Code § 41-4020 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4020 - RULES.

41-4020. RULES. (1) The director may promulgate reasonable rules necessary for or as an aid to effectuation of any provision of this chapter. No such rule shall extend, modify, or conflict with any provision of this chapter and the reasonable implications thereof. (2) Such rules, or any amendment thereof, shall be made by the director in accordance with chapter 52, title 67, Idaho Code.  History: [41-4020, added 1974, ch. 248, sec. 20, p. 1624; am. 2006, ch. 414, sec. 17, p. 1268; am. 2013, ch. 181, sec. 19, p. 432.]
ID Code § 41-4021 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4021 - OTHER PROVISIONS APPLICABLE.

41-4021. OTHER PROVISIONS APPLICABLE. Chapter 2, title 41, Idaho Code, (the director of the department of insurance), chapter 9, title 41, Idaho Code, (insurance administrators), chapter 13, title 41, Idaho Code, (trade practices and frauds), chapter 56, title 41, Idaho Code, (prompt payment of claims), chapter 59, title 41, Idaho Code, (external review), section 41-1845, Idaho Code, (recreational-related activities), sections 41-2141 and 41-2216, Idaho Code, (coordination with social security benefits), and section 41-2841, Idaho Code, (borrowed surplus), to the extent applicable and not in conflict with the express provisions of this chapter, shall also apply with respect to self-funded plans, and for the purpose such plans shall be deemed to be "insurers."  History: [41-4021, added 1974, ch. 248, sec. 21, p. 1624; am. 1978, ch. 10, sec. 6, p. 22; am. 2006, ch. 414, sec. 18, p. 1269; am. 2013, ch. 181, sec. 20, p. 433.]
ID Code § 41-4022 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4022 - PENALTIES.

41-4022. PENALTIES. (1) Any person who violates or causes or induces violation of any provision of this chapter, or any lawful rule of the director issued thereunder, shall be subject to an administrative penalty for each violation of not more than one thousand dollars ($1,000) for an individual and not more than five thousand dollars ($5,000) for any entity for each violation. (2) Any person who makes a false statement or representation of a material fact, knowing it to be false, or who knowingly fails to disclose a material fact in any application, examination or statement relating to self-funded plans, trust accounts, administration of a plan or any matter materially related thereto, shall be subject to penalty as provided in subsection (4) of this section. (3) Any person who makes a false entry in any book, record, statement, or report required by this chapter or any rule of the director promulgated thereunder, with intent to injure or defraud the trust fund or any beneficiary thereunder, or to deceive anyone authorized or entitled to examine the affairs of the plan, shall be subject to penalty as provided in subsection (4) of this section. (4) For each such violation, act or omission referred to in subsections (2) and (3) of this section, unless greater penalty is provided therefor under any other applicable law, the offender shall upon conviction thereof be subject to a fine of not more than fifteen thousand dollars ($15,000) and to imprisonment for not more than fifteen (15) years, or to both such fine and imprisonment. (5) Further, the director may in his discretion: (a) Order the person to cease and desist from the violation of such provision; (b) Issue an order revoking or suspending the registration of the plan that engaged in such violation; (c) Bring an action in the fourth district court in and for Ada county or in such other court as the director deems appropriate to seek appropriate injunctive relief and impose a civil penalty not to exceed five thousand dollars ($5,000) for each violation.  History: [41-4022, added 1974, ch. 248, sec. 22, p. 1624; am. 2006, ch. 414, sec. 19, p. 1269; am. 2013, ch. 181, sec. 21, p. 433.]
ID Code § 41-4024 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4024 - SERVICES PROVIDED BY GOVERNMENTAL ENTITIES.

41-4024. SERVICES PROVIDED BY GOVERNMENTAL ENTITIES. (1) From and after July 1, 1990, no self-funded plan shall be issued in Idaho which excludes from coverage services rendered the subscriber while a resident in an Idaho state institution, provided the services to the subscriber would be covered by the contract if rendered to him outside an Idaho state institution. (2) From and after July 1, 1990, no self-funded plan 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 a self-funded plan.  History: [41-4024, added 1990, ch. 300, sec. 5, p. 830.]
ID Code § 41-4025 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 40 - SELF-FUNDED HEALTH CARE PLANS|Section 41-4025 - MAMMOGRAPHY COVERAGE.

41-4025. MAMMOGRAPHY COVERAGE. (1) From and after July 1, 1992, all self-funded plans 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: [41-4025, added 1992, ch. 132, sec. 5, p. 415; am. 1993, ch. 113, sec. 5, p. 290.]
ID Code § 41-4101 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS|Section 41-4101 - DECLARATION OF PURPOSE.

41-4101. DECLARATION OF PURPOSE. It is the purpose of this chapter to recognize and provide reasonable public supervision of self-funded plans established by public agencies pursuant to a joint powers agreement in accordance with chapter 23, title 67, Idaho Code, for provision of health care service benefits to employees of public agencies in connection with or as an alternative to insurance and other prepayment plans.  History: [41-4101, added 2006, ch. 415, sec. 1, p. 1271.]
ID Code § 41-4102 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS|Section 41-4102 - DEFINITIONS.

41-4102. DEFINITIONS. As used in this chapter: (1) "Administrator" means a person, other than a board member, employed by the board to administer a joint public agency self-funded plan. (2) "Beneficiary" means any individual entitled, under the joint public agency self-funded plan, to payment by the trust fund of any part of all of the cost of any health care service rendered to him. (3) "Board of trustees" or "board" is the board of trustees of the trust fund. (4) "Contribution" means the amount paid or payable by the employer or employee into the trust fund. (5) "Director" means the director of the department of insurance of this state. (6) "Joint powers agreement" means an agreement entered into between public agencies pursuant to chapter 23, title 67, Idaho Code. (7) "Joint public agency self-funded plan" or "self-funded plan" or "plan" means any public agency plan established by a joint powers agreement and under which payment for any disability benefits not otherwise provided for under title 72, Idaho Code (worker’s compensation and related laws — industrial commission), medical, surgical, hospital, and other services for prevention, diagnosis, or treatment of any disease, injury, or bodily condition of an employee is, or is to be, regularly provided for or promised from funds created or maintained in whole or in part by contributions or payments thereto by a public agency employer, or by a public agency employer and the employees of the public agency, and not otherwise covered by insurance or contract with a health care service corporation, health maintenance organization, or similar other third party prepayment plan. (8) "Person" means any individual, corporation, association, firm, syndicate, organization or other entity. (9) "Public agency" means any city, county or political subdivision of this state, including, but not limited to: counties; school districts; highway districts; port authorities; instrumentalities of counties, county hospitals, cities or any political subdivision created under the laws of the state of Idaho; and the state of Idaho and any agency of the state government. "Public agency" also means any group of more than one (1) of the above public agencies acting together pursuant to a joint powers agreement in accordance with chapter 23, title 67, Idaho Code. (10) "Surplus" means the excess of the assets of a self-funded plan minus the liabilities of the plan, provided the liabilities of a self-funded plan shall include the claims liability of the plan. (11) "Trust fund" means a fund established under a joint public agency self-funded plan for receipt of contributions of employers and employees and payment of or with respect to health care service costs of beneficiaries.  History: [41-4102, added 2006, ch. 415, sec. 1, p. 1272; am. 2018, ch. 61, sec. 1, p. 151.]
ID Code § 41-4103 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS|Section 41-4103 - REGISTRATION REQUIRED — EXEMPTIONS — NOT SUBJECT TO INSURANCE CODE.

41-4103. REGISTRATION REQUIRED — EXEMPTIONS — NOT SUBJECT TO INSURANCE CODE. (1) No joint public agency self-funded plan shall operate in this state except while registered with the director as hereinafter provided. Joint public agency self-funded plans already in operation as of July 1, 2006, shall so register within ninety (90) days of the effective date of this act. (2) No registration shall be required of: (a) Any plan established and maintained for the purpose of complying with any worker’s compensation law or unemployment compensation disability insurance law; or (b) Any plan that is primarily for the purpose of providing first aid care and treatment, at a dispensary of an employer, for injury or sickness of employees while engaged in their employment. (3) Plans while so registered 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. (4) The plan shall provide to each employer participant and to each prospective employer participant a written notice stating that the plan is not insurance and does not participate in the state guaranty association.  History: [41-4103, added 2006, ch. 415, sec. 1, p. 1272.]
ID Code § 41-4104 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS|Section 41-4104 - QUALIFICATIONS FOR REGISTRATION.

41-4104. QUALIFICATIONS FOR REGISTRATION. No joint public agency self-funded plan shall register, and the director shall not register a joint public agency self-funded plan, which is not qualified as provided in this section. (1) The joint powers agreement must require all contributions to be paid in advance and to be deposited in and disbursed from a trust fund duly created and existing under an adequate written irrevocable trust agreement between the employer or employers and the board. (2) The plan must: (a) Have, or provide for, a board of trustees in accordance with this chapter for the administration of the plan; (b) Require that all members of the joint powers agreement comply with the provisions of the joint powers agreement; (c) Provide that the administrator or board on behalf of the plan, as the case may be, shall furnish to each employee-beneficiary of the plan a written statement or schedule adequately and clearly stating all benefits currently allowable under the plan, together with all applicable restrictions, limitations, and exclusions, and the procedure for filing a claim for benefits; and (d) Otherwise be in compliance with the provisions of this chapter. (3) The allocated trust fund must be actuarially sound; that is, assets and income of the fund must be adequate under reasonable estimates for payment of all benefits promised to beneficiaries by the plan. In determining actuarial soundness the director shall also give due consideration to: (a) Applicable stop-loss insurance provided or to be provided the plan by an insurer duly authorized to transact disability insurance in this state; (b) Contracts with health care service corporations or health maintenance organizations authorized to conduct such operations in this state and covering certain of the promised benefits; (c) Other applicable insurance or guarantys; and (d) The nature of the participating entities and other plan factors or provisions for prevention or reduction of adverse selection against the plan by those otherwise eligible to become beneficiaries. (4) The plan shall maintain aggregate stop-loss coverage and specific stop-loss coverage provided by an insurance company authorized to transact insurance in this state in accordance with the annual actuarial opinion of the plan, unless waived pursuant to section 41-4110(3), Idaho Code.  History: [41-4104, added 2006, ch. 415, sec. 1, p. 1273; am. 2018, ch. 61, sec. 2, p. 152.]
ID Code § 41-4105 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS|Section 41-4105 - APPLICATION FOR REGISTRATION.

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.]