reglab/housing_qa huggingface dataset:
ID Code § 41-5817 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 58 - PUBLIC ADJUSTER LICENSING ACT|Section 41-5817 - RECORD RETENTION.

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from any source whatsoever, in connection with the loss; (g) A register of all moneys received, deposited, disbursed or withdrawn in connection with a transaction with an insured, including fees, transfers and disbursements from a trust account and all transactions concerning all interest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.]
ID Code § 41-5819 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 58 - PUBLIC ADJUSTER LICENSING ACT|Section 41-5819 - REPORTING OF ACTIONS.

41-5819. REPORTING OF ACTIONS. (1) The public adjuster shall report to the department any administrative action taken against the public adjuster in another jurisdiction or by another governmental agency in this state within thirty (30) days of the final disposition of the matter. This report shall include a copy of the order, consent to order, or other relevant legal documents. (2) Within thirty (30) days of the initial pretrial hearing date, the public adjuster shall report to the department any criminal prosecution of the public adjuster taken in any jurisdiction. The report shall include a copy of the initial complaint filed, the order resulting from the hearing, and any other relevant legal documents.  History: [41-5819, added 2008, ch. 179, sec. 1, p. 543.]
ID Code § 41-5820 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 58 - PUBLIC ADJUSTER LICENSING ACT|Section 41-5820 - RULES.

41-5820. RULES. The department may, in accordance with section 41-211, Idaho Code, promulgate reasonable rules as are necessary or proper to carry out the purposes of this chapter.  History: [41-5820, added 2008, ch. 179, sec. 1, p. 543.]
ID Code § 41-5821 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 58 - PUBLIC ADJUSTER LICENSING ACT|Section 41-5821 - SEVERABILITY.

41-5821. SEVERABILITY. If any provisions of this chapter, or the application of a provision to any persons or circumstances, shall be held invalid, the remainder of the chapter, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.  History: [41-5821, added 2008, ch. 179, sec. 1, p. 543.]
ID Code § 41-5901 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5901 - SHORT TITLE.

41-5901. SHORT TITLE. This chapter shall be known and may be cited as the "Idaho Health Carrier External Review Act."  History: [41-5901, added 2009, ch. 87, sec. 1, p. 240.]
ID Code § 41-5902 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5902 - PURPOSE AND INTENT.

41-5902. PURPOSE AND INTENT. The purpose of this chapter is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of a final adverse benefit determination, as defined in this chapter.  History: [41-5902, added 2009, ch. 87, sec. 1, p. 240.]
ID Code § 41-5904 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5904 - APPLICABILITY AND SCOPE.

41-5904. APPLICABILITY AND SCOPE. (1) Except as provided in subsection (2) of this section, this chapter shall apply to all health carriers. (2) The provisions of this chapter shall not apply to a plan, policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage; nor shall this chapter apply to a credit, dental, disability income, hospital indemnity, long-term care insurance, vision care, limited benefit health plans or any other limited supplemental benefit; nor shall this chapter apply to a medicare advantage plan or medicare supplemental policy of insurance, as defined by the director by rule, coverage under a plan through medicare, medicaid, or the federal employees health benefits program, any coverage issued under chapter 55, title 10, of the United States Code and any coverage issued as supplemental to that coverage; nor shall this chapter apply to any coverage issued as supplemental to liability insurance, worker’s compensation or similar insurance, automobile medical payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis; nor shall this chapter apply to a single employer self-funded employee benefit plan subject to and operated in compliance with the employee retirement income security act of 1974 (ERISA); provided however, the single employer self-funded ERISA employee benefit plan administrator or designee may, by timely and appropriate written notice to the director, voluntarily elect to comply with the provisions of this chapter either for a single plan beneficiary or for a specific period of time. The director may promulgate rules establishing the procedure for an employee benefit plan administrator or designee, to voluntarily comply with the provisions of this chapter and to provide for an administrative fee to be paid by the employee benefit plan administrator for each voluntary external review request submitted to the department pursuant to this chapter. (3) The availability or use of external review pursuant to this chapter shall not alter the standard of review used by a court of competent jurisdiction when adjudicating the health carrier’s final adverse benefit determination.  History: [41-5904, added 2009, ch. 87, sec. 1, p. 245; am. 2011, ch. 122, sec. 2, p. 337; am. 2011, ch. 258, sec. 1, p. 703.]
ID Code § 41-5905 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5905 - NOTICE OF RIGHT TO EXTERNAL REVIEW.

41-5905. NOTICE OF RIGHT TO EXTERNAL REVIEW. (1) When a final adverse benefit determination is made, the health carrier shall notify the covered person in writing of the covered person’s right to request an external review to be conducted pursuant to section 41-5908, 41-5909 or 41-5910, Idaho Code, and include the appropriate statements and information set forth in subsection (2) of this section at the same time the health carrier sends written notice of the final adverse benefit determination. (2) The director may prescribe by rule the form and content of the notice required under this section, which shall include: (a) The following, or substantially equivalent, language: "We have denied your request for the provision of or payment for a health care service or course of treatment. You may have the right to have our decision reviewed by health care professionals who have no association with us if our decision involved making a judgment as to the medical necessity, appropriateness, health care setting, level of care or effectiveness of your health care service or supply, or your health care service or supply was denied based upon a determination that it was investigational. You may request an external review by submitting a written request to the department of insurance." The notice shall include contact information for the department of insurance, including the website, address and telephone number. (b) If the adverse benefit determination is for a pre-service or concurrent service, the health carrier shall notify the covered person of the right to an expedited external review if the request is an urgent care request. The notification shall include the definition of urgent care request. (c) The health carrier shall include a copy of the description of both the standard and expedited external review procedures the health carrier is required to provide pursuant to section 41-5916, Idaho Code, highlighting the provisions in the external review procedures that give the covered person the opportunity to submit additional information, and include any forms used to process an external review. (d) The health carrier shall include an authorization form, or other document approved by the director, that complies with the requirements of 45 CFR section 164.508, by which the covered person, for purposes of conducting an external review pursuant to this chapter, authorizes the health carrier and the covered person’s treating health care providers to disclose protected health information, including medical records, concerning the covered person that are pertinent to the external review. Until the director receives this form from the covered person, duly executed, the external review process is stayed and the health carrier has no obligations under this chapter.  History: [41-5905, added 2009, ch. 87, sec. 1, p. 245; am. 2011, ch. 122, sec. 3, p. 338.]
ID Code § 41-5906 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5906 - REQUEST FOR EXTERNAL REVIEW.

41-5906. REQUEST FOR EXTERNAL REVIEW. A covered person may make a request for an external review of a final adverse benefit determination. Except for a request for an expedited external review as set forth in section 41-5909, Idaho Code, all requests for external review shall be made in writing to the director. The director may prescribe by rule the form and content of external review requests required to be submitted under this section.  History: [41-5906, added 2009, ch. 87, sec. 1, p. 246; am. 2011, ch. 122, sec. 4, p. 339.]
ID Code § 41-5907 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5907 - EXHAUSTION OF INTERNAL GRIEVANCE PROCESS.

41-5907. EXHAUSTION OF INTERNAL GRIEVANCE PROCESS. (1) Except as provided in subsection (2) of this section, a request for an external review pursuant to section 41-5908, 41-5909 or 41-5910, Idaho Code, shall not be made until the covered person has exhausted the health carrier’s internal grievance process. A covered person shall be considered to have exhausted the health carrier’s internal grievance process for purposes of this section, if the covered person: (a) Has filed and completed a grievance, involving an adverse benefit determination, according to the terms and conditions of the covered person’s health benefit plan; or (b) Except to the extent the covered person requested or agreed to a delay, has not received a written decision on the grievance from the health carrier within thirty-five (35) days following the date the covered person filed the grievance with the health carrier, or the covered person filed a grievance on an urgent care request on a pre-service or concurrent care adverse benefit determination and has not received a determination from the health carrier within three (3) business days after filing. (2) A request for an external review of an adverse benefit determination may be made before the covered person has exhausted the health carrier’s internal grievance procedures as set forth in the health carrier’s grievance appeal process whenever: (a) The health carrier agrees to waive the exhaustion requirement; (b) The health carrier has failed to strictly follow its duties in affording a timely, full and fair opportunity for the covered person to take advantage of the internal grievance procedures; or (c) The urgent care request involves a medical condition for which the time frame for completion of the carrier’s internal grievance process pursuant to this section would seriously jeopardize the life or health of the covered person or would jeopardize the covered person’s ability to regain maximum function, and the covered person has applied for expedited external review at the same time as applying for an expedited internal review.  History: [41-5907, added 2009, ch. 87, sec. 1, p. 246; am. 2011, ch. 122, sec. 5, p. 339.]
ID Code § 41-5910 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5910 - BINDING NATURE OF EXTERNAL REVIEW DECISION.

41-5910. BINDING NATURE OF EXTERNAL REVIEW DECISION. (1) For a health care benefit plan not subject to the employee retirement income security act of 1974 (ERISA), the external review decision is final and binding on the health carrier and on the covered person. No judicial action or proceeding arising out of the external review decision or the issues determined by the external review decision shall be permitted. For a health care benefit plan subject to ERISA, the external review decision is final and binding on the health carrier; however, should the covered person seek judicial review of the external review decision, then the external review record and decision shall be included as a part of the administrative record for the purpose of review by any court of competent jurisdiction. (2) A covered person may not file a subsequent request for external review involving the same adverse benefit determination or final adverse benefit determination for which the covered person has already received an external review decision pursuant to this chapter.  History: [41-5910, added 2009, ch. 87, sec. 1, p. 252.]
ID Code § 41-5913 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5913 - HOLD HARMLESS FOR INDEPENDENT REVIEW ORGANIZATIONS.

41-5913. HOLD HARMLESS FOR INDEPENDENT REVIEW ORGANIZATIONS. No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent or contractor of an independent review organization shall be liable in damages or otherwise to any person for any opinions rendered or acts or omissions performed within the scope of the organization’s or person’s duties under the law during or upon completion of an external review conducted pursuant to this chapter unless the opinion was rendered or act or omission performed in bad faith or involved gross negligence; provided that the health carrier shall not be liable in damages or otherwise to any person for any opinions rendered or acts or omissions performed by the independent review organization, its employees, agents or contractors within the scope of the organization’s or person’s duties under the law during or upon completion of an external review conducted pursuant to this chapter.  History: [41-5913, added 2009, ch. 87, sec. 1, p. 255.]
ID Code § 41-5914 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5914 - EXTERNAL REVIEW REPORTING REQUIREMENTS.

41-5914. EXTERNAL REVIEW REPORTING REQUIREMENTS. (1) An independent review organization assigned pursuant to this chapter to conduct an external review shall maintain written records in the aggregate for Idaho by health carrier on all requests for external review for which it conducted an external review during a calendar year and, upon request, submit a report to the director, as required under this section. Each independent review organization required to maintain written records on all requests for external review pursuant to this section for which it was assigned to conduct an external review shall submit to the director, upon request or at specified intervals, a report in the format specified by the director. (2) The report shall include in the aggregate for Idaho for each health carrier: (a) The total number of requests for external review; (b) The number of requests for external review resolved and, of those resolved, the number resolved upholding the final adverse benefit determinations and the number resolved reversing the final adverse benefit determinations; (c) The average length of time for resolution; (d) A summary of the types of coverages or cases for which an external review was sought; (e) The number of external reviews pursuant to section 41-5908(18), Idaho Code, that were terminated as the result of a reconsideration by the health carrier of its final adverse benefit determination after the receipt of additional information from the covered person; and (f) Any other information the director may reasonably request or require. (3) The independent review organization shall retain the written records required pursuant to this section for at least five (5) years. (4) Each health carrier shall maintain written records in the aggregate for Idaho for each type of health benefit plan offered by the health carrier on all requests for external review that the health carrier receives notice of from the director pursuant to this chapter. (5) Each health carrier is required to maintain written records on all requests for external review pursuant to subsection (1) of this section and shall submit to the director, upon request or at specified intervals, a report in the format specified by the director. The report shall include in the aggregate for Idaho and by type of health benefit plan: (a) The total number of requests for external review; (b) From the total number of requests for external review reported, the number of requests determined eligible for a full external review; and (c) Any other information the director may reasonably request or require. (6) The health carrier shall retain the written records required pursuant to this section for at least five (5) years.  History: [41-5914, added 2009, ch. 87, sec. 1, p. 255.]
ID Code § 41-5915 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5915 - FUNDING OF EXTERNAL REVIEW.

41-5915. FUNDING OF EXTERNAL REVIEW. The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the reasonable cost of the independent review organization for conducting the external review.  History: [41-5915, added 2009, ch. 87, sec. 1, p. 256; am. 2011, ch. 122, sec. 8, p. 345.]
ID Code § 41-5916 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5916 - DISCLOSURE REQUIREMENTS.

41-5916. DISCLOSURE REQUIREMENTS. (1) Each health carrier shall include a summary description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to covered persons. The disclosure shall be in a format prescribed by the director. (2) The description required under subsection (1) of this section shall include: (a) A statement that informs the covered person of the right of the covered person to file a request for an external review of a final adverse benefit determination with the director; (b) An explanation that external review and, in certain circumstances, expedited external review are available when the final adverse benefit determination involves an issue of medical necessity, appropriateness, health care setting, level of care, effectiveness or investigational service or supply; (c) The website, telephone number and address of the director; and (d) A statement informing the covered person that, when filing a request for an external review, the covered person will be required to authorize the release of any medical records of the covered person that may be required to be reviewed for the purpose of reaching a decision on the external review including any judicial review of the external review decision pursuant to ERISA, if applicable. (e) If the health plan is not subject to ERISA, a statement informing the covered person that the plan is not subject to ERISA and that if the covered person elects to request external review, the external review decision of the independent review organization shall be final and binding on both the covered person and the health carrier, as provided in section 41-5910, Idaho Code. If the health plan is subject to ERISA, the statement shall inform the covered person that the plan is subject to ERISA and that if the covered person elects to request external review, the external review decision of the independent review organization shall be final and binding on the health carrier but not the covered person, as provided in section 41-5910, Idaho Code, and that the covered person may have the right to judicial review under ERISA in a court of competent jurisdiction.  History: [41-5916, added 2009, ch. 87, sec. 1, p. 256; am. 2011, ch. 122, sec. 9, p. 345.]
ID Code § 41-5917 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 59 - IDAHO HEALTH CARRIER EXTERNAL REVIEW ACT|Section 41-5917 - SEVERABILITY.

41-5917. SEVERABILITY. The provisions of this act are hereby declared to be severable and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the remaining portions of this act.  History: [41-5917, added 2009, ch. 87, sec. 1, p. 257.]
ID Code § 41-6001 (2021)
2021 Idaho Code|Title 41 - INSURANCE|Chapter 60 - IMMUNIZATION ASSESSMENTS [EFFECTIVE UNTIL JULY 1, 2024]|Section 41-6001 - LEGISLATIVE INTENT.

41-6001. LEGISLATIVE INTENT. [EFFECTIVE UNTIL JULY 1, 2024] The intent of the legislature is to provide a supplemental funding mechanism for the Idaho immunization program administered by the Idaho department of health and welfare, by creating a dedicated vaccine fund and an independent board, which board is empowered to assess fees from all carriers. The chapter’s goal is to ensure access to childhood vaccinations in Idaho, by decreasing costs and enabling the maintenance of a single distribution of vaccines available to health care providers in Idaho who administer the vaccines to program eligible children.  History: [41-6001, added 2010, ch. 32, sec. 1, p. 60.]