reglab/statecodes huggingface dataset:
2023 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.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4106 - GRANT OR DENIAL OF APPLICATION.

41-4106. GRANT OR DENIAL OF APPLICATION. The director shall act upon an application for registration of a joint public agency self-funded plan with all reasonable promptness. He may make a reasonable investigation of the proposal from the public agency. If the director finds that the application is complete and that the plan meets the qualifications stated in section 41-4104, Idaho Code, he shall issue and deliver a certificate of registration in appropriate form to the applicant; otherwise, the director shall refuse to register the plan and shall give written notice of such refusal to the applicant, stating the reasons therefor.
History:
[41-4106, added 2006, ch. 415, sec. 1, p. 1274.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4107 - TRUST FUND — POWERS.

41-4107. TRUST FUND — POWERS. In addition to the inherent applicable powers of its public agency members and those of a joint powers entity, the trust fund of a joint public agency self-funded plan shall have power:
(1) To have and use an appropriate descriptive name;
(2) To sue and be sued in its own name;
(3) To contract in its own name. All such contracts in writing shall be signed by the chairman of the board or his or her designee;
(4) To borrow money and give security therefor; and
(5) To engage exclusively in transactions authorized or required by this chapter, or reasonably incidental thereto.
History:
[41-4107, added 2006, ch. 415, sec. 1, p. 1274.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4108 - TRUST FUND LIABILITY.

41-4108. TRUST FUND LIABILITY. (1) The trust fund of a joint public agency self-funded plan shall be legally liable for payment of all applicable benefits stated in the statement or schedule of benefits in effect at the time a claim thereunder arises and subject to the terms of the joint powers agreement.
(2) Funds in the trust fund are fiduciary funds, and are not liable for any obligation of any employer participant in the plan, nor subject to garnishment or levy for the obligation of the beneficiary. This subsection (2) shall not be deemed to prohibit levy upon the trust fund by any provider thereof, or its assignee, for health care services rendered a beneficiary if the trust fund has theretofore agreed in writing to pay for the same direct to such provider.
History:
[41-4108, added 2006, ch. 415, sec. 1, p. 1275.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4109 - INVESTMENT OF TRUST FUND.

41-4109. INVESTMENT OF TRUST FUND. (1) The board may invest reserves and other funds available for the purpose in the trust fund of a joint public agency self-funded plan in the following kinds of investments only:
(a) General obligations of the United States government, or of any state, district, commonwealth or territory of the United States, or of any municipality, county, or other political subdivision or agency thereof.
(b) Obligations, the payment of principal and interest of which is guaranteed by any such government or agency.
(c) Corporate bonds and similar obligations meeting the requirements specified for investment of funds of insurers under section 41-711, Idaho Code.
(d) Collateral loans, payment of principal and interest of which is adequately secured by securities in which the trust fund could lawfully invest directly.
(e) Deposits, savings accounts, and share accounts in established banks and savings and loan associations located in the United States.
(2) In addition to investments excluded under subsection (1) of this section, the board is expressly prohibited from investing trust fund moneys in:
(a) Any loan to or security of any employer participating in the plan, or to or of any officer, director, subsidiary or affiliate of any such employer.
(b) The security of any person in which a member of the board, administrator, or any consultant of the plan has a direct or indirect material pecuniary interest.
(c) Real estate or loans thereon.
(d) Any personal loan, other than a collateral loan referred to in subsection (1)(d) of this section, but subject to paragraphs (a) and (b) of this subsection (2).
(3) All such investments shall be made and held in the name of the trust fund, and the interest and yield thereon shall inure to the account of the trust fund.
(4) No investment shall be made unless authorized in writing by the board and so shown in the records of the trust fund.
(5) Any person who authorizes any investment of trust fund moneys in violation of this section shall, in addition to other penalty therefor, be liable for all loss suffered by the trust fund on account of the investment.
(6) No investment made in violation of this section shall constitute an "asset" in any determination of the financial condition of the trust fund.
History:
[41-4109, added 2006, ch. 415, sec. 1, p. 1275.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4110 - RESERVES.

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.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4111 - RECORDS AND ACCOUNTS — ANNUAL STATEMENT.

41-4111. RECORDS AND ACCOUNTS — ANNUAL STATEMENT. (1) The board of a joint public agency self-funded plan shall cause full and accurate records and accounts to be entered and maintained covering all financial transactions and affairs of the trust fund.
(2) Within ninety (90) days after the close of a fiscal year of the plan, the board shall make an annual statement in writing summarizing the financial transactions of the trust fund for such fiscal year and its financial condition at the end of such year in accordance with this chapter and generally accepted and applicable accounting principles. The statement shall be in the form as prescribed by the director and the financial information therein shall be certified by an independent public accountant by whom such information was prepared. The board shall keep a copy thereof on file in the business office of the plan where it shall be available at all reasonable times for a period of not less than three (3) years for review by any beneficiary and shall deliver a copy of a financial summary to each participating employer.
(3) On or before expiration of such ninety (90) day period the board shall cause an original of the annual statement to be filed with the director. The joint public agency self-funded plan shall not be subject to any filing fees provided for by rule. The director may grant a thirty (30) day extension of the time for filing the annual statement.
(4) The board shall also file quarterly supplemental financial reports in a form and at the times prescribed by the director.
(5) The annual and quarterly reports required under this section are public records and are available to the public, notwithstanding the exemptions from disclosure provided in chapter 1, title 74, Idaho Code.
History:
[41-4111, added 2006, ch. 415, sec. 1, p. 1276; am. 2010, ch. 96, sec. 3, p. 185; am. 2015, ch. 141, sec. 114, p. 463.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4112 - TAXES — EXEMPTION.

41-4112. TAXES — EXEMPTION. Any plan established under this chapter is not subject to any state tax, including a premium or maintenance tax.
History:
[41-4112, added 2006, ch. 415, sec. 1, p. 1277.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4113 - EXAMINATION OF BOOKS, RECORDS AND ACCOUNTS.

41-4113. EXAMINATION OF BOOKS, RECORDS AND ACCOUNTS. (1) The books, records, accounts and affairs of a joint public agency self-funded plan shall be subject to examination by the director, by competent examiners duly authorized by him in writing, at such times or intervals as the director deems advisable. The purposes of the examination shall be to determine compliance of the plan with applicable laws, financial condition and actuarial adequacy of its trust fund, treatment accorded beneficiaries, and as to other factors materially related to the plan’s management and operation.
(2) The board shall promptly make the books, records and accounts of the plan and trust fund available in Idaho to the examiner and otherwise facilitate the examination.
(3) The examiner shall conduct the examination expeditiously, make his report of the examination in writing, and deliver a copy thereof to the board and to the director. The board shall have four (4) weeks after receipt of the report within which to recommend to the director such corrections or changes therein as the board may deem appropriate. After making such corrections or changes, if any, as he deems proper, the director shall file the report in his office as a document open to public inspection, and deliver to the board a copy of the report as so corrected or changed.
(4) Since a joint public agency self-funded plan is funded by local tax moneys, the costs of the examination shall not be borne by the plan or trust fund of the plan.
History:
[41-4113, added 2006, ch. 415, sec. 1, p. 1277.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4114 - BOARD OF TRUSTEES — ADMINISTRATORS.

41-4114. BOARD OF TRUSTEES — ADMINISTRATORS. (1) The trust shall be governed and managed by a board of trustees. This board shall consist of members elected by the governing boards of the member public agencies. The composition and membership of the board shall be established in the joint powers agreement between the members. The process and procedure for conducting the election and determining the members shall be set forth in the joint powers agreement establishing the plan, except that the election must be conducted, completed and results certified by December 31 of each year in which an election for members is conducted. Boards of joint public agency self-funded plans existing as of July 1, 2006, shall be deemed to be in compliance with the establishment requirements of this chapter but shall conduct future elections in accordance with the requirements of this chapter.
(2) An individual, firm or corporation may be an administrator of a plan.
(3) The board shall cause all individuals handling receipts and disbursements for the trust fund to be covered under a dishonesty insurance policy or surety bond in an amount not less than ten percent (10%) of the annual contributions to the plan or as the director may deem reasonably advisable, issued by an insurer authorized to transact such insurance in this state. This policy shall only be canceled upon giving no less than thirty (30) days’ notice to the board and to the director. The cost of the insurance shall be borne by the trust fund. The amount of any policy or bond required under this section shall be not less than twenty-five thousand dollars ($25,000) or more than five hundred thousand dollars ($500,000).
History:
[41-4114, added 2006, ch. 415, sec. 1, p. 1277.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4115 - PROHIBITED PECUNIARY INTERESTS IN PLAN MANAGEMENT.

41-4115. PROHIBITED PECUNIARY INTERESTS IN PLAN MANAGEMENT. No board member, administrator or other person having responsibility for the management of a joint public agency self-funded plan or the investment or other handling of plan funds shall:
(1) Receive directly or indirectly or be pecuniarily interested in any fee, commission, compensation, or emolument, other than salary or other compensation regularly fixed and allowed for services regularly rendered to the plan, arising out of any transaction to which the trust fund is or is to be a party;
(2) Receive compensation as a consultant to the plan while also acting as a board member or administrator, or as an employee of either; or
(3) Have any direct or indirect material pecuniary interest in any loan or investment of the trust fund.
History:
[41-4115, added 2006, ch. 415, sec. 1, p. 1278.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4116 - POLITICAL CONTRIBUTIONS PROHIBITED.

41-4116. POLITICAL CONTRIBUTIONS PROHIBITED. No board shall make or knowingly permit the making, directly or indirectly, of any political contribution by or from any joint public agency self-funded plan trust fund.
History:
[41-4116, added 2006, ch. 415, sec. 1, p. 1278.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4117 - RECOVERY OF DEPLETED FUNDS.

41-4117. RECOVERY OF DEPLETED FUNDS. If after notice and hearing the director finds that any joint public agency self-funded plan trust fund has been depleted by reason of any wrongful or grossly negligent act or omission of a board member 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.
History:
[41-4117, added 2006, ch. 415, sec. 1, p. 1278.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4118 - TERMINATION OF REGISTRATION.

41-4118. TERMINATION OF REGISTRATION. (1) The director may terminate the registration of a joint public agency self-funded plan upon written request of the board, or if he finds, after an examination, that the trust fund is insolvent.
(2) The director may terminate the registration of a plan for violation of this chapter, or failure of the board to file the annual statement with the director within the time required under section 41-4111, Idaho Code, or if he finds, after an examination of the trust fund or the plan:
(a) That the plan no longer meets the qualifications required by sections 41-4101 and 41-4110, Idaho Code, and that the deficiency will not or cannot be remedied within a reasonable time;
(b) That as a matter of frequent practice the benefits promised by the plan 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; or
(d) That the trust fund has been subject to fraudulent or dishonest practices on the part of the board, administrator, consultant, any participating employer, or beneficiaries.
(3) The director shall so terminate the registration by his written order given to the board and to each employer last of record a participant in the plan. The order shall state the grounds upon which it is made 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:
[41-4118, added 2006, ch. 415, sec. 1, p. 1278.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4119 - LIQUIDATION OF TRUST FUND.

41-4119. LIQUIDATION OF TRUST FUND. (1) Upon termination of registration the trust fund of a joint public agency self-funded plan shall be liquidated.
(2) Liquidation of a solvent joint public agency self-funded plan shall be conducted by its trustee under a plan of liquidation in writing filed with the director, found by the director to be fair and equitable to all persons having a pecuniary interest in the trust fund, and approved by him. 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 under the plan of liquidation liability for all unpaid claims and obligations of the trust fund has been assumed by other financially responsible person or persons, 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 joint public agency self-funded plan shall be carried out by the director in accordance with chapter 33, title 41, Idaho Code (supervision, rehabilitation and liquidation), and for this purpose the joint public agency self-funded plan shall be deemed to be an insolvent domestic insurer.
History:
[41-4119, added 2006, ch. 415, sec. 1, p. 1279.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4120 - RULES.

41-4120. RULES. (1) The director may make 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 nor any of the administrative, statutory or constitutional rights and responsibilities of a public agency.
(2) Such rules, or any amendment thereof, shall be made by the director in accordance with chapter 52, title 67, Idaho Code.
History:
[41-4120, added 2006, ch. 415, sec. 1, p. 1279.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4121 - OTHER PROVISIONS APPLICABLE.

41-4121. OTHER PROVISIONS APPLICABLE. Chapter 2, title 41, Idaho Code (the director of the department of insurance), chapter 13, title 41, Idaho Code (trade practices and frauds), and sections 41-2141(1) and 41-2216(1), Idaho Code (coordination of benefits, except to the extent the rules pertain to medicare coverage), to the extent applicable and not in conflict with the express provisions of this chapter, shall also apply with respect to joint public agency self-funded plans, and for the purpose such plans shall be deemed to be "insurers."
History:
[41-4121, added 2006, ch. 415, sec. 1, p. 1279.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4122 - PENALTIES.

41-4122. 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 hereunder, 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.
(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 required under this chapter or by lawful rule of the director hereunder, 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 lawful rule of the director thereunder to be kept by him for any joint public agency self-funded plan, with intent to injure or defraud the fund or any beneficiary thereunder, or to deceive any person 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.
History:
[41-4122, added 2006, ch. 415, sec. 1, p. 1279.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4124 - SERVICES PROVIDED BY GOVERNMENTAL ENTITIES.

41-4124. SERVICES PROVIDED BY GOVERNMENTAL ENTITIES. (1) From and after July 1, 2006, no joint public agency 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, 2006, no joint public agency 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 joint public agency self-funded plan.
(3) Any new or renewing joint public agency self-funded plan delivered or issued for delivery in this state shall provide that an unmarried child under the age of twenty-five (25) years and who receives more than one-half (1/2) of his financial support from the parent shall be permitted to remain on the parent’s or parents’ plan. Further, any unmarried child of any age who is medically certified as disabled and financially dependent upon the parent is permitted to remain on the parent’s or parents’ plan.
History:
[41-4124, added 2006, ch. 415, sec. 1, p. 1281; am. 2008, ch. 296, sec. 5, p. 830; am. 2009, ch. 125, sec. 7, p. 398.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 41 - JOINT PUBLIC AGENCY SELF-FUNDED HEALTH CARE PLANS › Section 41-4125 - MAMMOGRAPHY COVERAGE.

41-4125. MAMMOGRAPHY COVERAGE. (1) From and after July 1, 2006, all joint public agency 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:
[41-4125, added 2006, ch. 415, sec. 1, p. 1281.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 42 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES › Section 41-4201 - PURPOSE.

41-4201. PURPOSE. The purpose of this act shall be to provide reasonable standardization and simplification of terms and coverages of individual disability insurance policies, group supplemental disability insurance policies, nongroup subscriber contracts of nonprofit hospitals, medical and dental service associations, and nongroup subscriber contracts of managed care organizations to facilitate public understanding and comparison, to eliminate provisions contained in individual disability insurance policies, group supplemental disability insurance policies, nongroup subscriber contracts of nonprofit hospital, medical and dental service associations, and nongroup subscriber 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 disability coverages.
History:
[41-4201, added 1975, ch. 205, sec. 1, p. 569; am. 2009, ch. 66, sec. 1, p. 187.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 42 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES › Section 41-4202 - DEFINITIONS.

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.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 42 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES › Section 41-4203 - STANDARDS FOR POLICY PROVISIONS.

41-4203. STANDARDS FOR POLICY PROVISIONS. (1) The director shall issue rules, subject to chapter 52, title 67, Idaho Code, to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content, and required disclosure for the sale of individual policies of disability insurance, group supplemental policies of disability insurance, nongroup subscriber contracts of nonprofit hospital, medical and dental service associations and nongroup subscriber contracts of managed care organizations which shall be in addition to and in accordance with applicable laws of this state, which may cover but shall not be limited to:
(a) Terms or renewability;
(b) Initial and subsequent conditions of eligibility;
(c) Nonduplication of coverage provisions;
(d) Coverage of dependents;
(e) Pre-existing conditions;
(f) Termination of insurance;
(g) Probationary periods;
(h) Limitations;
(i) Exceptions;
(j) Reductions;
(k) Elimination periods;
(l) Requirements for replacement;
(m) Recurrent conditions; and
(n) The definition of terms including but not limited to the following: hospital, accident, sickness, injury, physician, accidental means, total disability, partial disability, nervous disorder, guaranteed renewable and noncancelable.
(2) The director may issue rules that specify prohibited policy provisions not otherwise specifically authorized by statute which in the opinion of the director are unjust, unfair, or unfairly discriminatory to the policyholder, any person insured under the policy, or beneficiary.
History:
[41-4203, added 1975, ch. 205, sec. 3, p. 569; am. 2009, ch. 66, sec. 3, p. 188.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 42 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES › Section 41-4204 - MINIMUM STANDARDS FOR BENEFITS.

41-4204. MINIMUM STANDARDS FOR BENEFITS. (1) The director shall issue rules, subject to chapter 52, title 67, Idaho Code, to establish minimum standards for benefits under each of the following categories of coverage in individual policies, group supplemental policies, nongroup subscriber contracts of nonprofit hospital, medical and dental service associations, and nongroup subscriber contracts of managed care organizations other than conversion policies issued pursuant to a contractual conversion privilege under a group policy of disability insurance:
(a) Basic hospital expense coverage;
(b) Basic medical-surgical and dental expense coverage;
(c) Hospital confinement indemnity coverage;
(d) Major medical expense coverage;
(e) Disability income protection coverage;
(f) Accident only coverage; and
(g) Specified disease.
(2) Nothing in this section shall preclude the issuance of any policy or contract which combines two (2) or more of the categories of coverage enumerated in paragraphs (a) through (g) of subsection (1) of this section.
(3) No policy or contract shall be delivered or issued for delivery in this state which does not meet the prescribed minimum standards for the categories of coverage listed in paragraphs (a) through (g) of subsection (1) of this section, which are contained within the policy or contract unless the director finds such policy or contract will be in the public interest and such policy or contract meets the requirements set forth in section 41-1813, Idaho Code.
(4) The director shall prescribe the method of identification of policies and contracts based upon coverages provided.
History:
[41-4204, added 1975, ch. 205, sec. 4, p. 569; am. 2009, ch. 66, sec. 4, p. 188.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 42 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES › Section 41-4205 - OUTLINE OF COVERAGE.

41-4205. OUTLINE OF COVERAGE. (1) In order to provide for full and fair disclosure in the sale of individual disability insurance policies, group supplemental disability insurance policies, nongroup subscriber contracts of a nonprofit hospital, medical or dental service association, or nongroup subscriber contracts of managed care organizations, no such policy or contract shall be offered, delivered, issued for delivery, continued or renewed in this state unless:
(a) In the case of a direct response insurance product, the outline of coverage described in subsection (2) of this section accompanies the policy;
(b) In all other cases, the outline of coverage described in subsection (2) of this section is delivered to the applicant at the time application is made and an acknowledgment of receipt of certificate of delivery of such outline is provided the insurer with the application. In the event the policy is issued on a basis other than that applied for, the outline of coverage properly describing the policy or contract must accompany the policy or contract when it is delivered and clearly state that it is not the policy or contract for which application was made.
(2) The director shall prescribe the format and content of the outline of coverage required by subsection (1) of this section. "Format" means style, arrangement, and overall appearance, including such items as the size, color, and prominence of type and the arrangement of text and captions. Such outline of coverage shall include:
(a) A statement identifying the applicable category or categories of coverage provided by the policy or contract as prescribed in section 41-4204, Idaho Code;
(b) A description of the principal benefits and coverage provided in the policy or contract;
(c) A statement of the exceptions, reductions and limitations contained in the policy or contract;
(d) A statement of the renewal provisions including any reservation by the insurer, nonprofit hospital, medical or dental service association or managed care organization of a right to change premiums;
(e) A statement that the outline is a summary of the policy, certificate or contract issued or applied for and that the policy, certificate or contract should be consulted to determine governing contractual provisions.
History:
[41-4205, added 1975, ch. 205, sec. 5, p. 569; am. 2009, ch. 66, sec. 5, p. 189.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 42 - INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES › Section 41-4207 - ADMINISTRATIVE PROCEDURE.

41-4207. ADMINISTRATIVE PROCEDURE. Rules and regulations promulgated pursuant to this act shall be subject to notice and hearing pursuant to section 41-211, Idaho Code, and chapter 52, title 67, Idaho Code.
History:
[41-4207, added 1975, ch. 205, sec. 7, p. 569.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4301 - SHORT TITLE.

41-4301. SHORT TITLE. This chapter shall be known and may be cited as the "Idaho Life and Health Insurance Guaranty Association Act."
History:
[41-4301, added 2011, ch. 196, sec. 2, p. 559.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4302 - PURPOSE.

41-4302. PURPOSE. (1) The purpose of this chapter is to protect, subject to certain limitations, the persons specified in section 41-4303(1), Idaho Code, against failure in the performance of contractual obligations under life and health insurance policies and annuity contracts specified in section 41-4303(2), Idaho Code, because of the impairment or insolvency of the member insurer that issued the policies or contracts.
(2) To provide the protection stated in subsection (1) of this section, an association of insurers will pay benefits and continue coverages as provided for and limited by this chapter. Members of the association are subject to assessment to provide funds to carry out the purpose of this chapter.
History:
[41-4302, added 2011, ch. 196, sec. 2, p. 559.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4304 - CONSTRUCTION.

41-4304. CONSTRUCTION. The provisions of this chapter shall be construed to effect the purpose under section 41-4302, Idaho Code.
History:
[41-4304, added 2011, ch. 196, sec. 2, p. 563.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4306 - CREATION OF THE ASSOCIATION.

41-4306. CREATION OF THE ASSOCIATION. (1) This chapter continues the existence of the nonprofit legal entity known as the Idaho life and health insurance guaranty association. All member insurers shall be and remain members of the association as a condition of their authority to transact insurance in this state. The association shall perform its functions under the plan of operation established and approved under section 41-4310, Idaho Code, and shall exercise its powers through a board of directors provided for under section 41-4307, Idaho Code. For purposes of administration and assessment, the association shall continue the existence and maintenance of three (3) accounts:
(a) Life insurance account;
(b) Health insurance account, formerly designated the "disability insurance account"; and
(c) Annuity account.
(2) The association shall come under the immediate supervision of the director and shall be subject to the applicable provisions of the insurance laws of this state.
History:
[41-4306, added 2011, ch. 196, sec. 2, p. 565.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4307 - BOARD OF DIRECTORS.

41-4307. BOARD OF DIRECTORS. (1) The board of directors of the association shall consist of not fewer than five (5) nor more than nine (9) member insurers serving terms as established in the plan of operation. The members of the board of directors shall be selected by member insurers subject to the approval of the director. Vacancies on the board of directors shall be filled for the remaining period of the term by a majority vote of the remaining board members subject to the approval of the director.
(2) In approving selections, the director shall consider, among other things, whether all member insurers are fairly represented.
(3) Members of the board of directors may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors, but members of the board of directors shall not otherwise be compensated by the association for their services.
History:
[41-4307, added 2011, ch. 196, sec. 2, p. 566.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4310 - PLAN OF OPERATION.

41-4310. PLAN OF OPERATION. (1) The association shall submit to the director a plan of operation and any amendments thereto necessary or suitable to assure the fair, reasonable and equitable administration of the association. The plan of operation and any amendments thereto shall become effective upon the director’s written approval or unless it has not been disapproved within thirty (30) days.
(2) All member insurers shall comply with the plan of operation.
(3) The plan of operation shall, in addition to requirements enumerated elsewhere in this chapter:
(a) Establish procedures for handling the assets of the association;
(b) Establish the amount and method of reimbursing members of the board of directors under section 41-4307, Idaho Code;
(c) Establish regular places and times for meetings including telephone conference calls of the board of directors;
(d) Establish procedures for records to be kept of all financial transactions of the association, its agents and the board of directors;
(e) Establish the procedures whereby selections for the board of directors will be made and submitted to the director;
(f) Establish any additional procedures for assessments under section 41-4309, Idaho Code; and
(g) Contain additional provisions necessary or proper for the execution of the powers and duties of the association.
(4) The plan of operation may provide that any or all powers and duties of the association, except those under section 41-4308(12)(c), Idaho Code, and section 41-4309, Idaho Code, are delegated to a corporation, association or other organization which performs or will perform functions similar to those of this association, or its equivalent, in two (2) or more states. Such a corporation, association or organization shall be reimbursed for any payments made on behalf of the association and shall be paid for its performance of any function of the association. A delegation under this subsection shall take effect only with the approval of both the board of directors and the director, and may be made only to a corporation, association or organization which extends protection not substantially less favorable and effective than that provided by this chapter.
History:
[41-4310, added 2011, ch. 196, sec. 2, p. 573.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4311 - DUTIES AND POWERS OF THE DIRECTOR.

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.]
2023 Idaho Code › Title 41 - INSURANCE › Chapter 43 - IDAHO LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT › Section 41-4312 - PREVENTION OF INSOLVENCIES.

41-4312. PREVENTION OF INSOLVENCIES. (1) To aid in the detection and prevention of insurer insolvencies or impairments, it shall be the duty of the director to:
(a) Notify the insurance directors or commissioners of all the other states, territories of the United States and the District of Columbia within thirty (30) days following the action taken or the date the action occurs, when the director takes any of the following actions against a member insurer:
(i) Revokes a license;
(ii) Suspends a license; or
(iii) Makes a formal order that the company restrict its premium writing, obtain additional contributions to surplus, withdraw from the state, reinsure all or any part of its business, or increase capital, surplus, or any other account for the security of policy owners or creditors.
(b) Report to the board of directors when the director has taken any of the actions set forth in paragraph (a) of this subsection or has received a report from any other director indicating that any such action has been taken in another state. The report to the board of directors shall contain all significant details of the action taken or the report received from another director.
(c) Report to the board of directors when the director has reasonable cause to believe from an examination, whether completed or in process, of any member insurer that the insurer may be an impaired or insolvent insurer.
(d) Furnish to the board of directors the national association of insurance commissioners (NAIC) insurance regulatory information system (IRIS) ratios and listings of companies not included in the ratios developed by the NAIC, and the board of directors may use the information contained therein in carrying out its duties and responsibilities under this section. The report and the information contained therein shall be kept confidential by the board of directors until such time as made public by the director or other lawful authority.
(2) The director may seek the advice and recommendations of the board of directors concerning any matter affecting the duties and responsibilities of the director regarding the financial condition of member insurers and companies seeking admission to transact insurance business in this state.
(3) The board of directors may, upon majority vote, make reports and recommendations to the director upon any matter germane to the solvency, liquidation, rehabilitation or conservation of any member insurer or germane to the solvency of any company seeking to do an insurance business in this state. The reports and recommendations shall not be considered public documents.
(4) The board of directors may, upon majority vote, notify the director of any information indicating a member insurer may be an impaired or insolvent insurer.
(5) The board of directors may, upon majority vote, make recommendations to the director for the detection and prevention of insurer insolvencies.
History:
[41-4312, added 2011, ch. 196, sec. 2, p. 574.]